Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death

statnews.com

Post reply on HN
Print view View original

161–170 of 205 posts

Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death

#161

Post by hammock »

em500 wrote: post #49
ricardobeat wrote: post #29

Earlier 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”…

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.

Dangerous misinformation!! Censor!! I have reported the author, Angus Chen, to his employer.

Or you could just comment...

Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death

#162

Post by SoftTalker »

mooxie wrote: post #122
prirun wrote: post #98

Earlier 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…

I have never had cancer of any kind in my family tree, and I had a precancerous polyp found at 38yo. 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.

You'll die of something else then. That's the part that so many people seem to overlook.

There is a money-making industry around colonoscopies and mamograms. I'm not saying to disregard medical advice in this regard as for any individual there may be good reasons to have these procedures. However you can't completely discount the financial incentives for the providers.

Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death

#163

Post by SoftTalker »

hef19898 wrote: post #131
PaulHoule wrote: post #107

Earlier quoted context omitted.

Prostate cancer is different from colon cancer. In the case of colon cancer detected in a colonoscopy they can snip it out right there without a lot of effort, risk or lost function. Surgery on the prostate is likely to cause all sorts of problems for men.

And not having surgery for it can mean death. Steve Jobs, even it wasn't prostate cancer, should serve as good example of how not to tackle it. Or at least to show what not tackeling it looks like, because feel free to do what you want, but be aware of the consequences.

Jobs had pancreatic cancer. His holistic approach to dealing with it notwithstanding, that diagnosis is usually a death sentence no matter what you do.

Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death

#164

Post by SoftTalker »

jdeibele wrote: post #149
timr wrote: post #144

Earlier quoted context omitted.

> Isn’t there just as much chance for bias if the treatment is voluntary? I'm not quite sure what you're asking here. If you're wondering if voluntary opt-out of colonoscopy carries risk of bias, then I'll say the following: it's an intervention that is painful, intrusive and time consuming. No reasonable person would get one absent demonstrated benefit. Pick a thing where people are reasonably likely to do it as def…

My father died of colon cancer at age 67. I've been getting screened every 5 years, first by sigmoidoscopy and the last couple of times with the full colonoscopy. With a sigmoidoscopy you're awake and the doctor will show you what they're looking at. I guess that's intrusive but it certainly wasn't painful. With colonoscopy, you're under anesthesia. It was probably intrusive but since I wasn't conscious, I didn't car…

There's not only a risk with the anesthesia but there's a risk of a perforated colon. It's not the routine risk-free procedure that the providers make it out to be.

Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death

#165

Post by JoeAltmaier »

SoftTalker wrote: post #164
jdeibele wrote: post #149

Earlier quoted context omitted.

My father died of colon cancer at age 67. I've been getting screened every 5 years, first by sigmoidoscopy and the last couple of times with the full colonoscopy. With a sigmoidoscopy you're awake and the doctor will show you what they're looking at. I guess that's intrusive but it certainly wasn't painful. With colonoscopy, you're under anesthesia. It was probably intrusive but since I wasn't conscious, I didn't car…

There's not only a risk with the anesthesia but there's a risk of a perforated colon. It's not the routine risk-free procedure that the providers make it out to be.

1 in 1000 have complications. Colon cancer attacks 1 in 25. So that math check out - have your colonoscopy

Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death

#166

Post by sokoloff »

JamesBarney wrote: post #159
sokoloff wrote: post #45

Earlier quoted context omitted.

If colonoscopies are helpful to avoid negative outcomes, but invitations to colonoscopies are not, looking into making invitations better seems like an obvious play to me.

The problem is you can't run a study on colonoscopies that doesn't involve an invitation without forcing people to get a colonoscopy at gun point. Which would both be illegal and never pass an IRB.

You can control for the invitation vs no-invitation and colonoscopy vs no-colonoscopy and analyze the outcomes of all four cells (provided you have enough people in each cell) or the column or row independently.

Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death

#167

Post by JoeAltmaier »

jdeibele wrote: post #149
timr wrote: post #144

Earlier quoted context omitted.

