Compliance, cost, and common sense limit cancer control in colitis.

Compliance, cost, and common sense limit cancer control in colitis In this issue a Swedish group' describe the results of a cancer surveillance programme over eight years in 71 patients with long standing extensive or substantial colitis. Their well presented study adds support to the development of such programmes which have also been reported from a number of other centres. In an elegant application of decision theory, Gage2 has shown that a patient's five year survival is likely to be better with surveillance, despite its limitations, than with operation advised solely on the basis of extent of disease and a long history. His analysis is, however, limited to a decision late in the course of the illness and misses the point that preventive surgery to be most successful should be undertaken during the lag phase before the cancer risk begins to rise. His analysis is concerned with the early treatment of carcinoma, using dysplasia as a marker, rather than regarding colectomy for dysplasia without carcinoma as the optimal result. The ideal of colectomy at the stage of dysplasia in all patients has not so far been achieved and carcinoma tends to develop in association with dysplasia, or less commonly without, as in the Swedish series. The advantages of a surveillance programme thus have to be assessed as presumed prevention of cancer by removing a dysplastic colon in some patients and early treatment of carcinoma by colectomy in others.