Colonoscopies: Not all they're cracked up to be
October 11, 2022 8:53 AM Subscribe
"In Gold-Standard NEJM Trial, Colonoscopy Fails to Reduce Rate of Cancer Deaths" by Angus Chen. [Mod note: This appears to be the article that was meant to be linked; please read the comments below for critiques of how this information has been presented / summarized].
Some excerpts from an article in Stat:
"The trial’s primary analysis found that colonoscopy only cut colon cancer risk by roughly a fifth ... didn’t provide any significant reduction in colon cancer mortality."
"Colonoscopies are still a good test ... but it may be time to reevaluate their standing as the gold standard of colon cancer screens."
"... none of those [previous] studies were large randomized trials, the ultimate experiment in clinical research."
"It’s not the magic bullet we thought it was ... we may have oversold colonoscopy."
"... may reduce your risk of getting colorectal cancer by 20 to 30% ... brings it more in line with the other main colorectal cancer tests, which analyze feces for signs of cancer, either abnormal DNA or blood, and can be taken at home..." and are cheaper.
Some excerpts from an article in Stat:
"The trial’s primary analysis found that colonoscopy only cut colon cancer risk by roughly a fifth ... didn’t provide any significant reduction in colon cancer mortality."
"Colonoscopies are still a good test ... but it may be time to reevaluate their standing as the gold standard of colon cancer screens."
"... none of those [previous] studies were large randomized trials, the ultimate experiment in clinical research."
"It’s not the magic bullet we thought it was ... we may have oversold colonoscopy."
"... may reduce your risk of getting colorectal cancer by 20 to 30% ... brings it more in line with the other main colorectal cancer tests, which analyze feces for signs of cancer, either abnormal DNA or blood, and can be taken at home..." and are cheaper.
This post was deleted for the following reason: Poster's Request -- loup
People will get the reassuring idea that they don't actually need a colonoscopy because the math machine didnt make numbers that were big enough. We have to stop telling people to make decisions based on complicated math they don't fully understand when reality is much simpler than that. It's like making a decision based on a complicated dream you half remember.
"In this randomized trial, the risk of colorectal cancer at 10 years was lower among participants who were invited to undergo screening colonoscopy than among those who were assigned to no screening. "
posted by bleep at 9:02 AM on October 11, 2022 [6 favorites]
"In this randomized trial, the risk of colorectal cancer at 10 years was lower among participants who were invited to undergo screening colonoscopy than among those who were assigned to no screening. "
posted by bleep at 9:02 AM on October 11, 2022 [6 favorites]
Oh, yeah, for all the good they've done me, I might as well have stuck them up my arse!
posted by kirkaracha at 9:03 AM on October 11, 2022 [18 favorites]
posted by kirkaracha at 9:03 AM on October 11, 2022 [18 favorites]
"a lot of people won't get one even if invited to do so."
DO. I. KNOW. YOU?
normalize the jokes butt normalize the procedure too.
posted by snuffleupagus at 9:06 AM on October 11, 2022 [1 favorite]
DO. I. KNOW. YOU?
normalize the jokes butt normalize the procedure too.
posted by snuffleupagus at 9:06 AM on October 11, 2022 [1 favorite]
Yeah this is being reported wrongly everywhere. If you get a colonoscopy, your risk is lower. Not that getting a colonoscopy is useless - it's not.
posted by tiny frying pan at 9:16 AM on October 11, 2022 [9 favorites]
posted by tiny frying pan at 9:16 AM on October 11, 2022 [9 favorites]
The accompanying editorial gives some useful discussion of the study. One thing that I wondered about was that “usual care” in the studied population was no screening for colon cancer. Why is that? Is colon cancer that much less common in Northern Europe than in the US? If so, a similar study done in the US could produce different results.
posted by TedW at 9:16 AM on October 11, 2022
posted by TedW at 9:16 AM on October 11, 2022
I don't think it's right to glibly dismiss this as badly reported. First of all the link here is to the NEJM study; not sure which article folks think is misreporting it, but presumably not the actual paper. Unfortunately the paper is paywalled and not on Sci-Hub yet; anyone have a copy? But the paper shows the intervention (suggesting a colonoscopy) did have an effect, reducing the number of cancers. It just didn't reduce deaths. That's interesting.
Colonoscopies are not easy tests. They average $2750 in the US, maybe $500-$1000 in Europe. That money could be spent effectively elsewhere. Also they're highly invasive; a day of prep, a few hours of procedure and recovery, and for many people a significant anesthetic. There should be a clear and significant benefit from this kind of test to be worth doing it as a regular screening.
The alternative is fecal screening. I'm unclear; what's the cost/benefit tradeoff of the basic occult blood test vs a DNA test? Either are pretty easy to perform.
It's very hard for me not to see the US recommendation (colonoscopies for all at 45!) other than through the lens of healthcare profiteering. I'm more inclined to look to European guidance for a cost/benefit tradeoff that makes sense from a public health perspective. This new study seems like important new information.
posted by Nelson at 9:32 AM on October 11, 2022 [38 favorites]
Colonoscopies are not easy tests. They average $2750 in the US, maybe $500-$1000 in Europe. That money could be spent effectively elsewhere. Also they're highly invasive; a day of prep, a few hours of procedure and recovery, and for many people a significant anesthetic. There should be a clear and significant benefit from this kind of test to be worth doing it as a regular screening.
The alternative is fecal screening. I'm unclear; what's the cost/benefit tradeoff of the basic occult blood test vs a DNA test? Either are pretty easy to perform.
It's very hard for me not to see the US recommendation (colonoscopies for all at 45!) other than through the lens of healthcare profiteering. I'm more inclined to look to European guidance for a cost/benefit tradeoff that makes sense from a public health perspective. This new study seems like important new information.
posted by Nelson at 9:32 AM on October 11, 2022 [38 favorites]
The problem is really - we don't know if there's enough benefit if no one will do the one test that can see (and often treat!) beginning cancers in one swoop. That was my take away - we need better ways to get people to do this test. Before we can make pronouncements that its not worth it. Unfortunately the headlines, including this one, pronounce that it's not worth it, which people want to believe anyway, so they don't take the test.
(It's really not that bad, as tests go.)
posted by tiny frying pan at 9:35 AM on October 11, 2022 [3 favorites]
(It's really not that bad, as tests go.)
posted by tiny frying pan at 9:35 AM on October 11, 2022 [3 favorites]
Maybe I just want the butt tube
posted by Going To Maine at 9:36 AM on October 11, 2022 [8 favorites]
posted by Going To Maine at 9:36 AM on October 11, 2022 [8 favorites]
I couldn't understand this article. (and I have a Ph.D. in a social science.)
Wouldn't you want to compare cancers in people who GET a colonoscopy (every x # of years) to people who do NOT get a colonoscopy every x # of years?
What is the point of the "invitation" thing? That's a test of "how many people who get invitations get colonoscopies vs how many people who do not get invitations get colonoscopies?", not "are colonoscopies good prevention measures"?
Also, I have never (in the US) gotten an invitation to a colonoscopy (good movie title?) However, when I go for my annual checkups, my internist always asks, "when was your last colonoscopy?" and tells me when to schedule my next one. Is that not an "invitation"?
What am I missing here??
posted by DMelanogaster at 9:38 AM on October 11, 2022 [10 favorites]
Wouldn't you want to compare cancers in people who GET a colonoscopy (every x # of years) to people who do NOT get a colonoscopy every x # of years?
What is the point of the "invitation" thing? That's a test of "how many people who get invitations get colonoscopies vs how many people who do not get invitations get colonoscopies?", not "are colonoscopies good prevention measures"?
Also, I have never (in the US) gotten an invitation to a colonoscopy (good movie title?) However, when I go for my annual checkups, my internist always asks, "when was your last colonoscopy?" and tells me when to schedule my next one. Is that not an "invitation"?
What am I missing here??
posted by DMelanogaster at 9:38 AM on October 11, 2022 [10 favorites]
The Stat headline is better:
In gold-standard trial, invitation to colonoscopy reduced cancer incidence but not death.
I suggest the headline of this FPP should be changed. The current headline is misleading, and problematic for anyone who doesn't click through and read the comments.
posted by Winnie the Proust at 9:42 AM on October 11, 2022 [24 favorites]
In gold-standard trial, invitation to colonoscopy reduced cancer incidence but not death.
I suggest the headline of this FPP should be changed. The current headline is misleading, and problematic for anyone who doesn't click through and read the comments.
posted by Winnie the Proust at 9:42 AM on October 11, 2022 [24 favorites]
I want to know if the "invitation" means free?
posted by tiny frying pan at 9:42 AM on October 11, 2022 [9 favorites]
posted by tiny frying pan at 9:42 AM on October 11, 2022 [9 favorites]
I have a family history of colon cancer death and my older brother is going for his first colonoscopy this week. He is already 42 and should have had one two years ago but it was 2020. Our dad has already had polyps removed multiple times after his colonoscopies and his brother died from colon cancer a couple years ago, so he’s basically been begging my brother to get a colonoscopy for years. I’ve assured him that I will be getting mine when I turn 40, no question. In my family the stigma isn’t in the procedure, it’s in not getting it.
I suppose in families who don’t have a history of colon cancer the specter of it is much more nebulous, so an invitation is more likely to be brushed off. But also they don’t know me and I am personally harassing everyone I care about as we turn middle aged to get the test as soon as recommended. Like, all cancer sucks, but some types of cancer suck extra, and colon cancer is one of them. And also colonoscopies can help diagnose other GI conditions, which in this high anxiety world are on the rise. I would much rather we destigmatize (and lower the costs of) the colonoscopy and also encourage fecal testing and other detection techniques, rather than toss them aside since folks don’t want to do them in the first place.
posted by Mizu at 10:00 AM on October 11, 2022 [11 favorites]
I suppose in families who don’t have a history of colon cancer the specter of it is much more nebulous, so an invitation is more likely to be brushed off. But also they don’t know me and I am personally harassing everyone I care about as we turn middle aged to get the test as soon as recommended. Like, all cancer sucks, but some types of cancer suck extra, and colon cancer is one of them. And also colonoscopies can help diagnose other GI conditions, which in this high anxiety world are on the rise. I would much rather we destigmatize (and lower the costs of) the colonoscopy and also encourage fecal testing and other detection techniques, rather than toss them aside since folks don’t want to do them in the first place.
posted by Mizu at 10:00 AM on October 11, 2022 [11 favorites]
Wouldn't you want to compare cancers in people who GET a colonoscopy (every x # of years) to people who do NOT get a colonoscopy every x # of years? ... What is the point of the "invitation" thing?
They want to make easy causal inferences -- "Does getting colonoscopies cause a lower incidence of cancer?"
The problem with comparing people who get a colonoscopy to people who don't is that getting a colonoscopy isn't randomly assigned and is almost certainly correlated with other relevant things.
Like, if we compared people who get an annual colonoscopy to people who get one every ten years, we'd almost certainly find that people who get an annual colonoscopy have a substantially higher rate of cancer. Because the reason you get a colonoscopy every year is that your family has a strong history of colon cancer.
They want a simple randomized trial because that's rightly the "gold standard" for simple, direct causal inference. But you can't randomly assign getting a colonscopy -- you can't just assign people to receive colonoscopies; they get to say no. But you can randomly assign people to get a mailing or not get a mailing, so they did that. This also means they fundamentally can't answer the question they care about. Me, I think they should just resign themselves to other approaches to get at the causal question.
posted by GCU Sweet and Full of Grace at 10:00 AM on October 11, 2022 [30 favorites]
They want to make easy causal inferences -- "Does getting colonoscopies cause a lower incidence of cancer?"
The problem with comparing people who get a colonoscopy to people who don't is that getting a colonoscopy isn't randomly assigned and is almost certainly correlated with other relevant things.
Like, if we compared people who get an annual colonoscopy to people who get one every ten years, we'd almost certainly find that people who get an annual colonoscopy have a substantially higher rate of cancer. Because the reason you get a colonoscopy every year is that your family has a strong history of colon cancer.
