[HN Gopher] At-home test for colon cancer is as reliable as trad...
___________________________________________________________________
At-home test for colon cancer is as reliable as traditional
screening: experts
Author : Kaibeezy
Score : 119 points
Date : 2021-01-12 14:23 UTC (1 days ago)
(HTM) web link (www.nytimes.com)
(TXT) w3m dump (www.nytimes.com)
| gilbetron wrote:
| Having "enjoyed" a colonoscopy recently, I looked into this
| option, but the upside of a colonoscopy is that if they do find
| polyps, then can usually take care of them right then and there.
| Plus, they can also look for other things, and generally react to
| what they find in real time.
|
| Unrelated side note: I did this all during the US election week,
| so that was a fun few days of stress and weirdness!
| BitwiseFool wrote:
| I heard from a nurse that the more gross, uncomfortable, or
| invasive a test is, the more accurate and useful it will be.
| aidenn0 wrote:
| Just finished a checkup with my Doctor who told me I'm likely to
| have a FIT at 45 rather than colonoscopy at 50. They've wanted to
| lower the screening age for a while, but the resources just
| aren't there to do colonoscopies on everyone 45+.
| [deleted]
| throwaway0a5e wrote:
| Naming the product "Cologuard" was a great opportunity
| squandered.
|
| I can't wait until the people who spent their formative years
| sharing shock images on IRC and calling people nasty things on
| 4chan and don't get offended easily (i.e. the people who
| graduated high-school after the internet became common but before
| "real name" social media became common) are old enough to be the
| ones calling the shots in the workplace. We're already starting
| to see the effect in low stakes and low formality area, e.g.
| Wendy's twitter account but it hasn't really taken off yet.
| shadowprofile77 wrote:
| The rubrics you describe basically cover a whole spectrum of
| people who also fit into the millennial category, and in my
| experience they're among the most easily, absurdly offended and
| politically correct people in modern society... I have more
| hope for younger generations than them.
| [deleted]
| haspoken wrote:
| http://archive.is/vIt5m
| elric wrote:
| "Faecal occult blood" (FOBT) home test kits have been around for
| years. And they don't require sending a sample back to the lab,
| you just poke a few holes in a turd with something that looks
| like a mascara brush, put it in a test tube and wait around for a
| bit. It's super simple. No lab required. If the result is
| positive, you talk to your doc and possibly have a colonoscopy
| scheduled.
|
| Not sure why this article talks about sending samples back to a
| lab. Maybe the 100% at home self test isn't approved in the US or
| something?
| flotzam wrote:
| Make sure it's an iFOBT though ("immunochemical"), not the
| legacy gFOBT type. Preferably with two test fields - Hb and
| Hb/Hp (hemoglobin and hemoglobin/haptoglobin complex) - for
| that extra bit of sensitivity:
| https://europepmc.org/articles/PMC4927976/table/tab3/
|
| Just buying a couple of those tests (they're cheap!) instead of
| going through the gatekeepers makes it practical to repeat them
| over the course of a few days, increasing the chance to catch
| intermittent bleeding. Obviously go to a doctor if there's any
| positive result at all.
| joezydeco wrote:
| This company sells iFOBT tests in the USA.
|
| https://www.pblabs.com/products/second-generation-fit-fecal-...
| raverbashing wrote:
| The annoying part for that exam is apparently the pre-exam diet
| Kaibeezy wrote:
| Upgraded, now _" as reliable as the traditional screening"_.
|
| Annual and free in most of the UK for a couple of years now.
| Thank you, NHS.
| elric wrote:
| Considering these tests detect blood, and not all polyps
| (cancerous or otherwise) bleed, there is no way that this is as
| accurate as a colonoscopy. Maybe if you take into account that
| more people are willing to use this test than a colonoscpy, it
| can be as effective because more people get tested. But that's on
| population level and not on the individual level.
| cstross wrote:
| I've done both tests.
|
| One thing the colonoscopy came with but the occult blood stool
| test didn't: a warning that there was a 1 in 1000-10,000 risk
| of an accidental tear in the colon leading to peritonitis, an
| immediate surgical emergency (and life-threatening if
| undetected and untreated).
