quote:

Originally posted by ZSMICHAEL:
No. Cannot remove polyps either. Often cannot tell until the surgeon opens up the area. Endoscopy cuts down on exploratory surgery which was far more invasive.

Only a tiny fraction of polyps ever develop into cancer. Less than 5% by most accounts. I have no doubt that companies like Cologuard would prefer people go with their product, but I wouldn't discount the motivation of surgical centers and GI docs out of hand. Personally, I've been doing Cologuard since I turned 50. Even if the sensitivity is slightly less, it gives you three opportunities every ten years to catch that early cancer vs one every ten years.

I believe there are only 3 countries (Germany, Switzerland, and Austria) in addition to the US where colonoscopy is used as a standard screening tool.

Very difficult to draw conclusions from this study.
1) Random--no discussion on who the "invited" participants were.
2) Only 42% of invited participated = 11,843
3) Control group (was not screened) = 56,365
4) No anesthesia--who undergoes an invitation for non medicated colonoscopy?
5) No discussion of adequacy of prep nor visualization of the entire colon.
6) 259 cases of colon cancer identified in the invited group. 622 cases identified in the control group.(unknown stage of diagnosis)
Unknown background rates of colon cancer in Norway, Sweden, Poland
Cannot use the "gold standard" of US colonoscopy in countries that don't screen by colonoscopy.

Figure is betwween five and ten percent that develop into cancers. You take your chances with Cologuard. Cancers of the colon generally develop from polyps. No polyps no cancer.

quote:

Originally posted by ZSMICHAEL:
Figure is betwween five and ten percent that develop into cancers. You take your chances with Cologuard. Cancers of the colon generally develop from polyps. No polyps no cancer.

Well, my mom (78) had her colonoscopies every ten years as scheduled.(50, 60,70). In those three, she had one benign polyp. Earlier this year, her hemoglobin started to get low. They did a colonoscopy/endoscopy and found an area of bleeding in a diverticulum. As an incidental finding, they removed one small polyp from a completely separate area. It had a 2mm area of T1 cancerous cells, but was a bit too close to the margin to call it 100% safe. She underwent a partial colectomy and had about 8" of colon removed a few weeks ago. Would Cologuard have caught it at 73 or 76 before it even reached 2mm? I have no idea, but she certainly didn't benefit from the "routine" screening colonoscopies.

Quality of the bowel prep, and the skill of the GI doc are additional factors. Some polyps in the cecum are missed because of location.

quote:

Originally posted by Some Shot:

quote:

the participants who were invited to colonoscopy

That's the test group? Rather than only the 42% of that group who actually got a colonoscopy?

Keeping that 58% of those invited, but who didn't participate, does dilute the results. The second way of analyzing the results is more useful (and shows colonoscopy to be more effective).

I have to agree with "follow the money".

This. The "data analysis" of this study is a flipping joke. You can't determine the effectiveness of a treatment by including people who didn't even receive the treatment in the "treatment group." This is basic Statistics 101.

Most medical trials/studies are jokes.

quote:

This. The "data analysis" of this study is a flipping joke. You can't determine the effectiveness of a treatment by including people who didn't even receive the treatment in the "treatment group." This is basic Statistics 101.

"Intention to treat" analysis is normally considered the gold standard; however the low response rate really calls into question the appropriateness of using that as the primary result of the study, IMO.

OTOH it is the first randomized controlled trial (RCT) of this procedure. 30 years ago I was director for preventive medicine of a very large medical group, and was responsible for developing and implementing the first evidence-based practice guidelines for preventive medicine for adults. Colonoscopy was one of the hard issues, because there was no RCT. A physician in our Division of Research did a clever study: he identified people who had colon cancer (at that time sigmoidoscopy was the standard procedure), then whether the cancer was found within the reach of the scope or beyond it. It showed that cancer found by the sigmoidoscope led to lower mortality.

