Yesterday, I had my second colonoscopy in a little over three years. Looking forward to the next one--a trend, fortunately, that matches Americans' heightened attention to proactive screenings.
Good luck with the polyps and I admire your hearty attitude.
I also reacted to the trial of a colonoscopy with punchiness, if not puns. I have found this is not appreciated, but I have no intention to quit. I can't just sit there placidly afterwards. Too boring.
The news I will link is a bit sobering, but I think the disappointing outcomes were in part due to people not availing themselves of their invitation to get a colonoscopy. I haven't reviewed the article and don't remember all of the details, so I'm not speaking as a journalist. Just providing a resource. Also, when my father was diagnised colon cancer in 2009, I heard then that 60% of people with coiled colons on one side or the other (I can't remember which) had their cancer undetected by the colonoscopy. So there is a lot of buzz that colonoscopys are not a panacea. My doctor grades people on their prep, and it was my hope that by having everything absolutely clear, she would be able to get an accurate reading.
Thank you for sharing, David.....I've cut-and-pasted that into my "draft" in e-mail to read later. Never heard of coiled colon before; hope your Dad fared well after his diagnosis. I believe I first heard the word "colonoscopy" from my dad, too----I suspect he had polyps, but I don't really know. Other stuff got him in the end. Oh--I should add: polyps are benign---my next scheduled date is in three years. So, really good news!
By far – as you discovered – the worst part of the colonoscopy is the prep. I’ve had five – accompanied by an EGD as well - since age 45. And I was one of those “brave souls” who fell in the less than 1% who refuse sedation. But I refused not because I was fearful of going under (hell I was a practicing anesthesiologist at the time) but because I wanted to immediately go back to work after the procedure and also I wanted to drive home. I did not want a designated driver. Anyway, five years ago my GI doc told me “hey Bruce, I know you don’t want sedation and all, but it really does make my job easier, and will make you much more comfortable.” OK. I gave it a try: into the procedure room … name rank and serial number … “a little propofol” … “hey when are you guys going to start the procedure?” … “well we already did and it’s over.” Wow. That propofol stuff is great. Michael Jackson was right. No more going “bare” for me.
So I’m a believer. But as a man of science belief is not good enough. Belief is great for religion but not necessarily for science. So is colonoscopy the miracle screening that saves lives that it’s all crapped up to be? I’m not sure anymore. David Harris provides the STAT report. Here is the primary source:
The actual reason why this study did not show a mortality benefit is complicated. It may in fact be that - contrary to the conventional wisdom - there is NO mortality benefit from colonoscopy. It may be that the design of the study was biased to show no mortality benefit. This has to do with comparing results from an “intention to treat” design (the design of this study) to a “per protocol” to a “per treatment” design. They often will result in different and divergent outcomes. Comparing the differences in outcomes (how robust the study results are) due to differences in trial design is known as sensitivity analysis. A supremely robust study will yield the same results regardless of design. That is not the case here. In fact if one were to analyze the results “per treatment” (rather than “intention to treat”) the results are then reassuring and drastically in favor of colonoscopy:
The risk of developing colon cancer decreased by about 31% and deaths were decreased by approx. 50%. (according to a post hoc analysis by the President of the American Society for GI Endoscopy via "per treatment" analysis).
Of course, colonoscopy and related procedures are extremely lucrative to both hospital and physician. In fact the open secret in medicine is we refer to colonoscopy as “scoping for dollars”. So if one was a cynic (I am a skeptic; not a cynic) one might be doubtful about the endorsement of colonoscopy by a President of a GI endoscopy society.
Thank you, Bruce.....I've got to circle back here and dig in later. Sometimes, I feel like I write posts so you can provide a companion piece/additional insights, sometimes-contrary viewpoints. Please keep it coming....it's a most valuable resource, and I am grateful for it, and you.
Way to stay on it. My sister got her first colonoscopy at age 50 which was the recommended age at that time. They told her she was good for ten years. Except she wasn't. In year 6 she developed back pain that they investigated as an injury of some sort for a year plus before finally diving deeper. At that point she had full blown stage 4 colon cancer. She was dead a little under two years later. All within the supposed safe 10 year time frame. So stay on it. Always. I have friends I have pleaded with to get theirs regularly. Also, understand this; you will always be your best advocate. Buy me a cup of coffee sometime and I'll tell you how I saved my own life by doing just that. In the mean time, what is your PSA? If you know it without having to go look, you're ahead of the game. That one will be diagnosed in one of seven men in their lifetimes. Be well Matt.
Thank you for your comment and encouragement, Dan -- so sorry to hear about your sister. Now I've got to get my PSA data point....thanks for that nudge.
The utility of PSA screening - in the absence of risk factors like family history of prostate Ca - is far more controversial than colonoscopy. Up until fairly recently substantive evidence proving a mortality benefit was lacking. Part of the reason may have been due to the fact that many prostate cancers picked up by PSA screening were relatively benign.
Good luck with the polyps and I admire your hearty attitude.