|
| So yes, the colonoscopy might pick up some rare non-bleeding
| cancers and polyps ... but it's also going to lead to
| unpleasant surgical complications in its own right.
|
| (I have no figures for relative risk: but feel it's worth
| noting.)
| hef19898 wrote:
| Thing is, even bleeding polyps and cancers don't bleed all
| the time. Ask me how I know.
|
| So, for simple screening purposes I'd say good enough. If
| there are _any_ other indications a full colonoscopy would be
| more reliable.
| cstross wrote:
| That's how it works in the Scottish NHS. National stool
| screening program every two years after you turn 50 (you
| get mailed a sample tube and send it back to the test
| centre). If it's a positive, you're called in for a
| colonoscopy. *But* if you show suspicious symptoms outside
| of the screening program you get a colonoscopy anyway.
|
| (Source: am at very high risk of hereditary colon cancer,
| had a colonoscopy when my GP learned of the family history,
| then screening thereafter. All clear so far ...)
| Kaibeezy wrote:
| Right, it was only a couple of years back we switched
| from the old test with the little landing pads to the new
| one that's a tube. I've only had one of the new ones so
| far.
|
| Also, should have corrected my comment above... it's two
| year intervals, as you mentioned.
|
| _Lang may yer lum reek,_ neighbour.
| JKCalhoun wrote:
| Correct me if I'm wrong, but I believe colonoscopy
| screenings are every 3 years or so (5?). If the stool
| sample is performed annually you get a lot more data
| samples/tests.
|
| That would seem to shift some weight to the stool test.
| smartbit wrote:
| Correct.
|
| As I read it, this article is more about the inadequate
| US healthsystem than anything else, in particular because
| it _forgets_ to mention that iFOBT is free and
| automatically sent to all between 50 /55-75 in several
| European countries. No diet required. Return envelop
| included. Lab results received by postal mail after a few
| weeks.
| Kaibeezy wrote:
| Yes, that's the problem. I was hoping these results for the FIT
| meant the uninvasive test was approaching the value of the
| invasive one, but clearly not close enough for my own comfort.
| [deleted]
| devnull255 wrote:
| I've had two colonoscopies 5 years apart because in the first
| procedure they found and removed polyps, which put me on the
| side 5-year plan (every 5 years). In the last procedure polyps
| were also found and removed. Since at least one of the polyps
| removed in both procedures were benign but possibly capable of
| becoming malignant, the FIT test by itself is probably not
| sufficient for me as the only cancer screening test.
| harveywi wrote:
| They missed an opportunity to call this the "Scatological Health
| Immunochemical Test"
| shadowprofile77 wrote:
| And how would this test avoid false scares caused by hemorrhoids?
| They also can create blood in human stool.
| hirundo wrote:
| My doctor requested that I get a diagnostic colonoscopy. Because
| I _needed_ one under my insurance plan I had to pay the full
| cost, over $3k. If I didn 't need one it would be a "screening"
| colonoscopy, and covered in full by the insurance.
|
| Under what logic does that make sense, that you get insurance
| coverage for a procedure but only if you don't really need it?
| Does it work like that anywhere outside of the U.S.?
|
| The colonoscopy was completely clear. Two years later I was
| having constipation and bloating problems and went to a
| gastroenterologist. He examined me, asked a bunch of questions,
| and I asked for his advice. He said he really couldn't tell me
| anything ... without a colonoscopy. The two year old one didn't
| tell him enough, he said.
|
| Now I'm supposed to drop another $3k, very likely for another
| clear test result, just to hear what the doctor says I should do
| about my constipation and bloating?
|
| It felt like a scam. Instead of getting advice from a specialist
| M.D. I was driven to get it from the internet. And dang if it
| didn't work. I went on a low-residue diet that resolved my
| digestive problems almost immediately and has had numerous other
| benefits. My diabetes is in complete remission, I've lost weight,
| etc. But when I asked the gastroenterologist if diet changes
| would help, his answer was short and simple: "No."
|
| So I'm very happy to see far less expensive alternatives. One
| less leverage point for the health care system to empty my
| wallet.