They want a simple randomized trial because that's rightly the "gold standard" for simple, direct causal inference. But you can't randomly assign getting a colonscopy -- you can't just assign people to receive colonoscopies; they get to say no. But you can randomly assign people to get a mailing or not get a mailing, so they did that. This also means they fundamentally can't answer the question they care about. Me, I think they should just resign themselves to other approaches to get at the causal question.
posted by GCU Sweet and Full of Grace at 10:00 AM on October 11, 2022 [30 favorites]
More than "80,000 people aged 55 to 64 in Poland, Norway, and Sweden" recruited for trial; "Roughly 28,000 of the participants were randomly selected to receive an invitation to get a colonoscopy. [...] After 10 years, the researchers found that the participants who were invited to colonoscopy had an 18% reduction in colon cancer risk but were no less likely to die from colon cancer than those who were never invited to screening."
"Of the participants who were invited to colonoscopy, only 42% actually did one."
You're all invited to a health screening of some sort.
posted by Iris Gambol at 10:00 AM on October 11, 2022 [1 favorite]
"Of the participants who were invited to colonoscopy, only 42% actually did one."
You're all invited to a health screening of some sort.
posted by Iris Gambol at 10:00 AM on October 11, 2022 [1 favorite]
I don't think it's right to glibly dismiss this as badly reported.
I think, no offense to the poster, that the post is rather confusingly contextualized. It seems to be linking the original paper but excerpting from a summary that draws broader conclusions?
posted by atoxyl at 10:03 AM on October 11, 2022 [1 favorite]
I think, no offense to the poster, that the post is rather confusingly contextualized. It seems to be linking the original paper but excerpting from a summary that draws broader conclusions?
posted by atoxyl at 10:03 AM on October 11, 2022 [1 favorite]
"Of the participants who were invited to colonoscopy, only 42% actually did one."
Not being able to pull down the paper from my school's library yet, I wonder what proportion of the control group got colonoscopies.
posted by GCU Sweet and Full of Grace at 10:06 AM on October 11, 2022 [9 favorites]
Not being able to pull down the paper from my school's library yet, I wonder what proportion of the control group got colonoscopies.
posted by GCU Sweet and Full of Grace at 10:06 AM on October 11, 2022 [9 favorites]
Also they're highly invasive; a day of prep, a few hours of procedure and recovery, and for many people a significant anesthetic.
An acquaintance had a genius idea recently: there should be resorts with hospitals attached, so you can book a two-week stay and get all of your necessary medical tests for that year done in one fell swoop by doctors who will come and do them right in your room, and then on the days you don't have a test you can lay by the pool or play volleyball or whatever and enjoy fine dining at each meal.
I did the fecal screening thing in lieu of a colonoscopy, but I'd totally go stay in the Annual Testing Arms or whatever. The fecal screening thing was hassle enough - not the collecting of the sample, the finding an open UPS place to drop it off at on my way to work so it would get to the lab on time. (I ended up late to work, and my boss was cool about it but curious about why I didn't just give my package to the guy in the mailroom so it could go out with our other packages. I didn't know how to tell him that "I didn't want to subject the mailroom staff to a box full of my own literal shit.")
posted by EmpressCallipygos at 10:10 AM on October 11, 2022 [31 favorites]
An acquaintance had a genius idea recently: there should be resorts with hospitals attached, so you can book a two-week stay and get all of your necessary medical tests for that year done in one fell swoop by doctors who will come and do them right in your room, and then on the days you don't have a test you can lay by the pool or play volleyball or whatever and enjoy fine dining at each meal.
I did the fecal screening thing in lieu of a colonoscopy, but I'd totally go stay in the Annual Testing Arms or whatever. The fecal screening thing was hassle enough - not the collecting of the sample, the finding an open UPS place to drop it off at on my way to work so it would get to the lab on time. (I ended up late to work, and my boss was cool about it but curious about why I didn't just give my package to the guy in the mailroom so it could go out with our other packages. I didn't know how to tell him that "I didn't want to subject the mailroom staff to a box full of my own literal shit.")
posted by EmpressCallipygos at 10:10 AM on October 11, 2022 [31 favorites]
A "gold standard" trial would be comparing cancer incidence and mortality in groups who received colonoscopy, stool sample testing, or no intervention.
My understanding is that the US is highly focused on colonoscopies more than other screening methods. European model of stool sample testing, starting at an earlier age and occurring more frequently, would catch a lot of issues and would be of higher benefit to most people in the US. However, the advantage of colonoscopy is that any issues detected can be addressed immediately - see a polyp? Cut it out.
Colonoscopy is also really the only solution for people genetically predisposed to colon cancer. Like my wife, who recently found out she has Lynch syndrome and thus she gets to have a colonoscopy annually. Stool testing won't catch issues early enough to prevent cancer if you have Lynch. (It's caused by a defective DNA repair gene, similar to BRCA.)
The article framing is misleading, and it's being badly reported to boot.
posted by caution live frogs at 10:15 AM on October 11, 2022 [7 favorites]
My understanding is that the US is highly focused on colonoscopies more than other screening methods. European model of stool sample testing, starting at an earlier age and occurring more frequently, would catch a lot of issues and would be of higher benefit to most people in the US. However, the advantage of colonoscopy is that any issues detected can be addressed immediately - see a polyp? Cut it out.
Colonoscopy is also really the only solution for people genetically predisposed to colon cancer. Like my wife, who recently found out she has Lynch syndrome and thus she gets to have a colonoscopy annually. Stool testing won't catch issues early enough to prevent cancer if you have Lynch. (It's caused by a defective DNA repair gene, similar to BRCA.)
The article framing is misleading, and it's being badly reported to boot.
posted by caution live frogs at 10:15 AM on October 11, 2022 [7 favorites]
I have access to the full article, here's some relevant bits:
42% of the participants in the invited group actually participated in the one-time screening, with large variation per country (60% in Norway and 33% in Poland). There are apparently more details about the screening process and rationale in an earlier experimental design paper that I don't have access to.
Here is one key sentence: "The risk of colorectal cancer–related death at 10 years was 0.28% (72 deaths) among participants in the invited group and 0.31% (157 deaths) among those in the usual-care group (risk ratio, 0.90; 95% CI, 0.64 to 1.16)." Doing some rough math, this means that the real risk of death for people invited should be between 0.19% and 0.35%. 0.35% is higher than the measured 0.31% of the usual care group, so being invited to take a free colonoscopy had the effect of saving somewhere between saving -7 and 26 lives out of 28,220.
But, the researchers did do more analysis to estimate the effect of actually getting a colonoscopy, and those numbers are significant. From the conclusion: "In adjusted analyses to estimate the effect of screening if all the participants who were randomly assigned to screening had actually undergone screening, the risk of colorectal cancer was decreased from 1.22% to 0.84%, and the risk of colorectal cancer–related death was decreased from 0.30% to 0.15%." Given the risk ratio confidence interval from a few paragraphs up (95% CI, 0.27 to 0.77), this means that actually getting a free colonoscopy had the effect of saving somewhere between 12 and 52 lives out of 28,220. It clearly made an improvement.
So yes, the Stat article and quoted text are definitely misrepresenting the paper because they confuse the invitation and actual treatment conditions. This paper provides good evidence that getting a colonoscopy provides real benefits, but the Stat article claims "the secondary analysis isn’t as robust as the primary or intention-to-treat analysis" without justification. The researchers gave their confidence intervals and it clearly shows a significant benefit, and the skeptical doctors quoted in the article need to justify why they do not think the results are valid.
posted by JZig at 10:30 AM on October 11, 2022 [23 favorites]
42% of the participants in the invited group actually participated in the one-time screening, with large variation per country (60% in Norway and 33% in Poland). There are apparently more details about the screening process and rationale in an earlier experimental design paper that I don't have access to.
Here is one key sentence: "The risk of colorectal cancer–related death at 10 years was 0.28% (72 deaths) among participants in the invited group and 0.31% (157 deaths) among those in the usual-care group (risk ratio, 0.90; 95% CI, 0.64 to 1.16)." Doing some rough math, this means that the real risk of death for people invited should be between 0.19% and 0.35%. 0.35% is higher than the measured 0.31% of the usual care group, so being invited to take a free colonoscopy had the effect of saving somewhere between saving -7 and 26 lives out of 28,220.
But, the researchers did do more analysis to estimate the effect of actually getting a colonoscopy, and those numbers are significant. From the conclusion: "In adjusted analyses to estimate the effect of screening if all the participants who were randomly assigned to screening had actually undergone screening, the risk of colorectal cancer was decreased from 1.22% to 0.84%, and the risk of colorectal cancer–related death was decreased from 0.30% to 0.15%." Given the risk ratio confidence interval from a few paragraphs up (95% CI, 0.27 to 0.77), this means that actually getting a free colonoscopy had the effect of saving somewhere between 12 and 52 lives out of 28,220. It clearly made an improvement.
So yes, the Stat article and quoted text are definitely misrepresenting the paper because they confuse the invitation and actual treatment conditions. This paper provides good evidence that getting a colonoscopy provides real benefits, but the Stat article claims "the secondary analysis isn’t as robust as the primary or intention-to-treat analysis" without justification. The researchers gave their confidence intervals and it clearly shows a significant benefit, and the skeptical doctors quoted in the article need to justify why they do not think the results are valid.
posted by JZig at 10:30 AM on October 11, 2022 [23 favorites]
One thing I'm not seeing mentioned is that colonoscopies can also be used to diagnose/treat other conditions. May be tangental, but I wanted to mention it.
For years, I had Iron Deficiency issues, that my old doctors couldn't get to the bottom of - pun intended. I just got thrown supplements ever year. My new doc recommended a colonoscopy - if that didn't help, then come back to him. I'm also above 50, so I needed one for routine screening anyways. The theory is that there could be some undiscovered rectal bleeding causing the iron deficiency.
Sure enough, there were benign polyps, one of which was quite large, and all of them were removed. I recently had my iron labs done, and my iron levels are back to normal - and I am also feeling quite a lot better, as well.
Because of these polyps and iron deficiency, I now have to get Butt Stuff done every three years now. I look forward to it. I love living without iron deficiency for once!
posted by spinifex23 at 10:31 AM on October 11, 2022 [14 favorites]
For years, I had Iron Deficiency issues, that my old doctors couldn't get to the bottom of - pun intended. I just got thrown supplements ever year. My new doc recommended a colonoscopy - if that didn't help, then come back to him. I'm also above 50, so I needed one for routine screening anyways. The theory is that there could be some undiscovered rectal bleeding causing the iron deficiency.
Sure enough, there were benign polyps, one of which was quite large, and all of them were removed. I recently had my iron labs done, and my iron levels are back to normal - and I am also feeling quite a lot better, as well.
Because of these polyps and iron deficiency, I now have to get Butt Stuff done every three years now. I look forward to it. I love living without iron deficiency for once!
posted by spinifex23 at 10:31 AM on October 11, 2022 [14 favorites]
I had my first colonoscopy at 40 on advice of my doc. It found and removed pre-cancerous growths. Since then I have had four more and all but one have also found and removed pre-cancerous growths. Scheduled to get yet another next spring.
My brother, who put off having one for a decade past 50 died in 2019 three and half years after a colonoscopy found a cancerous growth too late.
I don't love it, but so far it's worked for me.
posted by thecincinnatikid at 10:31 AM on October 11, 2022 [12 favorites]
My brother, who put off having one for a decade past 50 died in 2019 three and half years after a colonoscopy found a cancerous growth too late.
I don't love it, but so far it's worked for me.
posted by thecincinnatikid at 10:31 AM on October 11, 2022 [12 favorites]
you can book a two-week stay and get all of your necessary medical tests for that year done in one fell swoop by doctors who will come and do them right in your room
Every large medical center already does this. Google "executive physical." Hospitals love 'em because they are cash cows -- at mine, the executive physical program ("Signature Care") basically funds our indigent care program (which has a terrible unofficial name I won't repeat here).
This article has been making the rounds of MedTwitter, and consensus is that the article itself is fine but the media reporting gets it backwards. This is a study on whether or not invitation to screening -- not screening itself -- works. From the abstract, In intention-to-screen analyses, the risk of colorectal cancer at 10 years was 0.98% in the invited group and 1.20% in the usual-care group, a risk reduction of 18% (risk ratio, 0.82; 95% confidence interval [CI], 0.70 to 0.93)..
