This is an excellent discussion on screening. Patients would be well served to understand that early detection of many cancers is not necessarily beneficial and often leads to more harm than good. Prostate cancer screening has always been controversial. I was shocked by this recent study calling into doubt colonoscopies
Thanks, Buzz. I have none of the risk factors for colon cancer (except age). In the past I have weighed the financial factors ($10k deductible insurance) against the risk factors, and have always opted for the stool testing. I never even considered, and wouldn't have known where to find, statistics that address all cause mortality in this arena. And I never looked forward to having conversations with my friends about this issue:
"Just got my colonoscopy! All clean! How about you?"
"Uhh, I just poop in a bag and drop it off. So far, so good!"
Your skill at teasing out the probability and statistics surrounding healthcare are second to none. If we had had more of this type of guidance at the state and national level over the past few years, this country would be in much better shape than it is now. I try to never base my health decisions on fear, hysteria, or tunnel vision. I don't have that kind of control over what happens in politics. I wish more doctors were able to see the big picture like this when they are advising our politicians.
Is there another quality of life issue to consider? In my family's experience, death from at least some types of cancer is painful and stressful, emotionally for the family as well as the patient. Even with good palliative care.
It may be hard to balance against the pain an stress of treatment, much less the cost, given the age and condition of the patient, but if it results in a relatively quick death from another common cause, say a heart attack, doesn't that seem better than suffering from cancer for months?
Thank you for this valuable essay. Several reactions: 1. After reading the 2017 report of the CRC Task Force, I learned that Cologuard contains 2 tests, one fhe $15 Fit, the other the DNA test. However, Exact Sciences will not provide any details on the results. An essay by a physician in a medical jnl. detailed his attempt to get exact measures of his test results, as one would get from a blood test at any lab. The FDA has exempted Exact Sciences from this disclosure. 2. A recent study suggested that 5 FIT tests would approximate the accuracy of a colonoscopy (although not providing removal of polyps or tumors). but it did not state a time frame. Do you have some insight on that?
3. A better test is on the way, provided the company can get through the last FDA hurdle: FirstSight is a blood test detecting CRC (made by CellMaxLife). This seems like a vast improvement over either FIT or Cologuard, and your comments on this possibility would be welcome. Again, many thinks for this article.
I had a colonoscopy on July 20, 2022. On July 23 I had emergency surgery due to a perforated colon which was the result of the procedure. I had 12 incles of my large intestines removed. Three months later, I am still suffering from chronic diarrhea, loss of appetite and fatigue. I had none of the indicators for colon cancer but went ahead with the colonoscopy due to my Doctors recommendations and I am very sorry that I did.
Risk of complications is not zero, so one always has to balance that against the benefit of the procedure. And then some people will have a higher level of acceptable risk (both from the screening tests as well as from the actual disease). The other consideration is with regards to who is doing the procedures. Seeing the same person for a colonoscopy every ten years and having that person do a mediocre job is not likely to be of high benefit. But seeing different practitioners of varying skill level more frequently might well catch a cancer the mediocre provider misses. And then sometimes (oftentimes?) diagnoses are made or missed based on sheer dumb luck.
Thanks for a very interesting overview (from someone who just had a colonoscopy with no polyps and recommended next screening in three years (I did have some polyps removed in a prior colonoscopy three years back, so next one probably justified I'd guess). Worst thing about the prep was having to get up at 12 midnight and not much sleep after for an early morning procedure. I really like it that you generally report absolute risk ratios as well as relative as the latter can sometimes give very misleading impressions.
The meme with the colonoscopy scratched out and replaced with “letters to patients” best describes the results of the study. I find it disingenuous of the study authors to claim no benefit from colonoscopy and it raises questions about their objectivity.
Also, Swedish/European diet, racial background and obesity rates are very different from American and so I also question the direct translation to American practice I.e. African Americans get 20% more colon cancers than average. Also, the number of screening colonoscopies performed in this countries is much lower than the US, so skill could play a role.
I have first person proof that colo-rectal screening works.
But that's apocryphal, right?
My MSKCC oncological-surgeon told me that annual colonoscopies would unquestionably identify life threatening polyps/tumors without any real risk of perforations or other harm, but they just aren't done.
