Study..colonoscopies dont reduce cancer deaths

[Demovictory9]

https://www.bloomberg.com/news/articles/2022-10-09/colonoscopy-screening-exams-fail-to-prevent-cancer-deaths-in-large-study

Colonoscopy screening exams that are recommended for older US adults failed to reduce the risk of death from colon cancer in a 10-year study that questions the benefits of the common procedure.

[Chainfire]

1. I wonder which insurance company paid for the study.

The story is blocked for me.

[former9thward]

15. Early detection/prevention is far cheaper than treatment of the disease.

No reason an insurance company would want to get rid of these tests.

[Demsrule86]

50. It is bullshit...insurance doesn't want to pay anymore...it certainly does save lives...saved my

Dad's life.

[hunter]

57. The insurance companies only care about the size of the money streams they control.

The more medical care costs, the more money they make.

Why would they want to control costs?

[roamer65]

2. All depends on how aggressive the form of colon cancer.

I can’t see it either, but I’m sure slower growing ones get found more often than the aggressive forms.

[mahina]

3. Hmmm

I don’t know I have to try and find that study. Here’s another study. My daily public service announcement: you can search any health term with the term PubMed on google and get direct access to abstracts at your convenience any time. The citations and sometimes footnotes and stuff are there too.


Everything I hear from people including one update on a DUer’s melanoma on this page today says that early detection is the key to surviving this terrible diagnosis.
https://pubmed.ncbi.nlm.nih.gov/19268269/
Effect of screening colonoscopy on colorectal cancer incidence and mortality
Charles J Kahi et al. Clin Gastroenterol Hepatol. 2009 Jul.
Show details

Full text links
Cite

Abstract

Background & aims: Colonoscopy is used widely for colorectal cancer (CRC) screening; however, its long-term impact on the incidence and mortality of CRC is not known.

Methods: We assessed CRC incidence and mortality in a group of asymptomatic average-risk patients who underwent screening colonoscopy between 1989 and 1993 at a university hospital. By using standardized incidence ratios and standardized mortality ratios, we compared our observed CRC rates with expected rates from the Surveillance, Epidemiology, and End Results (SEER) data.

Results: The cohort comprised 715 patients (mean age, 61 +/- 6.5 y; 59% male; 95% Caucasian) with 10,492 patient-years of follow-up. There were 12 cases of CRC: 5 found at baseline and 7 found after a median follow-up period of 8 years (range, 3-16 y). When the first 2 years of follow-up were excluded, there were 7 incident cases of CRC (95% confidence interval [CI], 2-13) over 9075 person-years of follow-up. The expected number based on SEER data was 21. The incidence rate was 0.77 cases per 1000 person-years, and the standardized incidence ratio was 0.33 (95% CI, 0.10-0.62), consistent with a relative risk reduction in CRC incidence of 67%. Three patients died from CRC (95% CI, 0-9). The expected number of deaths based on SEER data was 9. The mortality rate was 0.29 per 1000 person-years, and the standardized mortality ratio was 0.35 (95% CI, 0.0-1.06), consistent with a relative reduction in CRC death of 65%.

Conclusions: In this average-risk cohort, CRC incidence and mortality were reduced after screening colonoscopy. These results provide additional evidence for the effectiveness of colonoscopy as a primary CRC screening modality.

[Ms. Toad]

22. The difference is that your study is comparing those with colonoscopies to those without.

The referenced study compared those invited to have a colonoscopy to those not invited. Only 42% accepted the invitation - which dramatically decreases the effectiveness of the "screening."

Colonoscopies can't detect anything if they aren't actually performed.

[unc70]

34. The subjects self selected, totally screwing up the statistics

Any pretense of following a valid experimental design was tossed. Just because you ran the resulting numbers through SAS or whatever doesn't make your "results" valid.

[Ms. Toad]

45. They didn't self-select for the data reported in the abstract.

Nothing in the abstract claims that colonoscopies are nearly worthless. What they claimed was that invitations (extended by the reseasrchers) were nearly worthless.

They did self-select for colonoscopies - but at least the abstract makes no claim about the effectiveness of actually having a colonoscopy.

[doc03]

4. I couldn't read the article but I personaly knew

three people that died as the result of a colonoscopy. I am 74 I am due for one at 80, they have never found anything so I am not taking any more of them.

[Maru Kitteh]

12. Stick to your guns. Tell them you will do the non-invasive kind as a

Compromise if they insist and you feel it’s warranted. There are better ways.