I do wish they had done an "as-treated" analysis, or per-country analysis, although I know those are not as good because you lose the benefit of randomization. I need to do a deeper dive into the article, but the actual screening proportion was twice as high in Norway (60.7%) compared to Poland (30%) and Sweden (33%). But the rate of adenoma detection was just 14% in Sweden vs 35% in Poland and 27% in Norway. That's a lot of variability!
posted by basalganglia at 10:36 AM on October 11, 2022 [15 favorites]
Every large medical center already does this. Google "executive physical." Hospitals love 'em because they are cash cows -- at mine, the executive physical program ("Signature Care") basically funds our indigent care program (which has a terrible unofficial name I won't repeat here).
This article has been making the rounds of MedTwitter, and consensus is that the article itself is fine but the media reporting gets it backwards. This is a study on whether or not invitation to screening -- not screening itself -- works. From the abstract, In intention-to-screen analyses, the risk of colorectal cancer at 10 years was 0.98% in the invited group and 1.20% in the usual-care group, a risk reduction of 18% (risk ratio, 0.82; 95% confidence interval [CI], 0.70 to 0.93)..
I do wish they had done an "as-treated" analysis, or per-country analysis, although I know those are not as good because you lose the benefit of randomization. I need to do a deeper dive into the article, but the actual screening proportion was twice as high in Norway (60.7%) compared to Poland (30%) and Sweden (33%). But the rate of adenoma detection was just 14% in Sweden vs 35% in Poland and 27% in Norway. That's a lot of variability!
posted by basalganglia at 10:36 AM on October 11, 2022 [15 favorites]
Nelson: It's very hard for me not to see the US recommendation (colonoscopies for all at 45!) other than through the lens of healthcare profiteering.
I am not arguing with you, but consider this situation: I had my first colonoscopy this summer, and they found a polyp at the opening of my appendix. They can't remove it, because it's sort of down inside the "tube" -- so they tell me to get my appendix out.
I asked the appendix surgeon, "Do I really need this? Is it medically indicated, or just precautionary, or what?" And he offers two reasons: first, the removal techniques are different, and the appendectomy will remove more tissue (which could be cancerous, maybe not) for extra safety. Second, he said that polyps continue to grow so eventually it will block the appendix and then I will suddenly need an emergency appendectomy.
I hadn't heard of this possibility before, and in fact I do appreciate scheduling this instead of having it thrust upon me.
posted by wenestvedt at 10:40 AM on October 11, 2022 [7 favorites]
I am not arguing with you, but consider this situation: I had my first colonoscopy this summer, and they found a polyp at the opening of my appendix. They can't remove it, because it's sort of down inside the "tube" -- so they tell me to get my appendix out.
I asked the appendix surgeon, "Do I really need this? Is it medically indicated, or just precautionary, or what?" And he offers two reasons: first, the removal techniques are different, and the appendectomy will remove more tissue (which could be cancerous, maybe not) for extra safety. Second, he said that polyps continue to grow so eventually it will block the appendix and then I will suddenly need an emergency appendectomy.
I hadn't heard of this possibility before, and in fact I do appreciate scheduling this instead of having it thrust upon me.
posted by wenestvedt at 10:40 AM on October 11, 2022 [7 favorites]
I had my first one at 50 and it found stage 3 colon cancer (one monsterous polyp). I'd had no symptoms, and here I am cancer-free 4 1/2 years later. Please go for your colonoscopy!
posted by AJaffe at 10:41 AM on October 11, 2022 [31 favorites]
posted by AJaffe at 10:41 AM on October 11, 2022 [31 favorites]
GCU:
Thus, none of the participants who were enrolled in the trial were eligible for any colorectal cancer screening programs outside the trial during screening or follow-up.8 Throughout the trial, we monitored opportunistic colonoscopy screening activity in the trial areas and did not identify additional colonoscopy procedures beyond what would have been expected for clinical indications.9
The monitoring link (ref 9) is in Norwegian, so I can't tell you how many control patients received a colonoscopy.
There are a lot of hot take (here and everywhere) mis-understanding the relationship between the effect of the invitation and the effect of a colonoscopy. If invitation leads to a 42% rate of colonoscopy and non-invitation a 2% rate, and colonoscopy causes a X% reduction in CRC deaths, then the treatment effect on the treated of the invitation is 0.4 * X, and you can do the simple maths to get X from the invited vs not-invited difference in CRC deaths. If anything this tends to overestimate the average effect of colonoscopy because the people who blew off the invitation tend to be people who benefit less (most of the time! there are cases where the defiers benefit more) (which is different from "have a lower rate of the outcome").
There isn't really a point in focusing on the per-protocol analysis, because that's basically just an observational study. There are already plenty of observational studies.
posted by a robot made out of meat at 10:43 AM on October 11, 2022 [2 favorites]
Thus, none of the participants who were enrolled in the trial were eligible for any colorectal cancer screening programs outside the trial during screening or follow-up.8 Throughout the trial, we monitored opportunistic colonoscopy screening activity in the trial areas and did not identify additional colonoscopy procedures beyond what would have been expected for clinical indications.9
The monitoring link (ref 9) is in Norwegian, so I can't tell you how many control patients received a colonoscopy.
There are a lot of hot take (here and everywhere) mis-understanding the relationship between the effect of the invitation and the effect of a colonoscopy. If invitation leads to a 42% rate of colonoscopy and non-invitation a 2% rate, and colonoscopy causes a X% reduction in CRC deaths, then the treatment effect on the treated of the invitation is 0.4 * X, and you can do the simple maths to get X from the invited vs not-invited difference in CRC deaths. If anything this tends to overestimate the average effect of colonoscopy because the people who blew off the invitation tend to be people who benefit less (most of the time! there are cases where the defiers benefit more) (which is different from "have a lower rate of the outcome").
There isn't really a point in focusing on the per-protocol analysis, because that's basically just an observational study. There are already plenty of observational studies.
posted by a robot made out of meat at 10:43 AM on October 11, 2022 [2 favorites]
(It's really not that bad, as tests go.)
This. I've had bloodwork done that was more uncomfortable than colonoscopy.
posted by Hardcore Poser at 10:50 AM on October 11, 2022 [2 favorites]
This. I've had bloodwork done that was more uncomfortable than colonoscopy.
posted by Hardcore Poser at 10:50 AM on October 11, 2022 [2 favorites]
Every large medical center already does this. Google "executive physical."
I just checked - sounds like that's only one day and there's no pool. What I'm envisioning is, like, Club Med where the "Med" part stands for "Medical".
posted by EmpressCallipygos at 10:50 AM on October 11, 2022 [10 favorites]
I just checked - sounds like that's only one day and there's no pool. What I'm envisioning is, like, Club Med where the "Med" part stands for "Medical".
posted by EmpressCallipygos at 10:50 AM on October 11, 2022 [10 favorites]
I want to know if the "invitation" means free?
These days, I'd probably also keel over dead if I was offered medical care for free.
The alternative is fecal screening
Cheap, easy, and good at testing for cancer. But it doesn't do a good job at catching precancerous polyps, which is the kind of thing you want the GI specialist to find and remove before you get to the point where you have cancer.
posted by They sucked his brains out! at 10:54 AM on October 11, 2022 [3 favorites]
These days, I'd probably also keel over dead if I was offered medical care for free.
The alternative is fecal screening
Cheap, easy, and good at testing for cancer. But it doesn't do a good job at catching precancerous polyps, which is the kind of thing you want the GI specialist to find and remove before you get to the point where you have cancer.
posted by They sucked his brains out! at 10:54 AM on October 11, 2022 [3 favorites]
As far as I can tell, this study is less about "do colonoscopies prevent colorectal cancer" than it's about "is telling people to get regular colonoscopies an effective public health measure?" The success rate of the test itself is only part of the story if most people are unwilling to go through the procedure.
posted by Holy Zarquon's Singing Fish at 10:54 AM on October 11, 2022 [8 favorites]
posted by Holy Zarquon's Singing Fish at 10:54 AM on October 11, 2022 [8 favorites]
the paper shows the intervention (suggesting a colonoscopy) did have an effect, reducing the number of cancers. It just didn't reduce deaths
What underlying processes could cause that? (assuming that’s deaths-from-colon-cancers)? All colon cancers that kill people being untreatable no matter when you find them?
posted by clew at 10:54 AM on October 11, 2022
What underlying processes could cause that? (assuming that’s deaths-from-colon-cancers)? All colon cancers that kill people being untreatable no matter when you find them?
posted by clew at 10:54 AM on October 11, 2022
If anything this tends to overestimate the average effect of colonoscopy because the people who blew off the invitation tend to be people who benefit less (most of the time! there are cases where the defiers benefit more) (which is different from "have a lower rate of the outcome").
That's what I was thinking, but my statistics are way too primitive to know whether it's the correct analysis.
Also, since we literally cannot compel colonoscopies in the real world, the lever we do have to pull is enticing patients in the door, so I'd say there's substantial value, at least as a first step, in figuring out whether straightforward "invitation" actually saves a meaningful number of lives. Then you can try to figure out whether various forms of incentive improves that. No?
Finally...it always feels strange for me to say this when this topic comes up. Because of overscreening (a CT scan I really shouldn't have had for something else totally unrelated), I had a potentially precancerous lesion diagnosed some years ago and then had a serious surgery to resect it. I missed two months of work. The hospital billed over $100,000 (fortunately I had very good insurance at that time). I've got scars, and probably some lingering health effects. I could've become diabetic. It was the worst pain of my entire life. But maybe it saved my life? But only maybe, and no one can even tell me the odds. Because to this day they still don't know how to distinguish the lesions that will progress to cancer from those that don't; they only know that a lot of them don't. So. Even setting aside the literal cost of a screening procedure, screening isn't free, to the medical system or the patient. Every anecdote of "they screened me, and found something"--they have to be understood in the light of the actual costs of false positives and the like. That's why they run studies like this one.
posted by praemunire at 10:55 AM on October 11, 2022 [17 favorites]
That's what I was thinking, but my statistics are way too primitive to know whether it's the correct analysis.
Also, since we literally cannot compel colonoscopies in the real world, the lever we do have to pull is enticing patients in the door, so I'd say there's substantial value, at least as a first step, in figuring out whether straightforward "invitation" actually saves a meaningful number of lives. Then you can try to figure out whether various forms of incentive improves that. No?
Finally...it always feels strange for me to say this when this topic comes up. Because of overscreening (a CT scan I really shouldn't have had for something else totally unrelated), I had a potentially precancerous lesion diagnosed some years ago and then had a serious surgery to resect it. I missed two months of work. The hospital billed over $100,000 (fortunately I had very good insurance at that time). I've got scars, and probably some lingering health effects. I could've become diabetic. It was the worst pain of my entire life. But maybe it saved my life? But only maybe, and no one can even tell me the odds. Because to this day they still don't know how to distinguish the lesions that will progress to cancer from those that don't; they only know that a lot of them don't. So. Even setting aside the literal cost of a screening procedure, screening isn't free, to the medical system or the patient. Every anecdote of "they screened me, and found something"--they have to be understood in the light of the actual costs of false positives and the like. That's why they run studies like this one.
posted by praemunire at 10:55 AM on October 11, 2022 [17 favorites]
All colon cancers that kill people being untreatable no matter when you find them?
A colonoscopy once every ten years will catch potentially pre-cancerous polyps (thus preventing cancers), but is not so great at catching any rapidly spreading malignancies early enough to save lives, I think.
posted by praemunire at 10:58 AM on October 11, 2022
A colonoscopy once every ten years will catch potentially pre-cancerous polyps (thus preventing cancers), but is not so great at catching any rapidly spreading malignancies early enough to save lives, I think.
posted by praemunire at 10:58 AM on October 11, 2022
They want to make easy causal inferences -- "Does getting colonoscopies cause a lower incidence of cancer?"
