A lot of posts urging people to get colonoscopies. But general anesthesia also carries risks. How should one weigh the risk vs benefit?
Is "colorectal cancer" rising in "young people"?
161–170 of 250 posts
Re: Is "colorectal cancer" rising in "young people"?
#162> Yes, if you are currently young, you face higher CRC risk than previous generations did when they were young. That’s the bad news. Unlike the usual Bettridge's law, the answer to the headline is only a qualified "No". It is a "So is all other cancers!", which is pretty bad news for folks who are young and healthy right now.
One thing I can't figure out from the content or the graphs (where I can read the legends with my 1975 eyes) is whether this adjusts for overall mortality rate, which is to say, is any of this effect due to the fact people are more and more likely to wear seat belts, not die of (now-)preventable diseases, etc.? EDIT: having thought that over a third time, I am not sure it makes any sense.
I think the standard calculation is per person-year, not per person. So a 22-year-old dying of a car crash shouldn't skew the statistics, because they only contribute 2 people-years to the 20-24 age group.
That being said, I can see a few plausible biases (though none of them explain the scale of the increase IMO):
1. CRC risk is correlated with some previously fatal, but now curable disease. The mechanism would be that your high-risk CRC patients would die due to yellow fever or something in 1970, meaning they don't have the chance to get CRC. The important thing is that it would have to "artificially" remove high-risk patients from the age group, but not low risk patients.
2. CRC risk is noticeably higher at 24 than it is at 20, and all-other-cause mortality is significantly lower today. That would lead to a higher proportion of 24-year-old "years" in the calculation.
3. People used to die of CRC before it was caught, which caused it to not be recorded as a cancer incidence.
1 seems unlikely, and even if true shouldn't make a big difference. 2 seems the most possible, but still unlikely to make a huge difference. I don't know enough about how they determine cause of death to know if 3 is a possible outcome.
Re: Is "colorectal cancer" rising in "young people"?
#163Earlier quoted context omitted.
Does insurance see it this way? I've had a couple precancerous moles (melanoma in situ) removed, which seems similar, and my health insurance provider billed me more than I was expecting because they didn't categorize it as preventive care.
I did a colonoscopy at 38, because I saw something in the toilet that looked like the lingonberries at Ikea. Everyone was like "Man that seems early" but when I woke up, the doctor expressed some surprise when he told me they removed a couple of polyps. A week or two later, I got a bill for several thousand dollars, and I just had to roll with it. I believe that in the US, there is a certain age, after which, they're…
> I believe that in the US, there is a certain age, after which, they're covered.
There is a lot of confusion over this point, even among support agents for health insurance companies.
i) The Affordable Care Act specifies that all Marketplace health plans must cover colorectal cancer screening for adults 45 to 75 years at zero cost [i]. That means no copay and no coinsurance, even if you haven't met your deductible. You pay $0.
ii) That generally means that colonoscopies will be zero-cost for anyone in that age bracket, but only if it is a "screening". If you have symptoms, the service may be billed as diagnostic rather than preventative, which takes it out of the "zero cost" category
iii) All of the above is separate from whether the procedure is "covered" or not, because "covered" in the context of health insurance means "your plan covers this, subject to your normal deductible, copay and coinsurance, so long as it is medically necessary". If something is truly "not covered" then your insurance pays $0 and the provider will bill you the full, undiscounted cost of the procedure.
In other words, there is a difference between "your plan covers this (as it does for any other regular medical care)" and "your plan covers this at zero cost, as it falls into one of the narrowly defined 'preventative care' buckets as defined by the ACA"
It's common for people to confuse these things.
In your case, it sounds like the procedure was not covered at zero cost (as expected, as you are not in the 45-75 age bracket defined by the ACA, and in any case your procedure was diagnostic, not preventative), but it was "covered" by your health insurance in that you paid your regular deductible and copay, rather than the insurance company saying "your plan does not cover this procedure (at all)" and then the hospital billing you the full cost of the procedure, which would be tens of thousands of dollars.
Re: Is "colorectal cancer" rising in "young people"?
#164Earlier quoted context omitted.
Does insurance see it this way? I've had a couple precancerous moles (melanoma in situ) removed, which seems similar, and my health insurance provider billed me more than I was expecting because they didn't categorize it as preventive care.
Most US insurance has very strict guidelines about what is diagnostic vs preventative for a colonoscopy. And its almost certianly diagnostic.
diagnostic does not mean "not covered", it just means it moves out of the "zero cost even if you haven't met your deductible yet" categroy defined by the ACA, and into the regular category where you pay your deductible, copays and coinsurance
Re: Is "colorectal cancer" rising in "young people"?
#165Earlier quoted context omitted.