[MOMFUDSKI]

31. My old really good doc

agreed with me that the risk of sepsis is great in an older individual from a colonoscopy. I only rely on the card test and I did the mail-in-the-box test once. Will not be getting a colonoscopy. Never had one. An AARP mag had an article on 10 tests to not have when older and this was one.

[Fullduplexxx]

37. You anti-scopeite

[Tree Lady]

40. Boy wish I hadn't read this my doc wants me to get one this

month because of some issues. I already hate them, the prep is the worst part.

[FreeState]

51. I would t worry too much

(I get one every year - as do most in my family - my father just stopped having them. He’s 85 and the doctor told him to stop (due to life span risk of cancer not the risk of colonoscopies).

While there are risks associated with even the most routine medical procedures, the benefits of a colonoscopy significantly outweigh the associated risks for people ages 45 to 75. The American Society for Gastrointestinal Endoscopy estimates that only three in 1,000 colonoscopies leads to serious complications. But even when serious complications arise, it is exceedingly rare that they are life-threatening, and doctors are well-trained to treat any complications with proven methods.

https://www.ccalliance.org/blog/prevention/are-colonoscopies-dangerous

[Doremus]

53. Our secondary insurance, United Healthcare, recently sent us cologuard kits.

We didn't request them, they just arrived in the mail. Neither of us have ever gotten colonoscopies and we have no plans to start now. We will take the non-invasive cologuard tests though.

[Ferrets are Cool]

5. Wow. I just have a hard time accepting this report.

Douglas Robertson of the Dartmouth Geisel School of Medicine said in an accompanying commentary. “Additional analyses, including longer follow-up and results from other ongoing comparative effectiveness trials, will help us to fully understand the benefits of this test.”

[CentralMass]

10. Me too. Some heartless bean counter is interpreting the result and giving .

the result he/she is being paid to give.

[former9thward]

17. That does not make sense.

Early treatment is far cheaper than the disease.
No reason an insurance company would want to get rid of these tests.

[Hassin Bin Sober]

42. Why not?

Maybe they don’t want to pay for 1 million $6,000 colonoscopies if a few thousand people die without?

The vast majority of people get clear reports.

[former9thward]

43. I guess I like my conspiracy theories with a least a little evidence.

[Ms. Toad]

55. Not even a bean counter -

The Bloomburg headline does not accurately describe the study.

The study isn't about whether colonoscopies prevent colon cancer deaths - it is about whether extending an invitation to have a colonoscopy prevents colon cancer deaths. in the invited group, only 42% actually had colonoscopies.

[Ms. Toad]

16. The "conclusion" doesn't match the abstract,

and is not supported by the limited data provided in the abstract.

The study distinguished between those who received an invitation to have a colonoscopy, and those who did not. Of those invited, only 42% actually had a colonoscopy.

https://www.nejm.org/doi/full/10.1056/NEJMoa2208375

[BannonsLiver]

39. That's the beauty of living in a post fact world.

You don’t have to accept it.

[RKP5637]

6. It sure saved my life. Cancerous polyp. They operated immediately. I'm OK. n/t

[Brother Buzz]

7. New Research Shows Blood Test Can Find Colorectal Cancer

https://www.cancer.net/blog/2018-01/new-research-shows-blood-test-can-find-colorectal-cancer

[FreeState]

52. Important to note this is not for everyone

If you have a genetic or family history the screening above will not prevent cancer but identify it. Whereas if it’s genetic (Lynch Syndrome) removing the polyps prevents cancer.

If you have a family history of colon cancer or have a genetic disorder please get your screenings to prevent cancer. It’s a pain, I do it yearly but it’s much better than the alternate.

[Bayard]

54. Very promising

But this study was done in 2018. I'm wondering what's been developed since, and will look it up when I have more time.

Both of my parents had colon cancer. My Dad's killed him. My Mom's was on the list of other things she had going on.

I had a colonoscopy a few years ago that was absolutely clean. Not even a polyp.

[Maru Kitteh]

8. I tend to feel it's an industry racket for those without elevated risk factors.

I will do the poop in a box thing, but that’s it.

[WhiskeyGrinder]

9. Isn't that kind of a short study for colon cancer?

[Ms. Toad]

18. It's reasonable in the age range - but it didn't compare actual screening to none.

It compared an invitation to screening to no invitation to screening. Only 42% of those invited to have a colonoscopy actually did.

[WhiskeyGrinder]

21. Thanks.

[Ms. Toad]

26. I've got a vested interest in this one -

my daughter has two chronic illnesses which dramatically increase her chances of colon cancer. She has a colonoscopy every year.

(On top of the fact that posting alarming headlines which aren't supported by the underlying study drive me nuts.)

[Boxerfan]

11. I have an issue to be seen by a professional soon.

So I should tell the Dr. to skip the colonoscopy-great!.


Not buying it at all. I think I'll see what my Dr. has to say.

[Gaugamela]

13. Here's another article on this study (CNN):

It looks like the results are being debated.

Less than half of people invited to get a colonoscopy in the study – just 42% – actually got one.

When the study authors restricted the results to the people who actually received colonoscopies – about 12,000 out of the more than 28,000 who were invited to do so – the procedure was found to be more effective. It reduced the risk of colorectal cancer by 31% and cut the risk of dying of that cancer by 50%.

Bretthauer said the true benefits of colonoscopy probably lie somewhere in the middle. He said he thinks of the results of the full study – including people who did and didn’t get colonoscopies after they were invited – as the minimum amount of benefit colonoscopies provide to a screened population. He thinks of the results from the subset of people who actually got the test as the maximum benefit people could expect from the procedure.

Based on his results, then, he expects that screening colonoscopy probably reduces a person’s chances of colorectal cancer by 18% to 31%, and their risk of death from 0% to as much as 50%.

https://www.cnn.com/2022/10/09/health/colonoscopy-cancer-death-study/index.html

[Ms. Toad]

19. Thanks - I didn't find the full article - only the abstract.

That pointed out the flaw (comparing invitation v. no invitation), but provided no data about what happened for those who actually had a colonoscopy.

[Ms. Toad]

14. From reading the abstract, that caption is extremely misleading.

The two groups were those invited to undergo a colonoscopy and those not (usual care).

Of those invited, only 42% actually underwent a colonoscopy (less than half). The abstract contains no information as to whether those not invited to undergo a colonoscopy.

58% of those in the invited group apparently had the exact same actual screening as those in the "usual care" group.

The conclusion was that inviting people to undergo a colonoscopy makes little difference - 455 invitations needed to be extended to prevent one case of colorctal cancer.

Unless the full report provides more detail and compares those actually screened (not those invited to be screened) to those not screened, the conclusion is not supported by the data.

[kysrsoze]

20. Terrible study. They failed to point out more than half the participants never got one.

If you read actual results and analyses, the reduction in death was still up to 50%, and 31% detection. They also were comparing colonoscopy to other tests. This article is spreading and REALLY dangerous in its false claims.

[sl8]

23. NEJM link:

https://www.nejm.org/doi/full/10.1056/NEJMoa2208375

Only the abstract is available without an account, although they do have a free option.

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

List of authors.
Michael Bretthauer, M.D., Ph.D., Magnus Løberg, M.D., Ph.D., Paulina Wieszczy, Ph.D., Mette Kalager, M.D., Ph.D., et al., for the NordICC Study Group*

October 9, 2022
DOI: 10.1056/NEJMoa2208375


Abstract

BACKGROUND
Although colonoscopy is widely used as a screening test to detect colorectal cancer, its effect on the risks of colorectal cancer and related death is unclear.

METHODS
We performed a pragmatic, randomized trial involving presumptively healthy men and women 55 to 64 years of age drawn from population registries in Poland, Norway, Sweden, and the Netherlands between 2009 and 2014. The participants were randomly assigned in a 1:2 ratio to either receive an invitation to undergo a single screening colonoscopy (the invited group) or to receive no invitation or screening (the usual-care group). The primary end points were the risks of colorectal cancer and related death, and the secondary end point was death from any cause.

RESULTS
Follow-up data were available for 84,585 participants in Poland, Norway, and Sweden — 28,220 in the invited group, 11,843 of whom (42.0%) underwent screening, and 56,365 in the usual-care group. A total of 15 participants had major bleeding after polyp removal. No perforations or screening-related deaths occurred within 30 days after colonoscopy. During a median follow-up of 10 years, 259 cases of colorectal cancer were diagnosed in the invited group as compared with 622 cases in the usual-care group. 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). The risk of death from colorectal cancer was 0.28% in the invited group and 0.31% in the usual-care group (risk ratio, 0.90; 95% CI, 0.64 to 1.16). The number needed to invite to undergo screening to prevent one case of colorectal cancer was 455 (95% CI, 270 to 1429). The risk of death from any cause was 11.03% in the invited group and 11.04% in the usual-care group (risk ratio, 0.99; 95% CI, 0.96 to 1.04).

