This is where I see the comparison of sigmoidoscopy versus colonoscopy. Colonoscopy is more sensitive, definitely. It’s going to pick up more and looks further. Sigmoidoscopy is maybe 85% as sensitive as colonoscopy. Colonoscopy is more invasive so sigmoidoscopy is safer, although every sigmoidoscopy that is a positive means the patient needs to have a colonoscopy, which is added risk. Colonoscopy is much more expensive. One of the big appeals of colonoscopy is they say that you only need one every ten years if you have one and it’s negative. The truth is that we have no data on whether ten years is adequate. Just looking at the PLCO trial, among people who have had a negative flex sig and then came back three years later for repeat flex sig, we’re finding about 1% incidence of advanced adenomas cancers. It is highly likely then that if you tell someone to have a colonoscopy once every ten years, some people will then be sent away and told they’re alright when they’re really not. Sigmoidoscopy is now targeted at one every five years. Again, we don’t know if that’s sufficient. Colonoscopy can only be done by specialized people who are trained in the procedure. Sigmoidoscopy is much more accessible. I think the patient may feel more satisfied with colonoscopy. They get drugs for the procedure, they have the notion that they’ve totally purged the colon, had their complete colon examined, and now don’t need anything for ten years. I think there is less satisfaction with sigmoidoscopy, although I’ll show you some data that shows it’s really very well tolerated and people like it.

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