> Isn’t there just as much chance for bias if the treatment is voluntary? I'm not quite sure what you're asking here. If you're wondering if voluntary opt-out of colonoscopy carries risk of bias, then I'll say the following: it's an intervention that is painful, intrusive and time consuming. No reasonable person would get one absent demonstrated benefit. Pick a thing where people are reasonably likely to do it as def…

My father died of colon cancer at age 67. I've been getting screened every 5 years, first by sigmoidoscopy and the last couple of times with the full colonoscopy. With a sigmoidoscopy you're awake and the doctor will show you what they're looking at. I guess that's intrusive but it certainly wasn't painful. With colonoscopy, you're under anesthesia. It was probably intrusive but since I wasn't conscious, I didn't car…

I never have anaesthesia for colonoscopy. The post-procedure nausea etc are worse than the discomfort of being probed. I you're not squeamish (and I am not) then it's not a big deal to be awake for the procedure.

Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death

#168

Post by gjreda »

theptip wrote: post #154
donohoe wrote: post #109

I personally advise everyone to get a colonoscopy. I personally know 4 people who had the procedure and cancer was detected. Some further along than others. All still living. Colonoscopy is one of the few procedures that as they screen they can also take action.

Please be aware that the procedure is not risk-free and there is general concern in the medical community that it does more harm than good in healthy adults. 5/1000 colonoscopy patients have complications (some fatal) which is way higher than the base rate for colon cancer. It’s not a harmless screen like a mammogram.

> 5/1000 colonoscopy patients have complications (some fatal) which is way higher than the base rate for colon cancer.

Can you provide a source for this?

Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death

#169

Post by timr »

BenoitEssiambre wrote: post #151
timr wrote: post #146

Earlier quoted context omitted.

> With enough data, there could totally have been a tight range around no effect or a small effect. This is not what we got here though. What the trial showed was a small effect with a wide uncertainty on a big sample. We cannot distinguish this from zero. Again, could the observed effect be significant with a larger trial? Sure. But that's always true for a negative result. The objection carries no information.

>could the observed effect be significant with a larger trial? Sure. But that's always true for a negative result. Sure, this is true, it's one of the reasons why results being significant or not is not very relevant. At some point you want to move towards whether the effect size is in a clinically relevant range or not. >The objection carries no information. Inasmuch as something like a confidence interval provides…

> Sure, this is true, it's one of the reasons why results being significant or not is not very relevant.

No. Significance is the only thing that matters here. If you don't have a significant result, you don't have a result. Making up stories about how the results coulda-woulda-shoulda been significant if only the study was different somehow is fine for bedtime or planning the next study, but absolutely irrelevant to interpreting the clinical trial in front of you.

The CI here is not actually that wide; I was being colloquial. It's an 80,000 person trial, with 40,000 per arm. The absolute observed difference in colo-rectal mortality between the two arms was 0.03%. The per-protocol analysis (just those people who got tested) was a difference of 0.15%.

That latter figure is the best possible argument for colonoscopy, and no matter how you look at it, it's just not a big difference. Even if you ran a huge trial to get a significant result at these effect sizes, you're still talking about a difference of 15 people per 10,000 (at best) screened. That's a lot of pain and expense for very little gain.

Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death

#170

Post by sillystuff »

ChrisMarshallNY wrote: post #120
jrochkind1 wrote: post #99

Earlier quoted context omitted.

I guess the question is if the scan makes a difference in intensity of treatment, if people who got a colonoscopy had fewer surgeries or fewer/less radiation. It doesn't say, I think? It's not at all obvious it would. (In general, one would think people who got the colonoscopy got more treatment -- in this case despite having no lower a death rate -- but perhaps it does not include as much intense treatment).

In my friend's case, it was Stage IV, before it was found. That may have had something to do with him not getting a gerbillcam until he started having symptoms. I will say his treatment wasn't fun, at all, although he'll be OK, in the long run (but chemo never leaves you the same).

> chemo never leaves you the same

For the chemo your friend likely experienced, this is especially true.

Colorectal cancer is often treated with the chemo cocktail, FOLFOX. The "OX" stands for oxaliplatin which causes nerve damage-- hearing loss (less than cisplatin, though), peripheral neuropathy, etc. The second half-life, in the body, of oxaliplatin is 535 months (44 years). And, the platinum remains in a reactive form.

I'd love to hear a professional chime in on if there are ways to speed the elimination. E.g., something like extended/extreme fasting (to free oxaliplatin from tissues) + sodium thiosulfate + blood plasma donation, or something?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2559818/

Some choice quotes from the link:

"The first elimination half-life (t1/2) for cisplatin was 5.02 months and the second 37.0 months. For oxaliplatin, these half-lifes were 1.37 and 535 months."

"...it was shown that Pt species in pUF were still present in a reactive form."

Edit: just submitted the above article:

https://news.ycombinator.com/item?id=33154606

Post reply on HN