CONCLUSIONS
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. (Funded by the Research Council of Norway and others; NordICC ClinicalTrials.gov number, NCT00883792. opens in new tab.)

[bucolic_frolic]

24. Just like the Swedish study of about 2016

and I'm posting from memory, but watchful waiting was as good or better than aggressive prostate screenings and surgery when comparing average life expectancy.

[unc70]

35. Exactly the same.

[Ms. Toad]

46. Not exactly the same.

This study only reviewed whether inviting people to have colonoscopies made a difference. Only 42% of them took them up on the invitation and actually had colonsocopies.

So only 42% of the non-control test subjects did anything other than watchful waiting. Comparing an invitation to screening is completely different from actually performing screening.

[Scrivener7]

25. I have a family history so I get one every 3 years. It is my understanding

that recommendation is because a polyp can turn into cancer in 5 years. So what good is screening every 10 years going to do?

[enid602]

27. Cancer

I’ve known/known of several people who died of colon cancer. None had colonoscopies.

[Fiendish Thingy]

28. I've read other studies about this issue

The one I recall said that many doctors miss polyps that are retracted into pouches in the lining of the colon rather than visibly protruding.

This data could be an indication that further training and a change in procedure is required.

[Hekate]

29. KnR

[Delmette2.0]

30. Just my opinion.

People need to know what to watch for or be concerned about.

My first warning was a change in bowel habits/ routine.

I was in pain before I said something. I had a CT scan first which showed a problem. Then the colonoscopy proved the cancer. I was lucky it was stage 2 and it has not spread.

[Stuckinthebush]

32. That's an apparent misread of the study results

The study doesn't find that colonoscopies don't reduce cancer deaths, it finds a statistically significant lower risk for those who were invited to have screenings over 10 years.

[no_hypocrisy]

33. A polyp removed today might have been

Cancer in the future.

[Sky Jewels]

38. I had a pre-cancerous polyp removed in my colonoscopy when I was 50.

It's weird to think I likely would have had to go through colon cancer had I not had that screening.

A colonoscopy also saved a close family member's life -- caught the cancer when it was stage II and treatable.

[gay texan]

36. Saved my dad's life

But predicted the damage that Agent Orange caused....

[Midnight Writer]

41. I have had multiple polyps removed at each of my four colonoscopies.

I will continue the regimen recommended by my doctors, who have pegged me at high risk for colon cancer.

[Dysfunctional]

44. My maternal grandmother died of colon cancer, my mother died of colon cancer,

and my sister had colon cancer, but it was caught in time. The VA insists, I have them even if they didn't insist, that I have a colonoscopy every 3 years and I always have polyps. I am 79 and want to live a lot longer. I also have an upper endoscopy every year for the last 3 years because of polyps.

[debm55]

48. Here in the Pittsburgh area, Doctors

are now doing both,the endoscopy and the colonoscopy at the same procedure.

[Ms. Toad]

47. How about you correct the headline to match the study.

Bloomberg news got it wrong - but there's no need to perpetuate the inaccurate information.

[Hawaii Hiker]

49. I do the scaredy cat version - Cologuard

I do the Cologuard test every three years....I think as long as that keeps coming up negative, chances are likely low there's no cancer

[Eureka]

56. In Aus we get a free test mailed every 2 years after 50

where you take a swab sample and send it back.

Simple, clean and effective, and saves lives and money.

Governments can do these things really effectively when they are motivated (ie, provide healthcare) but if it's a dog eat dog healthcare system then of course you're on your own.

Healthcare in the US (from my DU lens, no personal experience) leaves me shaking my head. We don't have single payer, much more like ACA, but that is a great model that straddles the fence between fully govt paid and private quite effectively.

[DFW]

58. The tests are to reduce the incidence of the disease. Once you have it, your chances diminish

The tests are for prevention (discovery and removal of pre-cancerous polyps), not for treatment of colon cancer once it has manifested itself. Once it is diagnosed, a test isn't going to help treat it, and it was never intended to serve that purpose.

The first time I got a colonoscopy, I had such a polyp. That was about 20 years ago. If I hadn't had it removed, I might have developed colon cancer--especially with a family history of cancer like mine--and never known it until it was too late. Having the polyp removed prevented the polyp from ever developing into full-blown cancer and metastasizing. THAT is what the colonoscopy is for, not to cure cancer once it is already there. That is another treatment altogether, and the chances of success are dependent on a number of factors, including how early it was detected. Not giving it a chance to form in the first place is by far the better option.