| TwoBit wrote:
| Most gastroenterologists are like that. You want a diagnosis
| then you need a very recent colonoscopy. And that's a quick
| $1000+ hour for them, of which they will do many in a given
| week. But what else can they do?
| davycro wrote:
| The test in the article screens for colon cancer, which is one
| of many reasons to have a colonoscopy. It sounds like the GI
| doctors you consulted performed colonoscopies to assess the
| cause of your digestive symptoms by looking at your GI tract.
| The test in the article could not replace that.
| tzs wrote:
| > My doctor requested that I get a diagnostic colonoscopy.
| Because I needed one under my insurance plan I had to pay the
| full cost, over $3k. If I didn't need one it would be a
| "screening" colonoscopy, and covered in full by the insurance.
|
| A similar, but at least nowhere near as expensive, gotcha in
| many US insurance plans happens with annual checkups. Many
| plans fully cover an annual check up with no deductible or co-
| pay.
|
| But during that checkup if you mention some issue that the
| doctor does not specifically find or ask about as part of the
| standard checkup, you might find that your insurance company
| counts that visit as a diagnostic visit or a treatment visit,
| not a checkup visit, and you pay the normal office visit
| deductible or co-pay.
|
| If you ask something that takes significant time for the doctor
| to deal with that might make sense, but I've read of it
| happening for things like you tell the doctor that you get sore
| wrists after a full day on the keyboard and the doctor spends a
| minute telling you about taking breaks and giving you some
| ergonomics tips.
| maxerickson wrote:
| It's the provider coding the visit as diagnostic vs annual
| preventative though, not the insurance company.
| perakojotgenije wrote:
| Americans and their health insurance problems.
|
| I live Serbia, to use Trump's words - in a "shithole country"
| (and I fully admit it is :-( ). I've never had a colonoscopy
| but I had a gastroscopy two months ago and it was fully covered
| by our single payer insurance.
|
| At the same time a friend of mine needed to have a gastroscopy
| and a colonoscopy. He decided to go the private route and also
| chose a full anesthesia. That costed him 30.000 serbian dinars
| (~255 euros).
|
| So it seems to me that you could buy a return plane ticket to
| Serbia, stay here for a few days, do a colonoscopy here and it
| would still cost less than what you need to pay there.
| throwaway894345 wrote:
| Yeah, health insurance is interesting over here. I've been
| fortunate and never had many problems with health insurance.
| Once or twice we got a surprise bill because a doctor
| deceptively ordered a test that our insurance wouldn't cover,
| and we had to pay the full cost (probably 1-2K). In one
| instance, we explained the issue to the company that produced
| the test and they comped it to us (and somehow the cost
| counted toward our deductible, which was really nice).
| Anyway, IIRC, there's legislation to make this kind of
| deceptive practice illegal (doctors can't refer you out of
| network or order tests without your explicit approval), but I
| might be misremembering.
|
| None of the above is to make any sort of political point. I
| still want universal healthcare. Too many people aren't
| insured or are under insured and it's far too easy for
| hospitals and insurance companies to screw you and leave you
| with no recourse, especially if you're already vulnerable.
| There was a time when I was undecided on the issue, but it
| seems like every country that has universal healthcare really
| likes it even if some of them complain endlessly that their
| healthcare system is a financial black hole (e.g., my UK
| friends complaining about NHS always getting more money and
| yet the quality of care doesn't improve perceptively--
| although that was a pre-COVID sentiment).
|
| I also know American friends who have flown to India to have
| lasik and paid full price for a reputable Indian doctor to
| perform it because all-in it was cheaper than paying for it
| domestically (it's possible that their insurance didn't cover
| lasik? I'm not really sure how that worked out).
| cardiffspaceman wrote:
| There are two things that UKans seem to consistently
| complain about with respect to NHS: taxes and queues. You
| don't have to pay for individual procedures but you have to
| wait for them because the politicians don't necessarily
| take enough of the tax paid in and apply it to care.