This is an excellent discussion on screening. Patients would be well served to understand that early detection of many cancers is not necessarily beneficial and often leads to more harm than good. Prostate cancer screening has always been controversial. I was shocked by this recent study calling into doubt colonoscopies
Thanks, Buzz. I have none of the risk factors for colon cancer (except age). In the past I have weighed the financial factors ($10k deductible insurance) against the risk factors, and have always opted for the stool testing. I never even considered, and wouldn't have known where to find, statistics that address all cause mortality in this arena. And I never looked forward to having conversations with my friends about this issue:
"Just got my colonoscopy! All clean! How about you?"
"Uhh, I just poop in a bag and drop it off. So far, so good!"
Your skill at teasing out the probability and statistics surrounding healthcare are second to none. If we had had more of this type of guidance at the state and national level over the past few years, this country would be in much better shape than it is now. I try to never base my health decisions on fear, hysteria, or tunnel vision. I don't have that kind of control over what happens in politics. I wish more doctors were able to see the big picture like this when they are advising our politicians.
Is there another quality of life issue to consider? In my family's experience, death from at least some types of cancer is painful and stressful, emotionally for the family as well as the patient. Even with good palliative care.
It may be hard to balance against the pain an stress of treatment, much less the cost, given the age and condition of the patient, but if it results in a relatively quick death from another common cause, say a heart attack, doesn't that seem better than suffering from cancer for months?
Thank you for this valuable essay. Several reactions: 1. After reading the 2017 report of the CRC Task Force, I learned that Cologuard contains 2 tests, one fhe $15 Fit, the other the DNA test. However, Exact Sciences will not provide any details on the results. An essay by a physician in a medical jnl. detailed his attempt to get exact measures of his test results, as one would get from a blood test at any lab. The FDA has exempted Exact Sciences from this disclosure. 2. A recent study suggested that 5 FIT tests would approximate the accuracy of a colonoscopy (although not providing removal of polyps or tumors). but it did not state a time frame. Do you have some insight on that?
3. A better test is on the way, provided the company can get through the last FDA hurdle: FirstSight is a blood test detecting CRC (made by CellMaxLife). This seems like a vast improvement over either FIT or Cologuard, and your comments on this possibility would be welcome. Again, many thinks for this article.
I had a colonoscopy on July 20, 2022. On July 23 I had emergency surgery due to a perforated colon which was the result of the procedure. I had 12 incles of my large intestines removed. Three months later, I am still suffering from chronic diarrhea, loss of appetite and fatigue. I had none of the indicators for colon cancer but went ahead with the colonoscopy due to my Doctors recommendations and I am very sorry that I did.
Risk of complications is not zero, so one always has to balance that against the benefit of the procedure. And then some people will have a higher level of acceptable risk (both from the screening tests as well as from the actual disease). The other consideration is with regards to who is doing the procedures. Seeing the same person for a colonoscopy every ten years and having that person do a mediocre job is not likely to be of high benefit. But seeing different practitioners of varying skill level more frequently might well catch a cancer the mediocre provider misses. And then sometimes (oftentimes?) diagnoses are made or missed based on sheer dumb luck.
Thanks for a very interesting overview (from someone who just had a colonoscopy with no polyps and recommended next screening in three years (I did have some polyps removed in a prior colonoscopy three years back, so next one probably justified I'd guess). Worst thing about the prep was having to get up at 12 midnight and not much sleep after for an early morning procedure. I really like it that you generally report absolute risk ratios as well as relative as the latter can sometimes give very misleading impressions.
I’m the 1%, aspiration pneumonia and 2 nights in the hospital after my last (and I mean last) colonoscopy. I’d rather give birth without drugs again.
The meme with the colonoscopy scratched out and replaced with “letters to patients” best describes the results of the study. I find it disingenuous of the study authors to claim no benefit from colonoscopy and it raises questions about their objectivity.
Also, Swedish/European diet, racial background and obesity rates are very different from American and so I also question the direct translation to American practice I.e. African Americans get 20% more colon cancers than average. Also, the number of screening colonoscopies performed in this countries is much lower than the US, so skill could play a role.
I have first person proof that colo-rectal screening works.
But that's apocryphal, right?
My MSKCC oncological-surgeon told me that annual colonoscopies would unquestionably identify life threatening polyps/tumors without any real risk of perforations or other harm, but they just aren't done.
Why not?