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The FOBT have rates of false negatives and false positives making them pretty close to useless. Logic says to just get the routine colonoscopy on a regular schedule-- If you find poylps (50% of cases), they can be removed. If the polyps prove to be benign, the procedure served a preventative function. If they were cancerous, it's curative, avoiding the possibility of incurable mets or obstruction requiring major surgery, possibly "ostomy bags" later on.
Pretty dumb not to get the colonoscopy just because you're afraid of a few hours of diarrhea from the prep.
You really think 50% of colonoscopy patients have polyps??
And if they are benign, that does NOT mean that would have become cancer!
"As often as 40% of the time, a precancerous polyp — frequently a type called an adenoma — is found during a screening colonoscopy.
Colon cancer is found during only in about 40 out of 10,000 screening colonoscopies, Dr. Sand said.
Colonoscopy is the only cancer screening technique that can actually prevent cancer and not just detect it. Removing a precancerous or benign polyp eliminates the risk of colon or rectal cancer from developing from that growth."
"In the colon, the evolution of normal epithelial cells to adenocarcinoma by and large follows a predictable progression of histological and concurrent epigenetic and genetic changes (Figure 3). In the ‘classic’ colorectal cancer formation model, the vast majority of cancers arise from a polyp beginning with an aberrant crypt, which then evolves into an early adenoma (<1 cm in size, with tubular or tubulovillous histology). The adenoma then progresses to an advanced adenoma (>1cm in size, and/or with villous histology) before finally becoming a colorectal cancer. This process is driven by accumulation of mutations and epigenetic alterations and takes 10–15 years to occur but can progress more rapidly in certain settings ..."
Not every polyp will become cancerous, but there is no way to know which will and which will not. They all need to be removed.
If you have it running in your family, the testing protocol is different, I believe. The "stop at 70" is for people who have never had any bad results from previous tests.
Yeah, my Dad died from colon cancer so I am stuck with it for a long time. He had several sections removed until the point where he didn't have enough left and had to get a colostomy. Unfortunately he died about 6 months later.
"As often as 40% of the time, a precancerous polyp — frequently a type called an adenoma — is found during a screening colonoscopy.
Colon cancer is found during only in about 40 out of 10,000 screening colonoscopies, Dr. Sand said.
Colonoscopy is the only cancer screening technique that can actually prevent cancer and not just detect it. Removing a precancerous or benign polyp eliminates the risk of colon or rectal cancer from developing from that growth."
"In the colon, the evolution of normal epithelial cells to adenocarcinoma by and large follows a predictable progression of histological and concurrent epigenetic and genetic changes (Figure 3). In the ‘classic’ colorectal cancer formation model, the vast majority of cancers arise from a polyp beginning with an aberrant crypt, which then evolves into an early adenoma (<1 cm in size, with tubular or tubulovillous histology). The adenoma then progresses to an advanced adenoma (>1cm in size, and/or with villous histology) before finally becoming a colorectal cancer. This process is driven by accumulation of mutations and epigenetic alterations and takes 10–15 years to occur but can progress more rapidly in certain settings ..."
Not every polyp will become cancerous, but there is no way to know which will and which will not. They all need to be removed.
If that were true, then the ONLY research that has tested the effectiveness of colonoscopies longterm would have shown a benefit for all cause mortality. And a benefit for colorectal cancer mortality. It did not.
And please explain why the non-invasive tests should not be used instead of going right to colonoscopies. The only reason I know if is that colonoscopies have been extremely profitable. Maybe also because too many MDs are not up to date on the research.
Why are you so hung up on overall statistics. If a person does a colonoscopy that ends up being life extending that's a very good thing for that one person (which is all that really matters here).
If that were true, then the ONLY research that has tested the effectiveness of colonoscopies longterm would have shown a benefit for all cause mortality. And a benefit for colorectal cancer mortality. It did not.
"Colonoscopic screening was associated with a lower risk of all-cause mortality in both young and older individuals. Multivariable-adjusted time-dependent hazard ratios (95% confidence intervals) for all-cause mortality comparing ever- to never-screening were 0.86 (0.75-0.99) for young individuals and 0.71 (0.65-0.78) for older individuals."
"All-cause mortality
There were 586 deaths (3.11%) during the observation period (total observed person-years, 67,119) and the proportion of colorectal cancer-related mortality to all-cause mortality was 0.68% (4/586) in our cohort; that value was significantly lower than the number of expected deaths in the general population, estimated to be 2,703. The standardized all-cause mortality ratios were 0.22 (95% CI, 0.206–0.23)."
Quote:
Originally Posted by Good4Nothin
And please explain why the non-invasive tests should not be used instead of going right to colonoscopies. The only reason I know if is that colonoscopies have been extremely profitable. Maybe also because too many MDs are not up to date on the research.
Because the noninvasive tests cannot remove polyps. Those who want noninvasive tests can have them.
How do you know "too many MDs are not up to date on the research"?
Why are you so hung up on overall statistics. If a person does a colonoscopy that ends up being life extending that's a very good thing for that one person (which is all that really matters here).
Science is hung up on overall statistics. Without overall statistics, there is no way to predict if a patient is likely to be helped or harmed by a procedure.
Until colonoscopies were based mostly on mythology and wishful thinking. If someone had polyps removed, there is no way to know if they would have become cancer. Most would not. And since all cause mortality was not improved in the research I mentioned, we can assume there is very little truth in the mythology.
Do you want to base your medical decisions on scientific reality, or wishful thinking and mythology?
"Colonoscopic screening was associated with a lower risk of all-cause mortality in both young and older individuals. Multivariable-adjusted time-dependent hazard ratios (95% confidence intervals) for all-cause mortality comparing ever- to never-screening were 0.86 (0.75-0.99) for young individuals and 0.71 (0.65-0.78) for older individuals."
"All-cause mortality
There were 586 deaths (3.11%) during the observation period (total observed person-years, 67,119) and the proportion of colorectal cancer-related mortality to all-cause mortality was 0.68% (4/586) in our cohort; that value was significantly lower than the number of expected deaths in the general population, estimated to be 2,703. The standardized all-cause mortality ratios were 0.22 (95% CI, 0.206–0.23)."
Because the noninvasive tests cannot remove polyps. Those who want noninvasive tests can have them.
How do you know "too many MDs are not up to date on the research"?
Your first link only shows the abstract, so it's impossible for us to evaluate the data and statistics used.
The second link did not consider all cause mortality. The research I linked DID consider all cause mortality, and THAT is why it is so important. If routine colonoscopies do not save lives, then they should only be used when absolutely needed.
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