See, this is the part that confuses me. A colonoscopy is a diagnostic procedure. It's not a treatment (unless you consider clipping the occasional polyp a cancer treatment) Getting a colonoscopy doesn't lower the incidence of cancer so much as it increases the likelyhood of catching the cancer early.
posted by Thorzdad at 10:58 AM on October 11, 2022 [3 favorites]
See, this is the part that confuses me. A colonoscopy is a diagnostic procedure. It's not a treatment (unless you consider clipping the occasional polyp a cancer treatment) Getting a colonoscopy doesn't lower the incidence of cancer so much as it increases the likelyhood of catching the cancer early.
posted by Thorzdad at 10:58 AM on October 11, 2022 [3 favorites]
The intervention wasn't an actual colonoscopy -- it was an INVITATION to get a colonoscopy
I have left my visiting card at every surgical center in this city and I have yet to get an invitation in return. I expect it is because of the incident at the Mount Sinai cotillion.
posted by PlusDistance at 10:58 AM on October 11, 2022 [26 favorites]
I have left my visiting card at every surgical center in this city and I have yet to get an invitation in return. I expect it is because of the incident at the Mount Sinai cotillion.
posted by PlusDistance at 10:58 AM on October 11, 2022 [26 favorites]
This. I've had bloodwork done that was more uncomfortable than colonoscopy.
The colonoscopy isn't the rough part, it's the spending the previous day on the toilet with induced diarrhea "prep" cleanse. I'm already dreading having to do it again in a year.
posted by Fleebnork at 11:01 AM on October 11, 2022 [9 favorites]
The colonoscopy isn't the rough part, it's the spending the previous day on the toilet with induced diarrhea "prep" cleanse. I'm already dreading having to do it again in a year.
posted by Fleebnork at 11:01 AM on October 11, 2022 [9 favorites]
See, this is the part that confuses me. A colonoscopy is a diagnostic procedure. It's not a treatment (unless you consider clipping the occasional polyp a cancer treatment) Getting a colonoscopy doesn't lower the incidence of cancer so much as it increases the likelyhood of catching the cancer early.
Per the paper:
Because most colorectal cancers develop from benign polyps that can be detected and removed during endoscopy, endoscopic screening may prevent colorectal cancer.
and, of course, colorectal cancer death is a primary outcome of concern, from the idea that if you catch a cancer early (or prevent it), somebody will not die of it.
posted by entropone at 11:16 AM on October 11, 2022
Per the paper:
Because most colorectal cancers develop from benign polyps that can be detected and removed during endoscopy, endoscopic screening may prevent colorectal cancer.
and, of course, colorectal cancer death is a primary outcome of concern, from the idea that if you catch a cancer early (or prevent it), somebody will not die of it.
posted by entropone at 11:16 AM on October 11, 2022
Now that I'm back on health insurance, I'll be speaking with my doctor (when I can see him -- right now it's nurse practitioners unless I want to book a visit two months out) about my first colonoscopy. My father had a stage 3 found in his 70s, I'm early 50s, it's time.
But the quote earlier of "They average $2750 in the US" does not fill me with joy, and neither does my insurance being Cigna, with whom I've had a celebrated war in the past over their classifying a quick endoscopic peek at my throat as "outpatient surgery."
It would be nice if preventative / screening care was made available to people with price incentives, i.e. insurance companies declaring "we'll cover cheaper care affordably to avoid paying out on surgical procedures later," rather than their common refrain of "We'll hit 'em on both ends."
(Quick Googling suggests that if a physician says "get one," some providers will cover it. But actually seeing that in the wild is left as an exercise for the reader.)
posted by delfin at 11:22 AM on October 11, 2022 [3 favorites]
But the quote earlier of "They average $2750 in the US" does not fill me with joy, and neither does my insurance being Cigna, with whom I've had a celebrated war in the past over their classifying a quick endoscopic peek at my throat as "outpatient surgery."
It would be nice if preventative / screening care was made available to people with price incentives, i.e. insurance companies declaring "we'll cover cheaper care affordably to avoid paying out on surgical procedures later," rather than their common refrain of "We'll hit 'em on both ends."
(Quick Googling suggests that if a physician says "get one," some providers will cover it. But actually seeing that in the wild is left as an exercise for the reader.)
posted by delfin at 11:22 AM on October 11, 2022 [3 favorites]
Guys, guys…. Y’all. C’mon now, y’all know by now that the purpose of these kind of papers isn’t to publish consumable information that’s useful for the layperson.
The point is to Publish.
Publish and be counted.
In this case, Mission Accomplished.
posted by armoir from antproof case at 11:29 AM on October 11, 2022 [1 favorite]
The point is to Publish.
Publish and be counted.
In this case, Mission Accomplished.
posted by armoir from antproof case at 11:29 AM on October 11, 2022 [1 favorite]
The colonoscopy isn't the rough part, it's the spending the previous day on the toilet with induced diarrhea "prep" cleanse.
And that's not as bad as the drinking of the prep liquid...next one I do I will ask for pills to be chased with water so I don't have to taste it. Still...it's not a bad test compared to oh so many.
posted by tiny frying pan at 11:30 AM on October 11, 2022 [1 favorite]
And that's not as bad as the drinking of the prep liquid...next one I do I will ask for pills to be chased with water so I don't have to taste it. Still...it's not a bad test compared to oh so many.
posted by tiny frying pan at 11:30 AM on October 11, 2022 [1 favorite]
And that's not as bad as the drinking of the prep liquid
I did them like shots, on a timer, and while it was still unpleasant I am accustomed to drinking unpleasant things as shots due to my past life as a woo girl, so it wasn't that bad.
posted by joannemerriam at 11:33 AM on October 11, 2022 [15 favorites]
I did them like shots, on a timer, and while it was still unpleasant I am accustomed to drinking unpleasant things as shots due to my past life as a woo girl, so it wasn't that bad.
posted by joannemerriam at 11:33 AM on October 11, 2022 [15 favorites]
I couldn't do it like a shot even tho I am a seasoned shot taker.
posted by tiny frying pan at 11:36 AM on October 11, 2022
posted by tiny frying pan at 11:36 AM on October 11, 2022
For me the worst part wasn't the drinking of the liquid nor its effect; the worst part was not being able to drink any water for the entirety of the several hours leading up to the test after having just voided all the H20 from my system.
posted by Atom Eyes at 11:40 AM on October 11, 2022 [6 favorites]
posted by Atom Eyes at 11:40 AM on October 11, 2022 [6 favorites]
I don't know how I feel about this. I avoided the colonoscopy for years that my doc wanted me to do (is that an "invitation"?), until the one year I had decent insurance and she said "let's run ALL the tests." Found out I had cancer. At the time, there were no advertisements for the mail-in tests, and I don't know that I'd have done that anyway, since I have such a bodily function horror (which this whole experience still hasn't rid me of), even if the option existed when I was diagnosed.
I think this kind of thing is very confusing for people (especially this bizarre invitation aspect), and will probably be used to avoid testing by people like me. I would have totally thrown around some study I didn't fully understand just to get out of it. And I worry they'll be like me, in an early enough stage that now I can say I won't get cancer again because now that we know what we know, I am on guard for it. It was major abdominal surgery, and not exactly a vacation to go through, but by the time it was over, I'm still glad that I finally relented and went through the procedure.
I don't want that for other people, and this feels like it might have a significant discouraging effect.
posted by kitten kaboodle at 11:43 AM on October 11, 2022 [7 favorites]
I think this kind of thing is very confusing for people (especially this bizarre invitation aspect), and will probably be used to avoid testing by people like me. I would have totally thrown around some study I didn't fully understand just to get out of it. And I worry they'll be like me, in an early enough stage that now I can say I won't get cancer again because now that we know what we know, I am on guard for it. It was major abdominal surgery, and not exactly a vacation to go through, but by the time it was over, I'm still glad that I finally relented and went through the procedure.
I don't want that for other people, and this feels like it might have a significant discouraging effect.
posted by kitten kaboodle at 11:43 AM on October 11, 2022 [7 favorites]
Please go for your colonoscopy!
I will try to. I stupidly failed to get one when I had insurance, just before I left the US. Now, I have no idea how to get one in Sweden. I think the focus in Sweden is testing your poop rather than peering around your plumbing. But I would like my plumbing plumbed, just in case. At least, now I would. Now that I don't have easy access to a colonoscopy. Typical human!!!
posted by Bella Donna at 11:49 AM on October 11, 2022 [2 favorites]
I will try to. I stupidly failed to get one when I had insurance, just before I left the US. Now, I have no idea how to get one in Sweden. I think the focus in Sweden is testing your poop rather than peering around your plumbing. But I would like my plumbing plumbed, just in case. At least, now I would. Now that I don't have easy access to a colonoscopy. Typical human!!!
posted by Bella Donna at 11:49 AM on October 11, 2022 [2 favorites]
Right now I'm trying to figure out how to get one since my teen can't drive and I don't have anyone else to get me home. I'm thinking I'll have to Uber and have her guide my druggy self to the car.
posted by emjaybee at 11:55 AM on October 11, 2022 [2 favorites]
posted by emjaybee at 11:55 AM on October 11, 2022 [2 favorites]
Please go for your colonoscopy!
Please do! Cancer sucks!
posted by They sucked his brains out! at 12:19 PM on October 11, 2022 [4 favorites]
Please do! Cancer sucks!
posted by They sucked his brains out! at 12:19 PM on October 11, 2022 [4 favorites]
Right now I'm trying to figure out how to get one since my teen can't drive and I don't have anyone else to get me home. I'm thinking I'll have to Uber and have her guide my druggy self to the car.
In my case, that requirement was, excuse the expression in this context, complete butt-covering. I live half a block away from the hospital where I work and where I had my colonoscopy done, and I had to ask my boss to drive me that half block, even though I was wide-awake coming out of general anesthesia and perfectly capable of walking. The prep for it (basically, you're giving yourself a real bad case of diarrhea) is way worse than the aftermath.
posted by Halloween Jack at 12:20 PM on October 11, 2022
In my case, that requirement was, excuse the expression in this context, complete butt-covering. I live half a block away from the hospital where I work and where I had my colonoscopy done, and I had to ask my boss to drive me that half block, even though I was wide-awake coming out of general anesthesia and perfectly capable of walking. The prep for it (basically, you're giving yourself a real bad case of diarrhea) is way worse than the aftermath.
posted by Halloween Jack at 12:20 PM on October 11, 2022
it's "a lot of people won't get one even if invited to do so."
My father did not get one, lied about it, and died at age 52.
posted by Melismata at 12:28 PM on October 11, 2022 [3 favorites]
My father did not get one, lied about it, and died at age 52.
posted by Melismata at 12:28 PM on October 11, 2022 [3 favorites]
emjaybee: in most of the world, colonoscopies are performed without sedation. Many GI docs in the US haven't trained with that, so they might not be comfortable with doing it. People with prior abdominal surgery or who are very thin are more likely to find the procedure too uncomfortable. Ambulatory centers will usually know / recommend a ride service with some basic medical knowledge for transport after non-general anesthetics. People are usually completely clear-headed by discharge but have demonstrably (if small compared to drinking) delayed reaction times.
posted by a robot made out of meat at 12:30 PM on October 11, 2022
posted by a robot made out of meat at 12:30 PM on October 11, 2022
I'm 50 and overdue for one. After my dad had an unrelated medical scare I was inspired to schedule one in early June. It was set for the end of July. But there was severe weather and the doctor couldn't make it in. They called me after the first couple of doses of the prep, but my phone didn't notify me that I had a voicemail. So I continued the whole course of it, then went to the endoscopy center later in the morning only to find out it had been cancelled.
It got rescheduled for the end of August. The doctor had a different emergency come up and had to reschedule again.
It's now set for November 9. I will scream and throw things if it gets cancelled/rescheduled again.
posted by Foosnark at 12:33 PM on October 11, 2022 [6 favorites]
It got rescheduled for the end of August. The doctor had a different emergency come up and had to reschedule again.
It's now set for November 9. I will scream and throw things if it gets cancelled/rescheduled again.
posted by Foosnark at 12:33 PM on October 11, 2022 [6 favorites]
See, this is the part that confuses me. A colonoscopy is a diagnostic procedure. It's not a treatment (unless you consider clipping the occasional polyp a cancer treatment). Getting a colonoscopy doesn't lower the incidence of cancer so much as it increases the likelyhood of catching the cancer early.