I also reacted to the trial of a colonoscopy with punchiness, if not puns. I have found this is not appreciated, but I have no intention to quit. I can't just sit there placidly afterwards. Too boring.
The news I will link is a bit sobering, but I think the disappointing outcomes were in part due to people not availing themselves of their invitation to get a colonoscopy. I haven't reviewed the article and don't remember all of the details, so I'm not speaking as a journalist. Just providing a resource. Also, when my father was diagnised colon cancer in 2009, I heard then that 60% of people with coiled colons on one side or the other (I can't remember which) had their cancer undetected by the colonoscopy. So there is a lot of buzz that colonoscopys are not a panacea. My doctor grades people on their prep, and it was my hope that by having everything absolutely clear, she would be able to get an accurate reading.
https://www.statnews.com/2022/10/09/in-gold-standard-trial-colonoscopy-fails-to-reduce-rate-of-cancer-deaths/
Thank you for sharing, David.....I've cut-and-pasted that into my "draft" in e-mail to read later. Never heard of coiled colon before; hope your Dad fared well after his diagnosis. I believe I first heard the word "colonoscopy" from my dad, too----I suspect he had polyps, but I don't really know. Other stuff got him in the end. Oh--I should add: polyps are benign---my next scheduled date is in three years. So, really good news!
By far – as you discovered – the worst part of the colonoscopy is the prep. I’ve had five – accompanied by an EGD as well - since age 45. And I was one of those “brave souls” who fell in the less than 1% who refuse sedation. But I refused not because I was fearful of going under (hell I was a practicing anesthesiologist at the time) but because I wanted to immediately go back to work after the procedure and also I wanted to drive home. I did not want a designated driver. Anyway, five years ago my GI doc told me “hey Bruce, I know you don’t want sedation and all, but it really does make my job easier, and will make you much more comfortable.” OK. I gave it a try: into the procedure room … name rank and serial number … “a little propofol” … “hey when are you guys going to start the procedure?” … “well we already did and it’s over.” Wow. That propofol stuff is great. Michael Jackson was right. No more going “bare” for me.
So I’m a believer. But as a man of science belief is not good enough. Belief is great for religion but not necessarily for science. So is colonoscopy the miracle screening that saves lives that it’s all crapped up to be? I’m not sure anymore. David Harris provides the STAT report. Here is the primary source:
https://www.nejm.org/doi/pdf/10.1056/NEJMoa2208375?articleTools=true
The actual reason why this study did not show a mortality benefit is complicated. It may in fact be that - contrary to the conventional wisdom - there is NO mortality benefit from colonoscopy. It may be that the design of the study was biased to show no mortality benefit. This has to do with comparing results from an “intention to treat” design (the design of this study) to a “per protocol” to a “per treatment” design. They often will result in different and divergent outcomes. Comparing the differences in outcomes (how robust the study results are) due to differences in trial design is known as sensitivity analysis. A supremely robust study will yield the same results regardless of design. That is not the case here. In fact if one were to analyze the results “per treatment” (rather than “intention to treat”) the results are then reassuring and drastically in favor of colonoscopy:
The risk of developing colon cancer decreased by about 31% and deaths were decreased by approx. 50%. (according to a post hoc analysis by the President of the American Society for GI Endoscopy via "per treatment" analysis).
Of course, colonoscopy and related procedures are extremely lucrative to both hospital and physician. In fact the open secret in medicine is we refer to colonoscopy as “scoping for dollars”. So if one was a cynic (I am a skeptic; not a cynic) one might be doubtful about the endorsement of colonoscopy by a President of a GI endoscopy society.
Thank you, Bruce.....I've got to circle back here and dig in later. Sometimes, I feel like I write posts so you can provide a companion piece/additional insights, sometimes-contrary viewpoints. Please keep it coming....it's a most valuable resource, and I am grateful for it, and you.
Way to stay on it. My sister got her first colonoscopy at age 50 which was the recommended age at that time. They told her she was good for ten years. Except she wasn't. In year 6 she developed back pain that they investigated as an injury of some sort for a year plus before finally diving deeper. At that point she had full blown stage 4 colon cancer. She was dead a little under two years later. All within the supposed safe 10 year time frame. So stay on it. Always. I have friends I have pleaded with to get theirs regularly. Also, understand this; you will always be your best advocate. Buy me a cup of coffee sometime and I'll tell you how I saved my own life by doing just that. In the mean time, what is your PSA? If you know it without having to go look, you're ahead of the game. That one will be diagnosed in one of seven men in their lifetimes. Be well Matt.
Thank you for your comment and encouragement, Dan -- so sorry to hear about your sister. Now I've got to get my PSA data point....thanks for that nudge.
The utility of PSA screening - in the absence of risk factors like family history of prostate Ca - is far more controversial than colonoscopy. Up until fairly recently substantive evidence proving a mortality benefit was lacking. Part of the reason may have been due to the fact that many prostate cancers picked up by PSA screening were relatively benign.
https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening