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Prevalence of Isolated Advanced Proximal Neoplasia—Reply
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In reply
We appreciate the comments of Dr Schoen regarding our article.1 He is indeed correct that we have not reported the absolute prevalence of isolated advanced proximal neoplasia among persons undergoing colon cancer screening, but rather the prevalence of advanced proximal neoplasia among persons who had no adenomatous lesion on flexible sigmoidoscopy. In essence, what we have reported is the false-negative rate of flexible sigmoidoscopy. What Dr Schoen has reported is the absolute prevalence of isolated advanced proximal neoplasia that would be missed among the total population of persons undergoing screening with flexible sigmoidoscopy. We believe that these 2 values are complementary, even prior to the performance of sigmoidoscopy. The absolute miss rate allows patients and physicians to estimate the likelihood that an advanced lesion in the proximal colon will be missed, while the false-negative rate provides the posttest probability that a lesion remains, given a negative screening result. . . . [Full Text of this Article]
James D. Lewis, MD, MSCE;
Kimmie Ng, MD;
Kenneth E. Hung, MD, PhD;
Warren B. Bilker, PhD;
Jesse A. Berlin, ScD;
Colleen Brensinger, MS;
Anil K. Rustgi, MD
Philadelphia, Pa
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