| inglor_cz wrote:
| The thing is, American healthcare prices are horribly
| overblown. IDK why, maybe the need for malpractice insurance
| in a litiguous society, but I am always shocked when I learn
| how much do relatively routine things (LASIK, uncomplicated
| birth) cost in the USA. Usually at least ten times as much as
| in Europe.
| react_burger38 wrote:
| One reason for this is the artificially limited supply of
| doctors. The AMA combined with the government keeps the
| number of doctors down by keeping the number of medical
| schools and medical residencies low, driving up prices.
|
| Among many other big factors.
| spaetzleesser wrote:
| American health care prices are a constant series of traps.
| If you are not careful, the insurance won't pay, or the
| hospital will out of network doctors or they will run tests
| you don't need or want. And pretty much everything is way
| overpriced without the patient having a realistic chance to
| determine the fair price. All in the pursuit of sucking
| more money out of you.
|
| And it's almost impossible to avoid these traps. It's
| basically a gamble every time.
| maxerickson wrote:
| LASIK is generally a few hundred dollars per eye. Is it
| really $50 in Europe?
|
| As far as births, the lifetime cost of the injuries that do
| happen are built into the price. Maybe not a good system,
| but it's clear enough where the money goes.
| gdebel wrote:
| Haha, nope ! As a convenience procedure, and as such
| exposed to liability risks, and because of the extremely
| high cost of the lasers, you'll have to pay 2-3000 euros
| for both eyes (in France, at least). It is in fact
| cheaper in the US.
|
| However, I'm always surprised by the cost of health in
| the US. The most surprising thing is that it looks like
| most Americans seem to not realize that it is perfectly
| possible to have high quality medicine and well payed
| doctors if the insurances don't suck all the money
| between the healthcare system and the patient. Our system
| has flaws, sure, but the US system looks like crazy to
| me.
| maxerickson wrote:
| It's not just insurers, it's death of 1000 cuts. Poor
| regulation, misaligned incentives, greed, etc.
| inglor_cz wrote:
| This is my fault, I have old info here.
|
| I underwent LASIK in 2002. At that time, it cost me about
| 1000 USD here in Czechia. On American web discussions,
| mostly quoted amounts were USD 5-7000.
| devonkim wrote:
| It's a complex question but the problem is that _everyone_
| that points out one reason or another is usually right - we
| disagree upon which factor is the biggest. Malpractice,
| bloated administrations in insurance and hospitals (just
| like our educational and corporate systems), a
| dysfunctional market leading to profiteering, bad /
| outdated regulations, Medicare being unable to negotiate
| costs, bad patient health across the country, and so forth.
| What I will argue against is that we have the best
| healthcare - maybe only if you exclude the outcomes for our
| poor, but even the outcomes for our wealthy are no better
| than the middle class in other developed Western countries.
| analog31 wrote:
| The system is so convoluted that nobody knows where the
| money is going. Every player can point their finger at
| someone else and say: "Those people are gouging you." But
| every player has an investment stake in the other
| players[0]. It means, when it comes right down to it,
| they're all gouging us.
|
| [0] For instance I read that the majority of stock in
| malpractice insurance companies is held by doctors.
| omgwtfbyobbq wrote:
| It's possible that his "No." was a hard answer to whether diet
| changes would affect your symptoms in general, but it's also
| possible that it's was a response in the context of whether it
| would help the things that he would find on a colonoscopy. If
| possible I would ask him to clarify.
|
| Some doctors I've been to assume that I've already tried simple
| things to help with whatever issues I've had, and that is
| sometimes an inaccurate assumption.
| petercooper wrote:
| There is a similar quirk in the UK's tax code.
|
| An employer can pay for medical checkups (which can run up to
| many PSPSPSPS full body medicals and scans - the works) without
| any tax implications for the employee or the business, but
| _not_ for similar things being done as 'treatment' for
| something (unless it relates to an issue caused by or within
| the employment itself, like if you crushed an arm in a
| warehouse accident, say).
| kurthr wrote:
| Your doctor is not good at his job or he doesn't like you.