This has been answered above but to reiterate: A colonoscopy is both diagnostic and (where needed) therapeutic. Precancerous polyps are found in over 30% of screening colonoscopies (the actual rates depend on the population studied as well as the skill of the endoscopist). Adenoma detection rate (ADR) is one of the quality measures in endoscopy. Actual cancer is found much less frequently in screening colonoscopies.
30% sounds like a lot but some of these are really small and would have to grow a lot more to become invasive. But still, not really "occasional".
Most polyps are removed immediately during the same procedure, usually with a snare.
As a GI, I worry that the article will be misunderstood by the media and general public.
Get your colonoscopies people.
posted by M. at 12:45 PM on October 11, 2022 [13 favorites]
This has been answered above but to reiterate: A colonoscopy is both diagnostic and (where needed) therapeutic. Precancerous polyps are found in over 30% of screening colonoscopies (the actual rates depend on the population studied as well as the skill of the endoscopist). Adenoma detection rate (ADR) is one of the quality measures in endoscopy. Actual cancer is found much less frequently in screening colonoscopies.
30% sounds like a lot but some of these are really small and would have to grow a lot more to become invasive. But still, not really "occasional".
Most polyps are removed immediately during the same procedure, usually with a snare.
As a GI, I worry that the article will be misunderstood by the media and general public.
Get your colonoscopies people.
posted by M. at 12:45 PM on October 11, 2022 [13 favorites]
I got my first one a while ago and can I just say the drugs were fantastic. I felt great for days. The doctor wants me to be on a five-year cycle instead of the routine 10 because of Things They Saw, and I'm fine with that if I keep getting those good drugs.
posted by The corpse in the library at 1:15 PM on October 11, 2022 [1 favorite]
posted by The corpse in the library at 1:15 PM on October 11, 2022 [1 favorite]
Having driven my ex home after one, I can safely say that at least some people do come out of them flying high, so who knows! And yeah the prep is No Fun Times.
Anyway I appreciate this discussion helping me understand that a. Medical benefits of any test can be hard to parse and b. I should go ahead and take care of it as the nice doctor asked.
posted by emjaybee at 1:20 PM on October 11, 2022 [1 favorite]
Anyway I appreciate this discussion helping me understand that a. Medical benefits of any test can be hard to parse and b. I should go ahead and take care of it as the nice doctor asked.
posted by emjaybee at 1:20 PM on October 11, 2022 [1 favorite]
it's the spending the previous day on the toilet with induced diarrhea "prep" cleanse.
I'm with those who don't mind the cleanse nearly as much as the sheer volume of gag-inducing gatorade, especially that last round at like 1 a.m.
That said, I've been having them so long I can remember taking Fleet, which was pulled from the market after it was linked to a risk of a serious form of kidney damage - so I got that going for me, which is nice.
posted by thecincinnatikid at 1:40 PM on October 11, 2022 [2 favorites]
I'm with those who don't mind the cleanse nearly as much as the sheer volume of gag-inducing gatorade, especially that last round at like 1 a.m.
That said, I've been having them so long I can remember taking Fleet, which was pulled from the market after it was linked to a risk of a serious form of kidney damage - so I got that going for me, which is nice.
posted by thecincinnatikid at 1:40 PM on October 11, 2022 [2 favorites]
As far as I can tell, this study is less about "do colonoscopies prevent colorectal cancer" than it's about "is telling people to get regular colonoscopies an effective public health measure?"
The question here isn't whether colonoscopies are effective, the question is where to put our public health resources. How much money and effort should we put into trying to get colonoscopies vs. trying to get them to do fecal screening?
If colonoscopy is "the gold standard," then there may be less funding for fecal screening. If the reality is that we can only get 40% of the population to get colonoscopies, then we need to be putting more resources into colorectal cancer screening methods that reach a higher percentage of the population.
posted by straight at 1:49 PM on October 11, 2022 [3 favorites]
The question here isn't whether colonoscopies are effective, the question is where to put our public health resources. How much money and effort should we put into trying to get colonoscopies vs. trying to get them to do fecal screening?
If colonoscopy is "the gold standard," then there may be less funding for fecal screening. If the reality is that we can only get 40% of the population to get colonoscopies, then we need to be putting more resources into colorectal cancer screening methods that reach a higher percentage of the population.
posted by straight at 1:49 PM on October 11, 2022 [3 favorites]
"[more inside]"
posted by Kabanos at 2:15 PM on October 11, 2022 [15 favorites]
posted by Kabanos at 2:15 PM on October 11, 2022 [15 favorites]
And then the search for data will be...does fecal screening do enough since it can't solve problems like polyps? I'll still try to do my part and convince people to get the colonoscopy. Part of it is branding - can they change the name? Half kidding.
posted by tiny frying pan at 2:24 PM on October 11, 2022
posted by tiny frying pan at 2:24 PM on October 11, 2022
I got my first one a while ago and can I just say the drugs were fantastic. I felt great for days.
Yes! I also loved the drugs and felt so great after. I'm surprised this isn't discussed more. All I heard about was how bad it is, but it wasn't bad at all and the high was great. I look forward to my next one!
posted by halehale at 4:51 PM on October 11, 2022 [2 favorites]
Yes! I also loved the drugs and felt so great after. I'm surprised this isn't discussed more. All I heard about was how bad it is, but it wasn't bad at all and the high was great. I look forward to my next one!
posted by halehale at 4:51 PM on October 11, 2022 [2 favorites]
Since my spouse just died of colon cancer detected at Stage Four when he finally got a long-resisted colonoscopy at 73, I am now no longer rational on the subject. God, it's a painful way to go. Colonoscopy prep is disagreeable but boy howdy dying of colon cancer is so much worse.
I urge people to get colonoscopies, only if it means they die of something else other than colon cancer.
Speaking of invitations, I get a regular automated invitation from my health care provider to get a pap smear, so I finally gave in and scheduled one. The gynecologist was amiably baffled by my request because I'm past a certain age, and I found out why when the results came back "insufficient sample." Apparently I no longer have much in the way of the cells that get cervical cancer. I can only conjecture that the invitations were in the way of fundraisers.
posted by Peach at 4:59 PM on October 11, 2022 [11 favorites]
I urge people to get colonoscopies, only if it means they die of something else other than colon cancer.
Speaking of invitations, I get a regular automated invitation from my health care provider to get a pap smear, so I finally gave in and scheduled one. The gynecologist was amiably baffled by my request because I'm past a certain age, and I found out why when the results came back "insufficient sample." Apparently I no longer have much in the way of the cells that get cervical cancer. I can only conjecture that the invitations were in the way of fundraisers.
posted by Peach at 4:59 PM on October 11, 2022 [11 favorites]
Ambulatory centers will usually know / recommend a ride service with some basic medical knowledge for transport after non-general anesthetics.Wait, is that true? I have been putting off getting a colonoscopy because I'd heard that you had to have someone go in with you, wait there, and drive you home. (It's not enough to have them come pick you up, because they worry the person won't show. They have to be there are the beginning and then stay the whole time.) Also, they're only open Monday to Friday, nine to five. So basically, if you don't have someone whom you can ask to take a half-day off work for you, you can't get a colonoscopy. If I could just hire a super-fancy ride service to take me home, I would definitely go ahead and get the frigging colonoscopy.
posted by ArbitraryAndCapricious at 5:47 PM on October 11, 2022 [2 favorites]
Hello as a sufferer of inflammatory bowel disease I would like to inform you that at least the gnawing hunger of a colonoscopy prep day can be alleviated by the fact that non-red gummy bears become a clear liquid when digested and will not ruin your prep. I prep without putting flavoring in the PEG and chase liberally with things I like.
Get your colonoscopy, bowel cancer is starting to happen at younger and younger ages. :(
posted by sibboleth at 6:45 PM on October 11, 2022 [5 favorites]
Get your colonoscopy, bowel cancer is starting to happen at younger and younger ages. :(
posted by sibboleth at 6:45 PM on October 11, 2022 [5 favorites]
When I drove for Lyft, I definitely picked people up after medical appointments where they could not drive, but don’t remember a colonoscopy. My mom did have a colonoscopy recently where they did tell her a friend or family member we had to be there waiting. Luckily she is of retirement age when retired friends. I don’t know what you’d do if you didn’t have that support
posted by CostcoCultist at 7:09 PM on October 11, 2022 [1 favorite]
posted by CostcoCultist at 7:09 PM on October 11, 2022 [1 favorite]
For my second colonoscopy a couple months ago, I opted for the pills rather than having to drink the the Gatorade stuff, which I had trouble getting down last time.
For the pills, you take 12 at a time, several hours apart. The first ones went down fine and did their thing. I managed to sleep for a bit before my alarm went off for the second round. I must have been taking them too quickly because I puked (liquid, no pills.) So that ended up being a rougher experience than drinking the PEG.
Gummy bears, definitely.
posted by emelenjr at 7:11 PM on October 11, 2022 [1 favorite]
For the pills, you take 12 at a time, several hours apart. The first ones went down fine and did their thing. I managed to sleep for a bit before my alarm went off for the second round. I must have been taking them too quickly because I puked (liquid, no pills.) So that ended up being a rougher experience than drinking the PEG.
Gummy bears, definitely.
posted by emelenjr at 7:11 PM on October 11, 2022 [1 favorite]
Got a colonoscopy last year. It is no big deal at all. I was required to have someone with me to get me home.
Drank the nasty lemonade... it's not nearly as bad as people make it out to be. I just gulped it down. Is it delicious? No. But FFS, just gather your strength and drink it. Be an adult. Pro tip: that stuff works really, really fast. Be ready to hit the toilet as soon as you drink it. I think it took less than 10 minutes for me.
Yes, fasting is annoying. I don't like Jell-o, but I ate Jell-o. Be an adult and do it for your own health and for the sake of everyone you love and everyone who loves you. I felt very grateful, thankful and privileged that I had the opportunity to do it.
posted by SoberHighland at 7:35 PM on October 11, 2022 [5 favorites]
Drank the nasty lemonade... it's not nearly as bad as people make it out to be. I just gulped it down. Is it delicious? No. But FFS, just gather your strength and drink it. Be an adult. Pro tip: that stuff works really, really fast. Be ready to hit the toilet as soon as you drink it. I think it took less than 10 minutes for me.
Yes, fasting is annoying. I don't like Jell-o, but I ate Jell-o. Be an adult and do it for your own health and for the sake of everyone you love and everyone who loves you. I felt very grateful, thankful and privileged that I had the opportunity to do it.
posted by SoberHighland at 7:35 PM on October 11, 2022 [5 favorites]
If I could just hire a super-fancy ride service to take me home
Google "medical escort" or "medical chaperone" + [your area]. You'll find such a service in most cities, not sure about rural areas.
posted by praemunire at 7:36 PM on October 11, 2022 [1 favorite]
Google "medical escort" or "medical chaperone" + [your area]. You'll find such a service in most cities, not sure about rural areas.
posted by praemunire at 7:36 PM on October 11, 2022 [1 favorite]
Drank the nasty lemonade... it's not nearly as bad as people make it out to be. I just gulped it down. Is it delicious? No. But FFS, just gather your strength and drink it. Be an adult.
Geez. I am an adult. Not all of us are the same! Was very surprised I had so much trouble with it but I did. Trust the internet for colonoscopy-prep shaming, LOL! (My report said the prep I did was "excellent" so at least I did something right! 🤣)
posted by tiny frying pan at 7:42 PM on October 11, 2022 [10 favorites]
Geez. I am an adult. Not all of us are the same! Was very surprised I had so much trouble with it but I did. Trust the internet for colonoscopy-prep shaming, LOL! (My report said the prep I did was "excellent" so at least I did something right! 🤣)
posted by tiny frying pan at 7:42 PM on October 11, 2022 [10 favorites]
(I think it's important people be honest about their experiences with this stuff - personally I found great comfort in reading people's accounts of what to expect beforehand.)
posted by tiny frying pan at 7:44 PM on October 11, 2022 [3 favorites]
posted by tiny frying pan at 7:44 PM on October 11, 2022 [3 favorites]
(Also...uhhhhh not everyone had the same prep medications? May I have a better one next time!)
posted by tiny frying pan at 7:47 PM on October 11, 2022 [1 favorite]
posted by tiny frying pan at 7:47 PM on October 11, 2022 [1 favorite]
I did the elimination diet starting a few days before (cheese and white bread FTW), which made things easier. Woke up to an excited doctor who told me she took out a bunch of polyps that progress to cancer 20% of the time. I go back in 3 years.