My doctor recommended a combination FIT+DNA test instead of colonoscopy (brand name "Cologuard"). She said it's not quite as good as the "gold standard" colonoscopy, but it also doesn't have the risks of colonoscopy. And the FIT+DNA test is so cheap and easy, you can do it every year or three instead of every 10 years with the colonoscopy. She still recommends colonoscopies for high-risk patients, but she thinks the…
The main issue with those tests is they have a relatively high false positive rate. If you pop on that one you need to follow up with a colonoscopy to confirm. The big issue has been that in the US, the followup colonoscopy was often no longer covered by insurance as it was no longer classified as part of the preventative medicine tier, and instead was now a different sort of procedure. My understanding is that this…
my PCP thinks i am over 50 twice a year and mentions i should get one, and he knows i won't pay for anything, so that means my insurance covers it.
This is anecdote by induction.
Re: Is "colorectal cancer" rising in "young people"?
#166Earlier quoted context omitted.
The risk of serious complications like major bleeding or perforation is closer to 40-80 per 10,000, significantly higher than the roughly 3-5 per 10,000 annual chance of actually having colorectal cancer for low-risk groups. My doctor says that since Cologuard catches a large percentage of those 3-5 per 10,000 without any of the colonoscopy risk, the marginal benefits from colonoscopy really aren't justified since FI…
> The risk of serious complications like major bleeding or perforation is closer to 40-80 per 10,000 What's your reference for this? That's incredibly (read, unbelievable) high for a routine procedure.
not who you asked but the perforation is 3-5 per 10,000; cardiovascular issues is 52 per 10,000, polyp removal carries risks of bleeding or perforation, and underlying patient physiology.
RESULTS Among the 30,818 records identified, 82 population-based studies from 24 countries were included, involving a total of 38.5 million colonoscopies. The estimated incidence per 10,000 colonoscopies was as follows: gastrointestinal AEs, including perforation (5.15; 95% confidence interval [CI] 4.19-6.34, I2 = 99%), bleeding (18.39; 95% CI 13.53-24.99, I2 = 100%), and splenic injury (0.61; 95% CI 0.43-0.85, I2 = 93%); nongastrointestinal AEs, including cardiovascular events (52.11; 95% CI 18.67-144.59, I2 = 100%), respiratory events (4.26; 95% CI 0.73-24.99, I2 = 100%), and deaths related to colonoscopy (0.18; 95% CI 0.10-0.34, I2 = 74%). Subgroup analyses yielded partially divergent findings. The majority of the included studies exhibited a low to moderate risk of bias.
just ask any AI, i don't got time to play tic-tac-toe with the NIH.gov website gating me behind click bus images for 10 minutes
Re: Is "colorectal cancer" rising in "young people"?
#167Personally I am hesitant to do colonoscopy after a relative had a botched procedure. Just this month two celebrities revealed botched colonoscopies. I hope they figure out ways to make this procedure safer. https://www.yahoo.com/entertainment/celebrity/articles/kathy... https://www.usatoday.com/story/entertainment/celebrities/202...
Those articles don't really say what the "botch" is. Was it the anesthesia? The actual endoscopic examination? Removal of polyps? If its the polyp removal, I can certainly see how that could lead to problems. But you're a little stuck: even if you use another technique to do the scan, you still have to remove any polyps you find, don't you?
A good friend's dad got a routine colonoscopy and they accidentally punctured his intestines. This was during the first COVID outbreak in the US, and the wait time for getting it fixed was so long that he had to walk around for months with a colonoscopy bag, as an old man that spends all day on his feet working. It was not a good experience.
Re: Is "colorectal cancer" rising in "young people"?
#168A lot of posts urging people to get colonoscopies. But general anesthesia also carries risks. How should one weigh the risk vs benefit?
A few now opt for twilight sedation - you'll not remember a thing though you're not fully knocked out, which I understand helps mitigate the risks.
I've had multiple surgeries under general anaesthesia. Twilight sedation was pretty much the same experience (at least for me): eyes slowly get heavy, then all of a sudden 'it's too damn bright in here, someone turn the damn lights off!.... Oh, that was quick...'
Re: Is "colorectal cancer" rising in "young people"?
#169> Yes, if you are currently young, you face higher CRC risk than previous generations did when they were young. That’s the bad news. Unlike the usual Bettridge's law, the answer to the headline is only a qualified "No". It is a "So is all other cancers!", which is pretty bad news for folks who are young and healthy right now.
No, not all cancers - a handful of cherry picked cancers.
The overall age-adjusted cancer rate has been going down, and the death rate even more so.
Re: Is "colorectal cancer" rising in "young people"?
#170[deleted]