| Filling out codes so that insurance pays for things is a skill
| that good doctors develop rapidly. The proper codes can also
| change rapidly, and often there is no easy way to find out what
| price a procedure is or how much insurance will pay for a
| particular code. MDs do usually have a hand up on others in
| figuring this out because healthcare and insurance companies
| will return their calls. (They also discuss it among
| themselves)
|
| If you are not an MD it may take 3-4weeks to find out what a
| code costs and what coverage will be. They'll call you about
| the single code and coverage that you requested, when they get
| around to it. However, if they have mis-billed you (eg 45min
| for a 15min visit) then you can get them to reverse and rebill
| the procedure. Personal experience.
| soperj wrote:
| >Your doctor is not good at his job or he doesn't like you.
| Filling out codes so that insurance pays for things is a
| skill that good doctors develop rapidly.
|
| My Doctor is great, and has zero skill w/r to filling out
| codes for insurance purposes. Socialized medicine for the
| win.
| multjoy wrote:
| Should this actually be part of an MD's job?
| vkou wrote:
| It's not in countries with other healthcare systems, but it
| is in the US.
|
| It's why doctors in America get paid the big bucks. /s
| ssully wrote:
| I would agree he isn't good at his job based on what you
| said, but also not even considering your diet. I've had
| stomach issues for a lot of my life, and my doctor was very
| good about asking my questions, and helping me figure out
| what might help me, including diet changes.
| pkaye wrote:
| > Under what logic does that make sense, that you get insurance
| coverage for a procedure but only if you don't really need it?
| Does it work like that anywhere outside of the U.S.?
|
| A screening procedure is considered preventive. Obamacare
| requires preventive care to be 100% covered. Before that, your
| plan might have also charged for preventive procedures.
| maest wrote:
| What is a low-residue diet, if I may ask?
| hirundo wrote:
| The biggest source of residue is fiber. I'm doing this:
| https://www.amazon.com/Carnivore-Code-Unlocking-Returning-
| An...
| azinman2 wrote:
| Sounds like a cholesterol nightmare.
| hirundo wrote:
| See chapter eleven.
| noir_lord wrote:
| I've had cameras both ways without anaesthesia, is that not
| common in the US?
|
| They offered sedation or gas and air though.
|
| I went for gas and air as it meant I didn't need anyone to come
| pick me up and I could go home straight after.
|
| Honestly the prep is the worst part.
| atombender wrote:
| I asked the gastroenterologist at my last procedure. He said
| some people find it painful when the doctor moves the camera
| around. My overall impression was that it's more for the
| doctor's convenience than the patient's; the doctor wants to
| work fast and efficiently without having to deal with the
| patient's immediate comfort.
| mtberatwork wrote:
| > Honestly the prep is the worst part
|
| Not to mention the follow up bill from the out of network
| anesthesiologist.
| noir_lord wrote:
| UK so NHS - bill wasn't a problem.
| quercusa wrote:
| I've had sedation for previous ones but plan to ask for the gas
| next time. I always felt dopey for a long time after and worry
| about long-term effects.
| TheCoelacanth wrote:
| I think sedation is typical. They would do it without if you
| ask, but are not typically going to suggest that.
| crispyambulance wrote:
| In colonoscopy, the prep is the worst part if you do it with
| sedation. The prep is just unpleasant because you spend so much
| time on the toilet.
|
| For myself and many others, it's not really about the pain
| (supposedly there is little to none), it's just the unsettling
| thought of that scope so far up one's...
|
| I was sedated with Propofol and that seemed to be routine in
| the facility I went to. It was a white fluid that came in
| through an IV. I remember saying to the nurse as I saw the
| propfol going in "that tingles..." and she said "that's
| normal", but it seemed to me that she said her answer before I
| finished saying "tingles", then a herringbone pattern visual
| from my tightly shut eyes, then nothing, and I woke as I was
| being wheeled out to the recovery area and felt no grogginess
| at all, seemed that only a couple seconds had elapsed from the
| time I saw the propfol (it was 20 minutes). Powerful drug.
| noir_lord wrote:
| I didn't find it unsettling but I got over body modesty
| issues a long time ago due to ill health, I'm just a machine
| for carrying a brain around and they are mechanics.
|
| The last one the doc doing the colonoscopy was training
| (under supervision) and kept not making the turn, that was
| somewhat painful but generally yeah they aren't very painful
| (for me, ymmv etc).