I've been told by doctors that not all insurance covers fecal tests, and/or if you do the fecal test, insurance may not let you do the colonoscopy.
Was very nervous waiting for the admin to check what the cost would be if my preventative care (one code) turned into something where they had to take stuff out (a different insurance code). Thankfully covered in both cases/codes (go USA!)
posted by armacy at 7:53 PM on October 11, 2022 [3 favorites]
I've been told by doctors that not all insurance covers fecal tests, and/or if you do the fecal test, insurance may not let you do the colonoscopy.
Was very nervous waiting for the admin to check what the cost would be if my preventative care (one code) turned into something where they had to take stuff out (a different insurance code). Thankfully covered in both cases/codes (go USA!)
posted by armacy at 7:53 PM on October 11, 2022 [3 favorites]
I have a diagnosis of Crohn's disease (which can only be confirmed by colonoscopy), I have a family history of inflammatory bowel disease, and so I have been having colonoscopies first every couple of years, and now every year. At nearly every procedure, polyps are found and removed, and some are adenomatous (might or might not develop into cancer). Biopsies of the colon wall are also taken. Photos are taken showing areas inflammation in the colon; I get a copy, cool! The colonoscopies help with making decisions about treating the Crohn's (in addition to their role in cancer detection).
Yeah, the prep. Just gotta be done. There are ways to make it easier: my gastroenterologist has me on a clear liquid diet 1 day before the prep, but I try to make that at least 2 full days before. (Get a Monday a.m. appointment if you can.) He also has me eat a low residue diet 5 days prior; you can check the Google, or your GI's instructions, for that. (If it doesn't go in, it doesn't have to come out.) Over the years I've done GoLytely, SUPREP (2-dose liquid), and SUTAB (two-dose tablets). I think the last is a tiny bit easier; they all get the job done. I follow my GI's prep guidance to the letter so I have never done the non-red gummy bears suggestion (though I may ask him about it). I have not had any issues with the anesthesia; I experience deep, restful sleep, someone drives me home, and I sleep it off the rest of the afternoon. My little reward for the prep.
I think that the *idea* of doing the prep is harder than actually doing it. I'm always so pleased with myself after it's all done (and my doctor or sometimes the outpatient nurse tells me I did a great job with my prep!).
posted by apartment dweller at 7:58 PM on October 11, 2022 [5 favorites]
Yeah, the prep. Just gotta be done. There are ways to make it easier: my gastroenterologist has me on a clear liquid diet 1 day before the prep, but I try to make that at least 2 full days before. (Get a Monday a.m. appointment if you can.) He also has me eat a low residue diet 5 days prior; you can check the Google, or your GI's instructions, for that. (If it doesn't go in, it doesn't have to come out.) Over the years I've done GoLytely, SUPREP (2-dose liquid), and SUTAB (two-dose tablets). I think the last is a tiny bit easier; they all get the job done. I follow my GI's prep guidance to the letter so I have never done the non-red gummy bears suggestion (though I may ask him about it). I have not had any issues with the anesthesia; I experience deep, restful sleep, someone drives me home, and I sleep it off the rest of the afternoon. My little reward for the prep.
I think that the *idea* of doing the prep is harder than actually doing it. I'm always so pleased with myself after it's all done (and my doctor or sometimes the outpatient nurse tells me I did a great job with my prep!).
posted by apartment dweller at 7:58 PM on October 11, 2022 [5 favorites]
Wait, is that true? I have been putting off getting a colonoscopy because I'd heard that you had to have someone go in with you, wait there, and drive you home.
Different facilities do different things. The network that I work for realized that it saved them $many to be able to dispatch a ride vs cancellations when a ride flakes or potentially admitting someone to the hospital. My understanding is that it's pretty common. It's the same service we use when someone needs a ride home from being discharged from the hospital.
posted by a robot made out of meat at 7:59 PM on October 11, 2022
Different facilities do different things. The network that I work for realized that it saved them $many to be able to dispatch a ride vs cancellations when a ride flakes or potentially admitting someone to the hospital. My understanding is that it's pretty common. It's the same service we use when someone needs a ride home from being discharged from the hospital.
posted by a robot made out of meat at 7:59 PM on October 11, 2022
What underlying processes could cause that? (assuming that’s deaths-from-colon-cancers)? All colon cancers that kill people being untreatable no matter when you find them?
One of two things could be going on here:
1) Inviting people to get colonoscopies reduces the number of people who get colorectal cancer, but it doesn't reduce the risk of dying from colorectal cancer, for some reason.
1) Inviting people to get colonoscopies reduces the number of people who get cancer and the number of people who die, but this study wasn't big enough to reliably detect the difference for deaths, because far fewer people die from colorectal cancer than get colorectal cancer.
Note that the risk ratio for getting cancer was 0.82; 95% confidence interval [CI], 0.70 to 0.93 and the risk ratio for dying of colorectal cancer was 0.90; 95% CI, 0.64 to 1.16. You can see that the confidence interval on the death risk was much wider than the confidence interval on the getting cancer risk. They could actually be the same risk, we just don't have enough data to know.
Basically, the study was underpowered when looking at whether being invited reduced the risk of death, so the conclusion was that the study doesn't show that the risk of death was reduced. That is absolutely not the same thing as the study showing the risk was not reduced. Some of the reporting confuses these two statements, but in this context they are very different.
Either of the two conclusions above is compatible with the results of this study, but one of the two conclusions seems more likely to me.
posted by ssg at 8:02 PM on October 11, 2022 [4 favorites]
One of two things could be going on here:
1) Inviting people to get colonoscopies reduces the number of people who get colorectal cancer, but it doesn't reduce the risk of dying from colorectal cancer, for some reason.
1) Inviting people to get colonoscopies reduces the number of people who get cancer and the number of people who die, but this study wasn't big enough to reliably detect the difference for deaths, because far fewer people die from colorectal cancer than get colorectal cancer.
Note that the risk ratio for getting cancer was 0.82; 95% confidence interval [CI], 0.70 to 0.93 and the risk ratio for dying of colorectal cancer was 0.90; 95% CI, 0.64 to 1.16. You can see that the confidence interval on the death risk was much wider than the confidence interval on the getting cancer risk. They could actually be the same risk, we just don't have enough data to know.
Basically, the study was underpowered when looking at whether being invited reduced the risk of death, so the conclusion was that the study doesn't show that the risk of death was reduced. That is absolutely not the same thing as the study showing the risk was not reduced. Some of the reporting confuses these two statements, but in this context they are very different.
Either of the two conclusions above is compatible with the results of this study, but one of the two conclusions seems more likely to me.
posted by ssg at 8:02 PM on October 11, 2022 [4 favorites]
I've picked up a friend after their colonoscopy, so there are some places that will allow that. This was pre-COVID too, so you'd think that would be more of an option now so they don't have people breathing on each other in the waiting room.
I read the CNN article yesterday and it leads with a quote: "...colon cancer screening is effective, and you should get screened."
posted by soelo at 9:09 PM on October 11, 2022
I read the CNN article yesterday and it leads with a quote: "...colon cancer screening is effective, and you should get screened."
posted by soelo at 9:09 PM on October 11, 2022
Mod note: Okay, weird situation. Normally this post should be deleted. The article isn't linked, the study that is linked is paywalled, and the conclusions as presented seem to be misleading. However there are a lot of comments at this point, with a lot of good information that I don't feel should be lost, so I've taken the unusual step of adding a mod note linking to the actual article and advising people to read the criticisms in the comments. If folks think a full delete would be better, please flag the post with a note. Thank you!
posted by taz (staff) at 10:33 PM on October 11, 2022 [13 favorites]
posted by taz (staff) at 10:33 PM on October 11, 2022 [13 favorites]
I'm over 50 and have had one colonoscopy so far, and everything about the actual process was overshadowed and minimized by the debilitating migraine the prep triggered. My usual migraine treatments are ibuprofen and sumitriptan. I knew I could't take any ibuprofen before the procedure, and I hadn't asked about taking the triptan, and I was prepping over the weekend so I couldn't call the office and ask. Tylenol does nothing for my migraines.
I arrived and got on my gurney and got the IV. They then had some kind of small emergency or something and I was lying there for what seemed forever, dying from head pain, although a nice nurse did get me something to put over my eyes because the lights were killing me.
I didn't wake up high after the procedure. I woke up begging to be allowed to 1) pee and 2) take a bunch of Advil asap.
I'm supposed to do another in 5 years, and I will make sure to ask about taking the triptan this time (also will try to get my daily caffeine and avoid laxatives with artificial sweetener if possible.)
posted by See you tomorrow, saguaro at 10:56 PM on October 11, 2022 [1 favorite]
I arrived and got on my gurney and got the IV. They then had some kind of small emergency or something and I was lying there for what seemed forever, dying from head pain, although a nice nurse did get me something to put over my eyes because the lights were killing me.
I didn't wake up high after the procedure. I woke up begging to be allowed to 1) pee and 2) take a bunch of Advil asap.
I'm supposed to do another in 5 years, and I will make sure to ask about taking the triptan this time (also will try to get my daily caffeine and avoid laxatives with artificial sweetener if possible.)
posted by See you tomorrow, saguaro at 10:56 PM on October 11, 2022 [1 favorite]
Right now I'm trying to figure out how to get one since my teen can't drive and I don't have anyone else to get me home. I'm thinking I'll have to Uber and have her guide my druggy self to the car.
You wouldn't need a chaperone if the procedure is done without sedition. (See recent AskMe).
posted by oceano at 11:35 PM on October 11, 2022
You wouldn't need a chaperone if the procedure is done without sedition. (See recent AskMe).
posted by oceano at 11:35 PM on October 11, 2022
Thank you everyone for your encouragement. I have one coming up this year and y’all have managed to turn my trepidation into mildly looking forward. One step above neutral, but hell even neutral would have been better than the dread that was welling in me. Gonna shit my brains out and then get a party nap out of it!
posted by Bottlecap at 11:57 PM on October 11, 2022 [4 favorites]
posted by Bottlecap at 11:57 PM on October 11, 2022 [4 favorites]
You wouldn't need a chaperone if the procedure is done without sedition.
You don't get much in the US without sedition these days.
posted by inexorably_forward at 2:44 AM on October 12, 2022 [13 favorites]
You don't get much in the US without sedition these days.
posted by inexorably_forward at 2:44 AM on October 12, 2022 [13 favorites]
We are motivated by family history to test/get the colonoscopy. If invited, we would go. Glad to read of more options for prep.
posted by childofTethys at 3:20 AM on October 12, 2022 [2 favorites]
posted by childofTethys at 3:20 AM on October 12, 2022 [2 favorites]
I got my first one a while ago and can I just say the drugs were fantastic. I felt great for days.
Drugs? I’ve had two colonoscopies and the only drug I got was the anesthesia.
posted by Thorzdad at 5:58 AM on October 12, 2022 [1 favorite]
Drugs? I’ve had two colonoscopies and the only drug I got was the anesthesia.
posted by Thorzdad at 5:58 AM on October 12, 2022 [1 favorite]
I heard how awful the prep was, and I was worried.
I did the low-residue diet, I did a day of clear beverages only, and then the morning before I mixed up the Gatorade and just...drank it? I thought it would be impossible to get down but it wasn't. I am super sympathetic to folks who suffer through their prep, and would happily be a friend's driver -- because I know I was just lucky, not good.
So yea verily, "Colon prep is a land of contrasts."
posted by wenestvedt at 6:12 AM on October 12, 2022 [1 favorite]
I did the low-residue diet, I did a day of clear beverages only, and then the morning before I mixed up the Gatorade and just...drank it? I thought it would be impossible to get down but it wasn't. I am super sympathetic to folks who suffer through their prep, and would happily be a friend's driver -- because I know I was just lucky, not good.
