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

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

#171

Post by hondo77 »

prirun wrote: post #98
em500 wrote: post #49

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 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…

> 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 any kind anywhere in my family tree and they are always on me to get one.

Wrong. They recommend on both. I had no cancer in my family history but then I got colon cancer (no, I hadn't gotten a colonoscopy before--yes, I was an idiot). As a result, all my siblings' (some of whom are still in their 30s) doctors had them get colonoscopies right away. All negative, thank goodness.

Good luck with sticking your head in the sand.

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

#172

Post by noduerme »

Shouldn't this study properly be called "Effect of Offering Colonoscopy Screening on Risks..."? The headline result is based on the 18% decrease in CR cancer among people who were offered a colonoscopy. Of the people offered, only 42% actually got a colonoscopy. That means in the "colonoscopy group" 58% never even had one. Among those who did get one, there was a 31% decrease in CR cancer, and a 50% reduction in deaths from CR cancer.

All the study really proves is that offering someone a colonoscopy isn't the same thing as giving them one.

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

#173

Post by timr »

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 grant you that I'm using an expansive definition of "pain" here...I'm including the day of diarrhea before the test, the stress and (yes, some) pain of the sedation itself, and the unpleasant recovery (nausea, fatigue, etc.) that follows. Maybe it isn't "pain", per se, but it's something we'd all rather avoid.

I should also say the following: if you've got a family history of colon cancer, active symptoms, or some other reason to believe that you're at risk, studies of statistical averages don't apply to you.

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

#174

Post by timr »

JoeAltmaier wrote: post #165
SoftTalker wrote: post #164

Earlier quoted context omitted.

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

> Colon cancer attacks 1 in 25.

The highest plausible 10-year estimate of colon cancer prevalence from the study was 1.2%. That's 1 in 83, not 1 in 25.

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

#175

Post by Supermancho »

JamesBarney wrote: post #158
Supermancho wrote: post #155

Earlier quoted context omitted.

> The gold standard is the invitation. I'm not sure what gold standard you are referring to (or the article or the paper - https://www.nejm.org/doi/full/10.1056/NEJMoa2208375 ). Double blind studies require there to be data. An invitation doesn't speak to the effects of Colonoscopy screening at all, while simultaneously adding a confounding variable about participation. The data is about the effects of offering scree…

Participation is a confounding variable if you compare the subset of invitation group that participated with the control group instead of the invitation to the control group. That's the whole reason they use intent to treat. Lifelong correlational data is not the gold standard for questions about mortality. It's intent to treat RCTs.

> Participation is a confounding variable if you compare the subset of invitation group that participated with the control group instead of the invitation to the control group.

I believe that's what I said. That's certainly what was used. You can't compare the group subset that didn't participate, so it's a confounding variable.

> Lifelong correlational data is not the gold standard for questions about mortality.

AFAIK it is and has been over the last century. If you aren't tracking lifelong data, your mortality data is always skewed against hidden results because you didn't want to wait. When making a paper that isn't qualified (decade long effects vs effects), it's not expected to have short time-boxed data.

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

#176

Post by wellbehaved »

gilbetron wrote: post #94
AlphaOne1 wrote: post #85

Vinay 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...

Beware David Gorski:

https://stevekirsch.substack.com/p/how-david-gorski-defends-...

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

#177

Post by thaumasiotes »

sokoloff wrote: post #166
JamesBarney wrote: post #159

Earlier quoted context omitted.

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.

You can do that, but you won't learn anything, because the populations within each cell are not comparable to each other.

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

#178

Post by theptip »

gjreda wrote: post #168
theptip wrote: post #154

Earlier quoted context omitted.

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?

I copied that stat from the link I posted in another comment: https://news.ycombinator.com/item?id=33153494

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

#179

Post by altdataseller »

SoftTalker wrote: post #163
hef19898 wrote: post #131

Earlier quoted context omitted.

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.

As far as I know, he had a type of (neuroendocrine?) pancreatic cancer that had a much better prognosis than other types.

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

#180

Post by hef19898 »

SoftTalker wrote: post #163
hef19898 wrote: post #131

Earlier quoted context omitted.

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.

Generally speaking, yes. Practically, Jobs cancer was of the rare but kind of treatable kind. Unless, of course, you forgo surgery, chemo and radio therapy.

Again, not blaming Jobs for his decisions, cancer is a scary thing. Just pointing out the benefit of eering on the side of aggressiveness when it comes to treatment.

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