Screening for gastrointestinal cancer.

No new sound evidence pointing to the effectiveness of screening for any gastrointestinal cancer has become available in the past year. Although recommended in Japan, screening for gastric cancer is expensive, and in a study in Venezuela it was found to be ineffective. The sensitivity of the standard hemoccult test for fecal occult blood is low; variants have improved sensitivity but relatively poor specificity remains. A major review of the evidence on colorectal cancer screening concluded that it was not recommended as part of the periodic health examination. Colorectal cancer mortality is falling in North America, possibly due to prevention (dietary modification) rather than screening. As dietary modification has benefits on other cancers and diseases, it is preferable as a colorectal cancer control strategy. Screening for other gastrointestinal cancers cannot be recommended.