| gwbas1c wrote:
| I had Propofol last Friday. I don't even remember going out.
| I climbed into the surgical seat, moved my limbs to where
| they could be tied down, while I joked with the nurses and
| anesthesiologist.
|
| I wonder if I just passed out mid-sentence?
| derekja wrote:
| more likely you carried on a conversation you don't
| remember. I came out of a procedure and the doctor came out
| afterward to talk about the results and mentioned things I
| had absolutely no memory of telling him!
| wincy wrote:
| I'm the only person I've ever met in the US who did a
| colonoscopy without any sedation. It was a little uncomfortable
| the same way bad cramps are uncomfortable, but great being able
| to go on with my day.
|
| The nurses were very uncomfortable with the whole thing, the
| doctor had to come in and assure them it was fine. Since it was
| preventative I didn't save any money by forgoing anesthesia (I
| HATE anesthesia, and my mother had had psychotic episodes after
| coming out of anesthesia, so I'm cautious). The whole procedure
| was fast and it was interesting to be awake.
| noir_lord wrote:
| They didn't really push one or the other here (UK), they just
| offered both and explained with one it's 10 minutes in
| recovery and I'm on my way, with the other I'd need to wait
| for longer and have someone pick me up and with me.
|
| So I went for the simpler option.
| wincy wrote:
| I had just happened to read that a high percentage of
| Europeans do it without sedation, which is where I got the
| idea. Anesthesia is something I avoid as much as I possibly
| can. I wish now that I'd pushed more to get the endoscopy I
| had recently done without being completely knocked out,
| although the doctor (a different doctor) seemed a lot more
| resistant to that.
| noir_lord wrote:
| Endoscopy without anything but the throat spray was fine,
| the dry heaving isn't awesome but unlike the endoscopy
| not eating the day before is no real challenge.
| LatteLazy wrote:
| Silly question, won't this push anyone with piles (haemorrhoids)
| to the doctor? Isn't that vastly more than the 5% they expect?
| Confiks wrote:
| Another interesting alternative: the pill camera. You fast,
| swallow a pill containing a camera, a bright LED and a battery, a
| video is transmitted through your body recorded by a sensor
| outside, and someone qualified can glance if anything is wrong.
|
| Pill teardown here [1], images here [2] (without fasting).
|
| The upside is quite clear, especially if you are already used to
| fasting. The downsides are that you can't control the speed of
| the pill going through your digestive system, and if a polyp is
| found, you still need a colonoscopy to remove it (and need to
| fast again).
|
| [1] https://www.youtube.com/watch?v=bH6i3bfie_E
|
| [2] https://www.youtube.com/watch?v=5ufESc1bK78
| azinman2 wrote:
| They don't show the same things as a colonoscopy (good for diff
| stuff), can't take biopsies, and my understanding is that those
| are actually more expensive.
| emayljames wrote:
| My uncle has created a disposable, biodegradable version and has
| been doing a lot of work to get this used and known:
| https://www.mccormackinnovation.co.uk/
|
| edit: https://www.mccormackinnovation.co.uk/flushaway-stool-
| collec...
| lucioperca wrote:
| Is there evidence that people benefit from the colonoscopy or FIT
| at all? Or does overtreatment and risk of the procedure outweigh
| any benefit?
| Kaibeezy wrote:
| My understanding has always been that colonoscopy is long
| proven to be one of the highest benefit ratio procedures in all
| of medicine. Let me see if there's a solid source for that...
| OK, here's the American College of Surgeons fact sheet -
| https://www.facs.org/~/media/files/education/patient%20ed/co...
|
| Unambiguously stating that up to 90% of polyps or the tumors
| they grow into can be detected and removed. Also that lifetime
| risk of these cancers is 4.5%, versus a low risk of
| complications from the procedure. Compare to much lower
| detection rates for non-invasive procedures, and note that a
| positive from a FIT or FOBT will get you a referral for... a
| colonoscopy.
