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In the News: Colonoscopy DOES lower the risk of dying from Colorectal cancer
Reading this article may save your life!
In the last 24 hours, I am sure most of you have seen on TV or in print media that 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. While people who underwent the exam were 18% less likely to develop colon cancer, the overall death rate among screened and unscreened people were the same at about 0.3%, researchers from Poland, Norway and Sweden said. I was ready to go into a tirade against The New England Journal of Medicine about publishing such a irresponsible article that will lead to more, not fewer cancer deaths, but thought I should read the actual article first! As usual, it is the media who is at fault and presented an inaccurate interpretation of the data that, in my view, is reprehensible.
So lets talk about what the study actually concluded. “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.” is the actual conclusion in the NEJM. In this study, 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. 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. (Only recently have Sweden, Poland and Norway started screening their populations for colon cancer. Their programs started about 2015, and in the study, people were invited to have a screening colonoscopy from 2009 to 2014.) In the European study, 28,000 people ages 55 to 64 were invited to get a screening colonoscopy. Only 42% said yes. You see the word “invited”! They were invited to have a colonoscopy. This makes it seem like you are getting an invitation to an amazing party. I don’t know many people that are excited to get a colonoscopy. The patients were then followed for about 10 years to see if they developed colon cancer.
In this study, about 12,000 people got colonoscopies. They saw a 31% reduction in their risk of colon cancer and a 50% reduction in their risk of dying from colon cancer compared with people who were not invited to get a colonoscopy. Pretty amazing results! That is what should have and needed to be reported.
Dr. Jason Dominitz, the national director of gastroenterology for the Veterans Health Administration, co-authored an editorial that accompanies the study in The New England Journal of Medicine. wrote “I think the most important message is that colon cancer screening is effective, and you should get screened.” Some US studies have suggested that colonoscopies are even more effective. One study followed nearly 90,000 health care professionals for 22 years. Some of them chose to receive a screening colonoscopy, and some did not. The researchers estimated that screening colonoscopy was associated with a 40% reduction in the risk of getting colon cancer and a 68% reduction in the risk of dying of colon cancer.
You are probably asking yourself why would there be different success rates in the three European countries compared with the US? Dominitz says one reason might be that most people, in a European study published in JAMA in 2016, didn’t have sedation when they got their colonoscopies. Only 23% of the patients in the European study received sedation, but virtually everyone having a colonoscopy in the US gets it. In other words, people don’t get the same access to routine screening in European countries as we do in the US. So those of you who think healthcare in better in many countries as compared to the US, I am sorry to be so blunt, but you have no clue what you are talking about.
Generally speaking, you should start getting regular colonoscopies at age 45. For people who are at high risk because of a family history or other factors, it’s even younger; see these recommendations from the US Centers for Disease Control and Prevention and the American Cancer Society So the bottom line is get screened!
For further guidance or medical advocacy, please go to PaladinMDs because “it’s like having a doctor in the family.”
We've come a long way (I think), from chugging the gallon or so of "Go Lytely" before colonoscopy. Still, the prep for the procedure for some is an impediment. What can you tell us about any improvements in making the prep easier and/or more effective? Are there cancer markers either in blood or stool analysis that may make colonoscopy required less?
Another interesting article
Keep them coming