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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

#81

Post by seanmcdirmid »

denton-scratch wrote: post #52

This is about colonoscopy screening . If you give a fecal sample and it comes up as suspicious, the next step will be a colonoscopy anyway. A colonoscopy is quite unpleasant; you starve for a day, and take an enema. They may sedate you before the procedure. If they don't, then the procedure is quite uncomfortable; not exactly painful, but unpleasant. Incidentally, if they find and remove a polyp, they will plant a ta…

The enema is replaced with a laxative often. That is still really hard, I barely got half of mine down and was in a rough state the morning of the procedure.

I was sedated, so laxative was the hardest part of the ordeal, not the fasting or actual procedure.

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

#82

Post by jugg1es »

iampivot wrote: post #60

"Gold-standard trial" sounds about as good as Genuine Leather does for leather. (Genuine leather is the cheapest leather, for those that don't know).

If you had a science background, the term "Gold-standard trial" would have meaning to you as a term for randomized double-blind studies with a large sample size. I don't know what textiles have to do with it.

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

#83

Post by m0llusk »

This is a very complex subject because the sensitivity of tests for colorectal cancer has improved over time and more testing is being done. This makes it appear as if there is a great increase in colorectal cancer when there really isn't.

A very interesting related study has become known as "The Norwegian Colorectal Study" found that early testing was a waste of money since only those with a family history of colorectal cancer or IBS symptoms or both actually got colorectal cancer before 55. For most people the polyps which are precursors to colorectal cancer do not appear before age 55. That means that the current push for aggressive testing starting at 50 is a distracting waste of time, money, and effort that should be eased back.

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

#84

Post by astura »

seanmcdirmid wrote: post #77
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…

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're not really wrong, but you're using the wrong terms which is extremely confusing.

https://www.cancer.org/cancer/colon-rectal-cancer/detection-...

For asymptomatic people without abnormal stool, colon cancer tests are called "screening," never "diagnostic." "Screening" is covered without cost sharing. Colonoscopy, fecal tests, etc.

>But if you have a screening test other than colonoscopy and the result is positive (abnormal), you will need to have a colonoscopy. Some insurers consider this to be a diagnostic (not screening) colonoscopy, so you may have to pay the usual deductible and co-pay.

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

#85

Post by AlphaOne1 »

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

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

#86

Post by refurb »

ChrisMarshallNY wrote: post #73
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”…

"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" col…

Yeah, it's pretty complicated.

I'm not that surprised death rates were similar. Colonoscopies will catch pre-cancerous masses like polyps, so I can see the cancer rate being lower.

But if diagnosed with cancer, treatments are quite good for colorectal cancer, so you may not see that much of a difference in death rate on a 10 year horizon.

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

#87

Post by pelario »

“They’re doing a 15-year follow, and I would expect to see a significant reduction in cancer mortality in the long term,” Dominitz said. “Time will tell.”

After all the debate here in HN about the interpretation of the data and the statistics, I'm really looking forward to see a post in 15 years with the new study.

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

#88

Post by jtc331 »

hef19898 wrote: post #47
kgwgk wrote: post #46

Earlier quoted context omitted.

It cannot be used to say that the help either, but you wrote “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.”

I read it that the invite doesn get you differnces, the colonoscopy itsrlf does. And if that isn't statistically a gold standard, randomization and all tgat, I don't care. What the study says, IMHO, is that invoting people doesn't do any good when people don't show up. Which is an interesting problem, isn't it? Not inviting people might be an option, one that doesn't provide any benefits, except an number of letters…

> I read it that the invite doesn get you differnces, the colonoscopy itsrlf does.

No, it doesn’t, because the two groups of people you’re comparing aren’t actually similar, and therefore any outcome difference can’t be tied to the intervention.

The difference in outcome between those two groups may merely be that the people who go through with the colonoscopy (not fun) are also willing to go through with their doctor’s recommendations on, say, diet restrictions (also not as fun!) so are healthier and have better outcomes.

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

#89

Post by peteradio »

ricardobeat wrote: post #78
hef19898 wrote: post #63

Earlier quoted context omitted.

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 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.

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

#90

Post by JohnJamesRambo »

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…

I’m so confused though, because based on my reading of it, it seems like the prostate screening thing where yes it might find cancer but no it won’t prevent deaths, so it might be better to just not know/do invasive procedures and treatment for it.

Is that the wrong conclusion to reach from the data?

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