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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

#71

Post by darkerside »

dis-sys wrote: post #68
Nokinside wrote: post #66

Years ago I learned that this is the reason why they don't do colonoscopies without good reason in Finland. I asked from a doctor who is a friend why you have regular colonoscopies in the US but not in the Finland and he said "no evidence and colonoscopy has a small risk factor". If you do medicine for profit and are allowed to advertise and market, doing more is always better.

as reported by the article, an impressive 50% reduction of cancer death for those who did colonoscopy. I call that solid evidence which could potentially save millions of real lives.

Not included in the study is data about how many other screenings those people did

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

#72

Post by ldoughty »

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.

That is exactly what I thought it was saying at a glance. If I skimmed the headline and moved on, instead of digging in, it might have contributed to an unconscious bias against the procedure.

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

#73

Post by ChrisMarshallNY »

ricardobeat wrote: post #29
em500 wrote: post #27

Several posters have criticized the title of the news article "In gold-standard trial, colonoscopy fails to reduce rate of cancer deaths". The actual study is titled "Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death" [1] The authors conclude that "In this randomized trial, the risk of colorectal cancer at 10 years was lower among participants who were invited to undergo screening colono…

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”…

"Death rate" != "Cancer Rate."

Cancer is much more treatable, these days.

I had a friend that just underwent seven months of chemo for colorectal cancer. Looks like he'll be fine, but it was Stage IV, when it was discovered. Had a couple of surgeries, and radiation. The chemo was the worst, though. He channeled Uncle Fester, and this was a fairly robust, somewhat overweight chap.

So he would not go in the "death" column, but I guarantee that he would not be one to dismiss the seriousness of the disease (or its treatment).

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

#74

Post by Traubenfuchs »

You might not die if you leave that cancer alone, but you might get part of your colon removed, or get a colostomy bag, or get your anus surgically sewn shut til death -all of which not necessarily changes your life expectancy.

Looking for death vs no-death alone as an outcome for medical diagnosis/treatment is short sighted.

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

#75

Post by hk__2 »

em500 wrote: post #27

Several posters have criticized the title of the news article "In gold-standard trial, colonoscopy fails to reduce rate of cancer deaths". The actual study is titled "Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death" [1] The authors conclude that "In this randomized trial, the risk of colorectal cancer at 10 years was lower among participants who were invited to undergo screening colono…

> I find it generally more useful link to the (abstract) of the original article, rather than second hand news reports. The abstracts are usually pretty accessible for a somewhat technical audience, they're not written for domain experts only.

If the second-hand news report is well done, it should give you more context on the matter, and so be more useful than the "raw" abstract.

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

#76

Post by ricardobeat »

From the HN guidelines:

> please use the original title, unless it is misleading or linkbait; don't editorialize

I'm finding myself disappointed with the application of guidelines here. The title has been changed to a completely made up headline, differing from the original, which is editorializing. It's the second time this happens in the past 24 hours - yesterday the ".. you idiot" part was removed from a blog post completely numbing the post's intention. Neither was misleading or clickbait.

EDIT: while typing this comment, the title has been changed yet again to reflect the paper's title "Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death".

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

#77

Post by seanmcdirmid »

ricardobeat wrote: post #43
hef19898 wrote: post #34

Earlier quoted context omitted.

Invited or not, if you don't show up to a colonoscopy you don't get one. Which means the study's data on invitations alone cannot be used to evaluate the effect of colonoscopies. Seems the study does provide data that allows this so, and shows clear differences in cancer rates and survival rates for those that did get colonoscopies. Argueing about the randomization of these numbers, and the meta-statistical aspects o…

You have to look at it from the perspective of medical practice. The hypothesis is that inviting people for a regular check up reduces mortality. If a lot of people don’t take up the offer because the procedure is too invasive, carries some risk, etc. then that is a very relevant variable to take into account. Vs, for example, fecal testing as mentioned in the article. It could have a lower precision, but if uptake i…

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 deductible/copays apply.

So in practice, doctors will tell you to just get the colonoscopy to save (your own) money.

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

#78

Post by ricardobeat »

hef19898 wrote: post #63
DanBC wrote: post #61

Earlier quoted context omitted.

> because every single additional person showing up for a screening is a net win We can't say that from this study. Colonoscopy does appear to be one of the screenings that reduces mortality. (That's why this is such a surprising result and is getting a lot of attention). But that does not mean that colonoscopy screening is useful for people in their 40s. There's a lot of discussion about the benefits and risks of co…

Now that is a useful discussion. The more I think about the study (the article covering it is just sh*), the more I think it would have been better to compare how many people had an actual colonoscopy between the two groups, compare everything that was compared between a) people with invite who did show up and those without invite that showed up b) people with invite who didn't show up vs. those without invite who di…

[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 intent-to-treat principle and why you can't compare only people who accepted the exam.

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

#79

Post by bstpierre »

dis-sys wrote: post #65
ricardobeat wrote: post #43

Earlier quoted context omitted.

You have to look at it from the perspective of medical practice. The hypothesis is that inviting people for a regular check up reduces mortality. If a lot of people don’t take up the offer because the procedure is too invasive, carries some risk, etc. then that is a very relevant variable to take into account. Vs, for example, fecal testing as mentioned in the article. It could have a lower precision, but if uptake i…

> then that is a very relevant variable to take into account. but that variable has nothing to do with whether the procedure itself is effective or not.

The question in this context is whether it’s an effective public health measure to recommend the procedure to a population: specifically, does it reduce the number of deaths over a given period?

Whether it’s effective on an individual basis is a related, but different, different question.

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

#80

Post by kwhitefoot »

hef19898 wrote: post #34
jvanderbot wrote: post #31

Earlier quoted context omitted.

Well, to be fair, the overall risk of death did not seem to be lower for the invited group. The risk was 11.04 vs 11.03 for those with invited colonoscopy, with fairly large confidence interval on the control group. But the risk of colon cancer did decrease, with a risk reduction of 18%. Maybe they just didn't track long enough to tease out a bigger risk reduction in overall mortality, or maybe colon cancer is associ…

Invited or not, if you don't show up to a colonoscopy you don't get one. Which means the study's data on invitations alone cannot be used to evaluate the effect of colonoscopies. Seems the study does provide data that allows this so, and shows clear differences in cancer rates and survival rates for those that did get colonoscopies. Argueing about the randomization of these numbers, and the meta-statistical aspects o…

> people like JBP, meaning it at least misses the point by a mile.

Who?

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