So yea verily, "Colon prep is a land of contrasts."
posted by wenestvedt at 6:12 AM on October 12, 2022 [1 favorite]
I am an adult. Not all of us are the same! Was very surprised I had so much trouble with it but I did. Trust the internet for colonoscopy-prep shaming,
No shit, eh? I've had five of them and generally never complain about any physical aches/pains/issues but the vast majority of folks I know who've had the procedure find the purge unpleasant at the least, the procedure itself no big deal as they dial you down and right back up. My wife is among those who began vomiting 2/3 through the purge and ended up having. to reschedule the procedure with a different prep.
After my second colonoscopy, we emerged into the garage to find my wife's car wouldn't start. Called AAA and it was going to be 1-2 hrs before they could arrive. Having slept very little the previous night, very much just wanting to lay down and being a still-stoned and stubborn asshat, I insisted on hoofing it home which was about 2 1/2ish somewhat wobbly and lightheaded miles on city streets but only 30ish minutes to sofa time. An hour and a half later my wife found me soundly sleeping.
posted by thecincinnatikid at 6:26 AM on October 12, 2022 [5 favorites]
No shit, eh? I've had five of them and generally never complain about any physical aches/pains/issues but the vast majority of folks I know who've had the procedure find the purge unpleasant at the least, the procedure itself no big deal as they dial you down and right back up. My wife is among those who began vomiting 2/3 through the purge and ended up having. to reschedule the procedure with a different prep.
After my second colonoscopy, we emerged into the garage to find my wife's car wouldn't start. Called AAA and it was going to be 1-2 hrs before they could arrive. Having slept very little the previous night, very much just wanting to lay down and being a still-stoned and stubborn asshat, I insisted on hoofing it home which was about 2 1/2ish somewhat wobbly and lightheaded miles on city streets but only 30ish minutes to sofa time. An hour and a half later my wife found me soundly sleeping.
posted by thecincinnatikid at 6:26 AM on October 12, 2022 [5 favorites]
Drugs? I’ve had two colonoscopies and the only drug I got was the anesthesia.
Same, as far as I know. But coming out of it, I felt the most profound and complete peace I've ever felt. I've literally never felt better than in that period.
posted by a snickering nuthatch at 8:31 AM on October 12, 2022 [1 favorite]
Same, as far as I know. But coming out of it, I felt the most profound and complete peace I've ever felt. I've literally never felt better than in that period.
posted by a snickering nuthatch at 8:31 AM on October 12, 2022 [1 favorite]
If it's okay to share an anecdote? I have some feelings about this. My mum was diagnosed with stage 4 colon cancer ~6 months after getting a negative fecal screening test, which is the standard for colon cancer screening without symptoms, here in the UK. You can't just "get your colonoscopy", you will be offered one if you have symptoms which suggest risk (as far as I can tell, please correct me knowledgeable UK people!). I'm not sure of the timeline, but I *think* that at the time of her fecal screening test, my mum was already getting symptoms. In this case, my (not a doctor) understanding is that a fecal screening test wasn't appropriate and that, had she spoken to her gp, she should have been referred for a colonoscopy. But the negative fecal screening test gave her a false reassurance that everything was, in fact, okay, and she didn't go to her gp for a further few months. She died about 10 months after getting a diagnosis.
I don't feel negative about fecal occult screening tests, I think it's just important to be aware of their limitations and of what they can and can't do. My main takeaway from this is not to mess around and ignore bowel symptoms, even though talking about this is embarrassing and symptoms can sound pretty generic (I feel like "changes in bowel habit" describes... a lot of people over 30). But also to say that fecal occult screening is a pretty blunt instrument - it isn't what is ultimately used for diagnosing cancer and can't establish that you *don't* have it.
Thank you to everyone who has been commenting, I've found this discussion very interesting.
posted by sequel at 8:40 AM on October 12, 2022 [5 favorites]
I don't feel negative about fecal occult screening tests, I think it's just important to be aware of their limitations and of what they can and can't do. My main takeaway from this is not to mess around and ignore bowel symptoms, even though talking about this is embarrassing and symptoms can sound pretty generic (I feel like "changes in bowel habit" describes... a lot of people over 30). But also to say that fecal occult screening is a pretty blunt instrument - it isn't what is ultimately used for diagnosing cancer and can't establish that you *don't* have it.
Thank you to everyone who has been commenting, I've found this discussion very interesting.
posted by sequel at 8:40 AM on October 12, 2022 [5 favorites]
Had my first one at 38 only because I had an injury and they decided to do all the tests. Found small polyps and they were removed. If I had waited until 40 -- or worse 50 -- it may have been too late. I had my second 5 years later and there were more, so they asked me to come in 3 years later. This past one in January only 1 small polyp was found and so I am back on 5 year schedule.
Someone close to me had to beg for a colonoscopy at 44 because she had symptoms but they weren't finding anything via other tests -- ultrasound, etc. Insurance didn't want to pay of it. Wouldn't pay for a CT at all, and eventual gave in to the colonoscopy after lots of complaining on her part. The colonoscopy found a non-cancerous ulcer in her intestine that explains her symptoms that the doctors said weren't anything. She has adjusted her diet and has significantly less pain. They didn't find any polyps and she is on a 10 year schedule.
A very good friend of mine (mid-50s) went in for a colonoscopy earlier this year after finally finding out there is a history in his family. His mother wouldn't talk about it, and they found cancer. He had surgery and just went back for scans and it has spread, and I am mad at his mother for not talking about it. My father was the same way and he was in the medical field and that also pisses me off.
If you can afford to do any tests or procedures, please please do. And let's all work for universal health care so that fucking capitalism is out of the equation.
posted by terrapin at 8:53 AM on October 12, 2022 [1 favorite]
Someone close to me had to beg for a colonoscopy at 44 because she had symptoms but they weren't finding anything via other tests -- ultrasound, etc. Insurance didn't want to pay of it. Wouldn't pay for a CT at all, and eventual gave in to the colonoscopy after lots of complaining on her part. The colonoscopy found a non-cancerous ulcer in her intestine that explains her symptoms that the doctors said weren't anything. She has adjusted her diet and has significantly less pain. They didn't find any polyps and she is on a 10 year schedule.
A very good friend of mine (mid-50s) went in for a colonoscopy earlier this year after finally finding out there is a history in his family. His mother wouldn't talk about it, and they found cancer. He had surgery and just went back for scans and it has spread, and I am mad at his mother for not talking about it. My father was the same way and he was in the medical field and that also pisses me off.
If you can afford to do any tests or procedures, please please do. And let's all work for universal health care so that fucking capitalism is out of the equation.
posted by terrapin at 8:53 AM on October 12, 2022 [1 favorite]
I'm sorry for your loss, sequel.
fecal occult screening is a pretty blunt instrument - it isn't what is ultimately used for diagnosing cancer and can't establish that you *don't* have it
In the U.S., they don't merely screen for blood, but for DNA fragments from cancer. It's actually pretty good (~95% sensitivity) at identifying cancer. (Of course, nothing can absolutely, with true 100% certainty, determine that you don't have any cancer. Every test has some false negatives.) The big limitation of Cologuard is that it doesn't pick up on polyps, so it doesn't catch precancerous conditions. Is it different in the UK?
posted by praemunire at 9:04 AM on October 12, 2022 [1 favorite]
fecal occult screening is a pretty blunt instrument - it isn't what is ultimately used for diagnosing cancer and can't establish that you *don't* have it
In the U.S., they don't merely screen for blood, but for DNA fragments from cancer. It's actually pretty good (~95% sensitivity) at identifying cancer. (Of course, nothing can absolutely, with true 100% certainty, determine that you don't have any cancer. Every test has some false negatives.) The big limitation of Cologuard is that it doesn't pick up on polyps, so it doesn't catch precancerous conditions. Is it different in the UK?
posted by praemunire at 9:04 AM on October 12, 2022 [1 favorite]
But coming out of it, I felt the most profound and complete peace I've ever felt. I've literally never felt better than in that period.
I'd like to introduce you to my old friend Psilocybin.
posted by Thorzdad at 9:31 AM on October 12, 2022 [2 favorites]
I'd like to introduce you to my old friend Psilocybin.
posted by Thorzdad at 9:31 AM on October 12, 2022 [2 favorites]
I'm glad to hear there are pills you can take for the prep. My stomach simply isn't big enough to down all that liquid.
I got a call to schedule a few weeks ago and ignored it because things are crazy here right now. I'm off to find the number and get that shit scheduled.
posted by kathrynm at 9:48 AM on October 12, 2022 [1 favorite]
I got a call to schedule a few weeks ago and ignored it because things are crazy here right now. I'm off to find the number and get that shit scheduled.
posted by kathrynm at 9:48 AM on October 12, 2022 [1 favorite]
Many European countries balked at putting public health dollars towards a large, expensive program,
So, apart from the fact we don't have dollars, colonoscopies are fairly inexpensive over here relative to the US. You can get a full colonoscopy with sedation at an experienced center for under 250 bucks. Less if you go no sedation which is very common.
The public system pays even less for one.
posted by M. at 9:50 AM on October 12, 2022 [2 favorites]
So, apart from the fact we don't have dollars, colonoscopies are fairly inexpensive over here relative to the US. You can get a full colonoscopy with sedation at an experienced center for under 250 bucks. Less if you go no sedation which is very common.
The public system pays even less for one.
posted by M. at 9:50 AM on October 12, 2022 [2 favorites]
Fecal occult blood testing is not appropriate for a person with a clinical suspicion of colon cancer. It's used to screen healthy people with an average risk of CRC.
posted by M. at 9:53 AM on October 12, 2022 [2 favorites]
posted by M. at 9:53 AM on October 12, 2022 [2 favorites]
I have had two colonoscopies without sedation. I declined sedation because I didn't want to lose an entire day to grogginess and fog, I didn't want my wife to have to miss work, and I thought it would be interesting.
I highly recommend it, provided you have a reasonable tolerance for pain and discomfort. It's not a walk in the park. But it is fascinating to see what the inside of your colon looks like. It was not at all what I expected. It felt like I was in Fantastic Voyage.
If you go the non-sedated route, do try to find a practitioner who has experience with non-sedated colonoscopies. They can make it less unpleasant by being careful as they navigate around. They don't have to be as careful about filling you up with air and bumping into things if you're unconscious.
posted by Winnie the Proust at 10:08 AM on October 12, 2022
I highly recommend it, provided you have a reasonable tolerance for pain and discomfort. It's not a walk in the park. But it is fascinating to see what the inside of your colon looks like. It was not at all what I expected. It felt like I was in Fantastic Voyage.
If you go the non-sedated route, do try to find a practitioner who has experience with non-sedated colonoscopies. They can make it less unpleasant by being careful as they navigate around. They don't have to be as careful about filling you up with air and bumping into things if you're unconscious.
posted by Winnie the Proust at 10:08 AM on October 12, 2022
I'm glad to hear there are pills you can take for the prep. My stomach simply isn't big enough to down all that liquid.
You take pills along with the liquid prep. They're mainly OTC things like anti-gas and stool softeners. You will still have to do a large amount of liquid, either Gatorade or a pre-packaged liquid prep, which may or may not require a prescription. It's the only way to literally flush your system clean.
Don't worry. The liquid doesn't stay in for very long.
posted by Thorzdad at 10:46 AM on October 12, 2022
You take pills along with the liquid prep. They're mainly OTC things like anti-gas and stool softeners. You will still have to do a large amount of liquid, either Gatorade or a pre-packaged liquid prep, which may or may not require a prescription. It's the only way to literally flush your system clean.
Don't worry. The liquid doesn't stay in for very long.
posted by Thorzdad at 10:46 AM on October 12, 2022
To clarify my earlier comment, colonoscopies are free over here for the insured and it's easy to get a referral. You can self refer for one if you want to or if you're uninsured and that's what costs the 200 bucks.
posted by M. at 10:56 AM on October 12, 2022
posted by M. at 10:56 AM on October 12, 2022
Since we're talking best practices for colonoscopies, I have a cautionary tale from my father...
My father has rheumatoid arthritis which he is treating with immunosuppressant medication. And one year, when he was getting a colonoscopy, he forgot to mention this to his doctor. They found a polyp, they snipped it, he was discharged. But...because he was on this immunosuppressant medication, the wound from snipping the polyp later got infected, and he had to go back into the hospital for treatment for that about three days later, complete with a couple nights' hospital stays. He's fine now (this was about 10 years ago).