|
| I don't have any expertise here, only marginal interest, and
| hoping like hell that it always stays that way. But it's not
| comforting to read that the odds of a serious horror show are
| higher than flipping a coin and getting heads 5 times in a row.
| Seems unlikely but do you want to bet your life on it?
|
| Also not comforting to see the low rate of detection for the
| lab tests. FOBT misses 2 to 4 out of 10. FIT misses 97% of
| advanced cancer? That must be a typo. Checking... "FIT has been
| extensively evaluated for screening, with sensitivity estimates
| of a single low-threshold FIT for CRC approaching 90%."
| (https://gut.bmj.com/content/68/9/1642) But of course, that's
| once you have something that bleeds. The scope finds those
| earlier.
|
| All very unnerving. A lot depends on the goal: catch your own
| cancer early, which suggests getting a scope early, or increase
| detection broadly among a population, which suggests focusing
| on easy-to-take tests that more people complete.
| chanmad29 wrote:
| sorry, in all this doom, what do you suggest is the best way
| to detect? I had hopes on FIT until you pointed the 97% out.
| Kaibeezy wrote:
| Huge disclaimer: I don't know much of anything more about
| this than I've already said herein, but the basic info
| seems fairly easy to find and parse. - A
| colonoscopy will detect *most* precursor or active
| anomalies. - A FIT or FOBT will detect *many* active
| anomalies once they are bad enough to start releasing
| traces of blood.
|
| What's plain from even a quick read of the info out there
| is that national health systems and big insurers can't
| afford to do colonoscopies on everyone, so they have a huge
| interest in these lower cost lab tests. If enough people
| take them, then the headline can be "we caught more cancer
| earlier, and helped a lot of people". But "helped" means
| things like surviving a few years, which, thanks, but
| that's not the same as surviving full stop.
|
| As an individual, a lab test is way better than nothing,
| but if your health system or insurance will cover the cost,
| or if you can afford to pay for it out of pocket, then a
| colonoscopy will reveal most problems, even fairly early
| and small ones, and give the surgeon a chance to snip out
| polyps and such right then and there. If the scope comes
| back reasonably clear, you can be 10 years until the next
| one.
|
| Keep in mind there is a low risk of "serious complications"
| (one paper concludes ~2.8 per 1000) or death (~0.34 per
| 1000) from the colonoscopy procedure. If you'd like to have
| nightmares about it, source is https://www.giejournal.org/a
| rticle/S0016-5107(11)01965-1/pdf
|
| Please, anyone, correct me if anything there isn't a fair
| generalization.
| chanmad29 wrote:
| thank you for the TLDR
| RobertoG wrote:
| I think that one advantage is that the procedure it's not only
| for screening but preventive. They use it for, at the same time
| they are checking for problems, remove polyps, that can be
| precursors of cancer.
| est31 wrote:
| > Compared with no endoscopic screening, receipt of a screening
| colonoscopy was associated with a 67% reduction in the risk of
| death from any colorectal cancer (adjusted OR (aOR)=0.33, 95%
| CI 0.21 to 0.52). By cancer location, screening colonoscopy was
| associated with a 65% reduction in risk of death for right-
| colon cancers (aOR=0.35, CI 0.18 to 0.65) and a 75% reduction
| for left-colon/rectal cancers (aOR=0.25, CI 0.12 to 0.53).
|
| http://dx.doi.org/10.1136/gutjnl-2016-312712
|
| As a rule of thumb, the earlier it is detected, the better any
| type of cancer is treatable.
| hannob wrote:
| My impression is that colonoscopy is less controversial than
| other forms of screening, even among people who tend to see
| cancer screening very critical.
|
| The USPSTF tends to advise against cancer screenings without
| good evidence, and they are positive about colonoscopy:
| https://uspreventiveservicestaskforce.org/uspstf/draft-recom...
| capitainenemo wrote:
| https://uspreventiveservicestaskforce.org/uspstf/recommendat.
| .. A link to the current recommendation (2016) since the
| other one is still in progress.
| maxerickson wrote:
| There's good evidence that removing polyps prevents cancer. So
| the subset of people that have polyps benefit a lot.
___________________________________________________________________
(page generated 2021-01-13 23:02 UTC)