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Colonoscopy: Unexpected Results From a Major Study, Is It Worth Doing?

re: colonoscopy

re: Colonoscopy: Not Worth the Risk for Some of Us?

I’m 7 years due for a colonoscopy, in my late 50's here. I opted to skip it this year. Maybe in a few more years. My wife had one after 10 years, and maybe it can be her last.

Colonoscopy: Unexpected Results From a Major Study, Is It Worth Doing?

2023-01-26, by Yuwei Zhang, MD, PhD, MPH, MBA

Although many view a colonoscopy as an uncomfortable or even scary procedure, 17.7 million of them are carried out annually in the United States, and 60.6 percent of people have had one in the past 10 years.

It’s believed that a colonoscopy not only helps find cancer but also prevents cancer from developing from polyps. Because of its high level of sensitivity and specificity, colonoscopy has been regarded as the gold standard for colon cancer screenings for a long time.

Unexpected Result From a Major Colonoscopy Study

However, a recent major clinical study, the Nordic-European Initiative on Colorectal Cancer (NordICC) study published in October 2022, raised questions about the efficacy of colonoscopy.

The study suggested that colonoscopies don’t save as many lives as previously thought.

Researchers recruited 84,585 participants in Poland, Norway, Sweden, and the Netherlands; 28,220 were in the invited group (invited to do colonoscopy), and 56,365 were in the usual-care group.

At the end of the 10-year follow-up, the risk of colorectal cancer-related death at 10 years was 0.28 percent among participants in the invited group and 0.31 percent in the usual-care group. The risk of death from any cause was 11.03 percent in the invited group and 11.04 percent in the usual-care group.

In terms of adverse events, 15 people had major bleeding after polyp removal. According to the study, there were no screen-related deaths within 30 days after colonoscopy.

The incidence of colon cancer has dropped significantly since 1975. Most people believe this is due to increased screening and improved treatment.

Since there were no randomized clinical trial data on colonoscopy for colorectal cancer before, the NordICC trial sparked a heated discussion: Can colonoscopy truly prevent colon cancer?

If the benefit is not what people have expected, the colon cancer-screening landscape could be totally reshaped.

The Study Invokes Intense Debate

Numerous doctors argue that NordICC’s researchers should maintain follow-up in their study, and assessments of other current trials may shed light on the advantages of screening colonoscopies after 10 years. Follow-up time is very important, as many believe the benefit of a colonoscopy is treating precancerous polyps. It may be decades before we see the long-term benefit of colonoscopy screening.

Doctors perceive the results of the NordICC study differently for the following reasons.

First, the trial had lower-than-expected participation—only 42 percent underwent colonoscopy—and provides no information on adherence to guidelines for polyp surveillance.

Most think the study doesn’t change the value of colonoscopy. The test would have lowered cancer risk by 31 percent and cut the probability of dying from colorectal cancer by 50 percent if compliance had been 100 percent, according to the research findings.

Also, the tested countries have a higher mortality rate and incidence rate compared to the United States. U.S. clinicians favor colonoscopy, while European health systems rely far more on flexible sigmoidoscopy, which only examines the lower part of the colon.

...

WIND: those are very large groups, though I’m unclear on whether they are really random. For example, the group not wanting to get it done might be inherently less healthy. Which would make the study results worthless.

The incidence of side effects seems extremely low and also very limited in scope/type, which I find suspicious at best and highly at odds with the other article. Huh?

Isn’t it odd that here in 2023 we don’t even have long term compelling data here in the USA as to the benefits vs risks? Or, maybe we do and I’m unaware of it.

My belief is that modern medicine in every area has an overwhelming incentive to institute procedures primarily for the benefit of practicioners eg assembly line medicine for profit, particularly our administrator top-heavy instititutions. In this case, is it an 80/20 (profit vs patient) thing or a 50/50 thing, or something else?

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