So Patercallipygos says: make sure you mention all of your regular prescriptions to your doctor when you get a colonoscopy!
posted by EmpressCallipygos at 11:08 AM on October 12, 2022 [1 favorite]
My father has rheumatoid arthritis which he is treating with immunosuppressant medication. And one year, when he was getting a colonoscopy, he forgot to mention this to his doctor. They found a polyp, they snipped it, he was discharged. But...because he was on this immunosuppressant medication, the wound from snipping the polyp later got infected, and he had to go back into the hospital for treatment for that about three days later, complete with a couple nights' hospital stays. He's fine now (this was about 10 years ago).
So Patercallipygos says: make sure you mention all of your regular prescriptions to your doctor when you get a colonoscopy!
posted by EmpressCallipygos at 11:08 AM on October 12, 2022 [1 favorite]
Wait, is that true? I have been putting off getting a colonoscopy because I'd heard that you had to have someone go in with you, wait there, and drive you home. (It's not enough to have them come pick you up, because they worry the person won't show. They have to be there are the beginning and then stay the whole time.)
Definitely check with the place where you'd have it done. At our clinic, you can drop the person off & then leave. The clinic calls when they're done with the procedure & are waking up. You then have 20-30 minutes before the person is ready to leave, which gives plenty of time to drive back.
I had my first colonoscopy earlier this year. The worst parts were 1) not being able to eat Easter candy (because I did my prep over Easter weekend and those peanut butter eggs were taunting me) and 2) having to drink a gigantic jug of Gatorade, which made me puke because it is so disgusting.
posted by belladonna at 11:26 AM on October 12, 2022 [1 favorite]
Definitely check with the place where you'd have it done. At our clinic, you can drop the person off & then leave. The clinic calls when they're done with the procedure & are waking up. You then have 20-30 minutes before the person is ready to leave, which gives plenty of time to drive back.
I had my first colonoscopy earlier this year. The worst parts were 1) not being able to eat Easter candy (because I did my prep over Easter weekend and those peanut butter eggs were taunting me) and 2) having to drink a gigantic jug of Gatorade, which made me puke because it is so disgusting.
posted by belladonna at 11:26 AM on October 12, 2022 [1 favorite]
I half woke up during my only colonoscopy and had the Fantastic Voyage experience for a bit. Quite nifty.
posted by clew at 11:54 AM on October 12, 2022 [1 favorite]
posted by clew at 11:54 AM on October 12, 2022 [1 favorite]
Fun fact: if you have an extra-long colon, you may need an extra day of colonoscopy prep. How do you know if you have an extra-long colon? You get a colonoscopy and the doctor says insufficient bowel prep and you feel insulted, but do more fasting next time, and it just barely works, and the next doctor tells you: You have an extra-long colon, so here's a medal (and we'll change your prep instructions in your medical record to remind you in five years).
posted by kozad at 12:08 PM on October 12, 2022 [4 favorites]
posted by kozad at 12:08 PM on October 12, 2022 [4 favorites]
Instructions for my prep with pills said to take each set of 12 with a liter of water, after which you could resume your safe liquids (and gummy bears) diet until the next round of pills.
posted by emelenjr at 12:09 PM on October 12, 2022
posted by emelenjr at 12:09 PM on October 12, 2022
I've got Crohn's disease, so I've had a ton of colonoscopies. Here's the best colonoscopy tip I've ever received:
Diaper cream.
If you apply diaper cream every time you visit the bathroom on the dread day of colonoscopy prep your butthole will be much less angry with you by the end.
posted by MrVisible at 12:17 PM on October 12, 2022 [4 favorites]
Diaper cream.
If you apply diaper cream every time you visit the bathroom on the dread day of colonoscopy prep your butthole will be much less angry with you by the end.
posted by MrVisible at 12:17 PM on October 12, 2022 [4 favorites]
Whether you find the drugs enjoyable probably depends on which drugs they give you. Some places use propofol, and many people find the effects of that drug to be profoundly pleasurable. Michael Jackson found it so enjoyable that he ended up fatally overdosing himself with it.
That last time I got a colonoscopy, I was not blessed by the propofol gods. I instead got a combination of fentanyl and diazepam, and since I tend to be comparatively insensitive to opioids, I remained 100% conscious during the entire procedure. I could feel the scope going through me, and each time they cut off a polyp, it caused a nonnegligible amount of pain, which I related to the doctor.
posted by mikeand1 at 1:07 PM on October 12, 2022 [1 favorite]
That last time I got a colonoscopy, I was not blessed by the propofol gods. I instead got a combination of fentanyl and diazepam, and since I tend to be comparatively insensitive to opioids, I remained 100% conscious during the entire procedure. I could feel the scope going through me, and each time they cut off a polyp, it caused a nonnegligible amount of pain, which I related to the doctor.
posted by mikeand1 at 1:07 PM on October 12, 2022 [1 favorite]
Well, as long as we're telling colonoscopy stories....
1) did the Cologuard, got a positive (which was false) so had to get a colonoscopy anyway.
2) received a ranting lecture at the medical center from the first nurse who took me back about insurance either paying for Cologuard OR the colonoscopy, but not both and how there is a tremendous rate of false positives, and I was like WTF lady I've been prepping for days and I don't need a lecture about things my doctor had me do, none of this was my idea AT ALL
3) like Kozad, evidently I also have a long colon, and how I found out was similar, and also I felt insulted because I had done my prep exactly to the letter. So guess what they had me do? Another entire prep right then. It was the thick of lockdown times and my spouse wasn't allowed inside, so I had to call down to him in the car to buy me all the supplies and deliver them inside, so I could do it all again IMMEDIATELY right then and there to try to "clear everything out" after having done an actual prep already! And they had institutional-grade TP, let's just leave it at that. So I sat alone in an exam room chugging diet gatorade white frost or whatever with miralax in it and crying because in between I would run to the bathroom while nurses banged on the door asking to inspect the toilet. It was awful.
4) they also tried other things that didn't work.
5) eventually I got bored of this nightmare and started to just get dressed but then someone caught me and persuaded me to stay and they would do the colonoscopy anyway.
6) they did it, I had no problems in there at all. No polyps. I was grateful for the drugs.
7) the whole process took seven hours. The next time I'm supposed to fast or whatever for an extra day, or maybe two. Ugh. Maybe in several years they'll have FOUND A MUCH BETTER WAY but I doubt it.
posted by 41swans at 2:18 PM on October 12, 2022 [1 favorite]
1) did the Cologuard, got a positive (which was false) so had to get a colonoscopy anyway.
2) received a ranting lecture at the medical center from the first nurse who took me back about insurance either paying for Cologuard OR the colonoscopy, but not both and how there is a tremendous rate of false positives, and I was like WTF lady I've been prepping for days and I don't need a lecture about things my doctor had me do, none of this was my idea AT ALL
3) like Kozad, evidently I also have a long colon, and how I found out was similar, and also I felt insulted because I had done my prep exactly to the letter. So guess what they had me do? Another entire prep right then. It was the thick of lockdown times and my spouse wasn't allowed inside, so I had to call down to him in the car to buy me all the supplies and deliver them inside, so I could do it all again IMMEDIATELY right then and there to try to "clear everything out" after having done an actual prep already! And they had institutional-grade TP, let's just leave it at that. So I sat alone in an exam room chugging diet gatorade white frost or whatever with miralax in it and crying because in between I would run to the bathroom while nurses banged on the door asking to inspect the toilet. It was awful.
4) they also tried other things that didn't work.
5) eventually I got bored of this nightmare and started to just get dressed but then someone caught me and persuaded me to stay and they would do the colonoscopy anyway.
6) they did it, I had no problems in there at all. No polyps. I was grateful for the drugs.
7) the whole process took seven hours. The next time I'm supposed to fast or whatever for an extra day, or maybe two. Ugh. Maybe in several years they'll have FOUND A MUCH BETTER WAY but I doubt it.
posted by 41swans at 2:18 PM on October 12, 2022 [1 favorite]
I colonoscopied last summer for the first time. It was OK. I found the lemon lime prep thick liquid of grossness kind of gaggy to get down, but the rest of it was tolerable. I had a couple of good books on my phone to read while doing the prep (because you can't really go anywhere or do anything that isn't, like, IN THE BATHROOM). The only other bad part was that I was freezing on the day-of. It was high summer and I had a sweatshirt and a t-shirt and jeans on and I was still goosebumps-n-shivering cold. My driver was in a tank top and shorts.
If you are freezing at your colonoscopy, try asking the staff for a blanket. I was blue-lipped and visibly shivering before I felt it necessary to speak to a stranger and be a bother and such but finally I was like "Excuse me, I am freezing cold. Can I have another blanket?" and the nice staffer was "Of course. Would you like it pre-warmed?." and I was "YES PLEASE!!!" It was amazing, toasty like just out of the dryer. Not everyone is freezing cold at colonoscopy, but some people are. My tiny little rural Pennsylvania colonoscopy place has WARM BLANKETS for people who are freezing cold so probably this is a thing at colonoscopy places. If you're one of those people who is freezing cold at colonoscopy, do ask if they have pre-warmed blankets available.
posted by which_chick at 6:34 PM on October 12, 2022 [5 favorites]
If you are freezing at your colonoscopy, try asking the staff for a blanket. I was blue-lipped and visibly shivering before I felt it necessary to speak to a stranger and be a bother and such but finally I was like "Excuse me, I am freezing cold. Can I have another blanket?" and the nice staffer was "Of course. Would you like it pre-warmed?." and I was "YES PLEASE!!!" It was amazing, toasty like just out of the dryer. Not everyone is freezing cold at colonoscopy, but some people are. My tiny little rural Pennsylvania colonoscopy place has WARM BLANKETS for people who are freezing cold so probably this is a thing at colonoscopy places. If you're one of those people who is freezing cold at colonoscopy, do ask if they have pre-warmed blankets available.
posted by which_chick at 6:34 PM on October 12, 2022 [5 favorites]
As I mentioned in the AskMe linked above (posting here in response to the trick of using diaper cream) an even better approach is a Washlet (or other brand of bidet toilet seat). And the best part of getting one, if you can afford it, and can have it installed, is that you get to use it ALL the time, not just for colonoscopy prep. Because as someone who suffers from inflammatory bowel disease, I use the toilet more often, and am always glad to have a warm seat that cleans comfortably.
posted by birdsquared at 11:20 PM on October 12, 2022 [1 favorite]
posted by birdsquared at 11:20 PM on October 12, 2022 [1 favorite]
As long as we're telling colonoscopy stories...
An Unusual Finding of a Ladybug on Screening Colonoscopy
An Unusual Finding of a Ladybug on Screening Colonoscopy
Bug ingestions are rarely reported but can occur even during sleep. The patient's colonoscopy preparation was 1 gallon of polyethylene glycol the evening before colonoscopy, and the colonoscopy examination was otherwise normal. His colonoscopy preparation may have helped the bug to escape from digestive enzymes in the stomach and upper small intestine.posted by MrVisible at 2:36 PM on October 13, 2022 [1 favorite]
Oh, which_chick, I'm so sorry that it wasn't part of their regular protocol to tuck you into the warm blankets, without you even having to ask! At my outpatient surgical center, I get the warm blankets, the non-slip socks, the offer to have the television on if I wish, the nurses checking in on me beforehand, and afterwards, offering me soda, juice, or water. Not a spa experience exactly, but everyone is extremely kind and solicitous!
posted by apartment dweller at 10:37 PM on October 13, 2022 [1 favorite]
posted by apartment dweller at 10:37 PM on October 13, 2022 [1 favorite]
Sorry if I'm double-commenting: colon cancer steadily becoming more common in younger people
posted by clew at 1:02 PM on October 14, 2022 [1 favorite]
posted by clew at 1:02 PM on October 14, 2022 [1 favorite]
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So the takeaway isn't really "colonoscopies don't work," it's "a lot of people won't get one even if invited to do so." Which I get. I should get one and so very, very don't want to.
posted by humbug at 8:56 AM on October 11, 2022 [60 favorites]