Earlier quoted context omitted.
You are complaining about the rare situation where someone gets fecal scanning first (and I agree this leads to perverse incentives)... But here's what the real racket is... American healthcare considers the colonoscopy preventative so the exam is covered... but if they see even a single polyp and decide to cut it off to get checked whether it is benign or not, that is not preventative but is diagnostic and thus is n…
Huh. I didn’t see that in my exam. They did a biopsy on one polyp, but I wasn’t charged for it.
Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
121–130 of 205 posts
Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
#122Earlier quoted context omitted.
The problem with the title is that it might lead individuals to believe they shouldn't bother with getting a colonoscopy. You can't conclude that from this study at all. If your doctor recommends you to get one, you probably should. The study answers a question pertaining public health policy (should we invite everyone in some age group for a colonoscopy?). It does not answer any individual health/treatment/screening…
> The problem with the title is that it might lead individuals to believe they shouldn't bother with getting a colonoscopy. You can't conclude that from this study at all. If your doctor recommends you to get one, you probably should. The problem with your doctor's recommendation is that doctors recommend colonoscopy based on age, not whether you have any factors that might indicate colon cancer. I have no cancer of…
You should get a colonoscopy. If you are at low risk and look totally healthy after, they'll tell you that you don't need another for a good while and you'll get the benefit of not (often) getting something that you don't think you need and, as a bonus, not die of treatable cancer.
Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
#123Earlier quoted context omitted.
[removed - beating a dead horse] The whole study is about the usefulness of regular colonoscopies as a tool to reduce mortality in the general population, and the surprise comes from the already known "usefulness of colonoscopies in increasing survivability, early detection and decreasing probability of colon cancer" not leading to a decrease in overall death rate. See the other comments in this thread about the inte…
Don't be a jerk, they are suggesting a repurposing of this studies data, which I wouldn't be surprised to learn is already in the works. That's not to say this study was done wrong, it is assessing a different probe. The thing about invitations is that there are more than one way to make one, this is a single snapshot in time of how a population responds to one particular kind of invite.
No idea if the study was done correctly or not, I am no expert in medical studies. So to rephrase it, I'd like to see a follow up study as outlined above. Reason being that the corrent one requires a lot of nuance to properly interpret (and I somehow fail to see the point of the results so far, but that ir purely on me), and we all know that technical and scientific nuance is impossible to come by in public discurs. So the risk I see is, that the current study can be seen as showing colonoscopies are pointless and needless, a piint I don't see the study making. And that is not the studies fault, it is us laypeoples and the medias fault on how we cover and consume reporting about medical studies, or scientific studies in general.
Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
#124Earlier quoted context omitted.
There is nothing wrong with the title. The study failed to find a reduction in death rate despite lowering the incidence of cancer, and that is the center of the piece. It goes into detail of why this is surprising. The study authors were interviewed and agreed. The reporting actually adds a lot of context that you would never get from a link to a random study. Like, for example, how it is called the “gold standard”…
That is incorrect. The title is completely wrong. "Study failed to find a reduction" _does not equal_ "There wasn't a reduction". From the abstract: "The risk of death from colorectal cancer was 0.28% in the invited group and 0.31% in the usual-care group (risk ratio, 0.90; 95% CI, 0.64 to 1.16)" Look at the confidence interval. This study was both consistent with a 36% reduction in deaths or a 16% increase in deaths…
Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
#125Earlier quoted context omitted.
There is nothing wrong with the title. The study failed to find a reduction in death rate despite lowering the incidence of cancer, and that is the center of the piece. It goes into detail of why this is surprising. The study authors were interviewed and agreed. The reporting actually adds a lot of context that you would never get from a link to a random study. Like, for example, how it is called the “gold standard”…
That is incorrect. The title is completely wrong. "Study failed to find a reduction" _does not equal_ "There wasn't a reduction". From the abstract: "The risk of death from colorectal cancer was 0.28% in the invited group and 0.31% in the usual-care group (risk ratio, 0.90; 95% CI, 0.64 to 1.16)" Look at the confidence interval. This study was both consistent with a 36% reduction in deaths or a 16% increase in deaths…
Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
#126Earlier quoted context omitted.
> The problem with the title is that it might lead individuals to believe they shouldn't bother with getting a colonoscopy. You can't conclude that from this study at all. If your doctor recommends you to get one, you probably should. The problem with your doctor's recommendation is that doctors recommend colonoscopy based on age, not whether you have any factors that might indicate colon cancer. I have no cancer of…
No one in my family history going back several generations had colo/rectal cancer. Yet I developed it at age 41. Diet is increasingly viewed as a factor.
Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
#127Earlier quoted context omitted.
American health insurance really screws the pooch here. If you go for a colonoscopy without a previous fecal testing, it is a diagnostic procedure that is fully covered by your insurance without triggering deductible and copay. However, if you go for fecal testing first and then they find something suspicious that warrants a colonoscopy, it is no linger considered diagnostic (you have a legitimate problem now) and de…
You are complaining about the rare situation where someone gets fecal scanning first (and I agree this leads to perverse incentives)... But here's what the real racket is... American healthcare considers the colonoscopy preventative so the exam is covered... but if they see even a single polyp and decide to cut it off to get checked whether it is benign or not, that is not preventative but is diagnostic and thus is n…
https://www.npr.org/sections/health-shots/2022/05/31/1101861...
Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
#128Earlier quoted context omitted.
That is incorrect. The title is completely wrong. "Study failed to find a reduction" _does not equal_ "There wasn't a reduction". From the abstract: "The risk of death from colorectal cancer was 0.28% in the invited group and 0.31% in the usual-care group (risk ratio, 0.90; 95% CI, 0.64 to 1.16)" Look at the confidence interval. This study was both consistent with a 36% reduction in deaths or a 16% increase in deaths…
I'm also confused about the "invited" group. Not all of them had the procedure and there is a part talking about lower cancer rates among the subset that actually accepted the invite. It sounds like there is still confusion about how to interpret it.
"Intention to treat" here means that you count everyone in the group that got an invitation to get a colonoscopy, regardless of whether or not they actually did it. Though this sounds counterintuitive, it's the "gold standard" because, if you don't do this, you leave yourself open to bias -- maybe the people who seek out colonoscopy have some symptom, family history or other reason that leads them to seek out treatment. Maybe the people who get a test get more treatment, and that treatment is harmful in the marginal case. Or just as importantly: maybe the people who don't have the time/inclination to do one would be better served by an alternative test.
Everyone (including GP) is fixating on the magnitude of the primary outcome and squabbling about whether or not colonoscopies help people. But I think the more interesting aspect of this study is that it shows that the genetic tests probably aren't inferior to the invasive, painful, time-consuming rectal exam. If that's true, it's great news!
Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
#129Earlier quoted context omitted.
There is nothing wrong with the title. The study failed to find a reduction in death rate despite lowering the incidence of cancer, and that is the center of the piece. It goes into detail of why this is surprising. The study authors were interviewed and agreed. The reporting actually adds a lot of context that you would never get from a link to a random study. Like, for example, how it is called the “gold standard”…
That is incorrect. The title is completely wrong. "Study failed to find a reduction" _does not equal_ "There wasn't a reduction". From the abstract: "The risk of death from colorectal cancer was 0.28% in the invited group and 0.31% in the usual-care group (risk ratio, 0.90; 95% CI, 0.64 to 1.16)" Look at the confidence interval. This study was both consistent with a 36% reduction in deaths or a 16% increase in deaths…
In a randomized controlled trial you either find a significant difference in your metrics, or you don't. There's no other option. In all cases where you don't find a significant difference, the problem is that the confidence interval is too wide for whatever difference seems to exist. Your argument here is a fallacy (i.e. "you just didn't do a big enough sample!") which is a variant of my personal favorite: "it would have worked if you'd done X, Y or Z!"
There's always another X, Y, or Z. The negative study is always too small for the people who believe in the thing it's testing. As a supporter of some intervention, the onus is therefore on you to prove your claim in a demonstrated scenario, not on everyone else to disprove it in all scenarios. Could it be true that colonoscopies have some significant benefit to mortality smaller than detectable by a 80,000-person RCT? Sure. But that doesn't make the headline wrong.
This study didn't find a mortality benefit. Arguing that there's some theoretical other study that might find a benefit isn't relevant.
Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
#130Vinay Prasad, MD (Heme/Onc) gives a very good rundown on why this trial is so important. He also points out why having accurate data for screening recommendations is so crucial. USPTF has been making recommendations recently without data to back up them up and get appropriately taken to task for that. [1] https://m.youtube.com/watch?v=SMRS4-ng8T0
Beware Vinay Prasad: https://www.respectfulinsolence.com/2022/07/27/john-ioannidi...
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