Then the Southern California group in our "federation" decided to implement colonoscopy routinely; taught nurse-practitioners to do the procedure, did other things to make its use widespread and reasonably cost-effective. Soon routine colonoscopy was adopted--BUT there remained the question of acceptability of the procedure due primarily to the widely known discomfort of the prep, I think.

Given the results of the new study, I would hope that colonoscopy would still be offered at least to (1) those with family history and (2) patients who request it, based on a discussion with their physician. Colonoscopy reduces colorectal cancer mortality for those who choose to have the procedure. And of course the cost of the procedure should continue to be covered by insurance.

I’ve had questions about the colonoscopy testing. My FIL died of colon cancer at 62, 6 months after being given a clean colonoscopy result.

My wife is on a 3 year testing regimen as a result of her family history. If she has the same cancer, that’s still over 2 years and 6 months too infrequent.

The cologuard style tests can be done much more frequently, in addition to the colonoscopy 10, 5 or 3 years apart.

Is the cologuard mentioned the poop in a bucket and then ship it to California? (which has so many jokes available you don't know where to start)

That's what I chose to do. Not sure which is a better option but it sure seems like checking for Cancer cell DNA is a more modern approach than ramming a camera up your ass.

quote:

Most medical trials/studies are jokes.

^^^^^^^^^^^^^^
I call it junk science. Many of the older studies are being called into question.

One thing to consider on a cologuard test. We found out this summer that if a cologuard test is taken instead of a colonoscopy and it comes back positive the colonoscopy afterwards is no longer considered a preventative procedure by the insurance company and is no longer fully covered. So we now have to pay the copay and the 20% of the total bill.

^^^^^^^^^^^^
That is crazy. Typical insurance scam.

quote:

Originally posted by ZSMICHAEL:
^^^^^^^^^^^^
That is crazy. Typical insurance scam.

Agreed. When we told our doctor about this she was quite upset. We informed her so she can inform her patients. My wife would have had a colonoscopy if she was aware of this.

quote:

Originally posted by Ozarkwoods:
One thing to consider on a cologuard test. We found out this summer that if a cologuard test is taken instead of a colonoscopy and it comes back positive the colonoscopy afterwards is no longer considered a preventative procedure by the insurance company and is no longer fully covered. So we now have to pay the copay and the 20% of the total bill.

This is a common problem. Because an "issue" was found with the cologuard test, the procedure is now considered "diagnostic" by the insurance company.

Several insurance companies have also been changing screening colonoscopies to diagnostic colonoscopies if a polyp is found and taken out by the endoscopist.

Just another shady practice insurance companies have been using to get out of paying for things.

quote:

Originally posted by sjtill:

quote:

This. The "data analysis" of this study is a flipping joke. You can't determine the effectiveness of a treatment by including people who didn't even receive the treatment in the "treatment group." This is basic Statistics 101.

"Intention to treat" analysis is normally considered the gold standard; however the low response rate really calls into question the appropriateness of using that as the primary result of the study, IMO.

That's the exact issue of how the "study" presents its data. It is claiming that the "intent to treat" represents the efficacy of colonoscopy as a cancer screening test — which is simply not true.

There are several other issues and hidden variables that are not addressed as well.

-Endoscopist skill (I assume the endoscopists weren't that skilled at looking for, and removing polyps, due to the fact that it isn't common practice where the study took place)

- Quality of prep (In the USA, a bad prep = come back in a few days, few months, or 1-3 years depending on how bad the prep was. This was not the case in the study).

- Starting age of 45 with variation and followup colonoscopies dependent on family hx and personal hx (not the case in this study).

Practically all the details and variables that have been found to reduce risk and incidence in the USA were ignored by this study.

When I see a study that doesn't make much "sense" to me, I wait until I see more studies that confirm the original before it changes my opinions.

I think I'll wait a couple of years to see if anyone else confirms these results.... until then, count me as very skeptical of this study.

Just my opinion...mike

quote:

Originally posted by Ozarkwoods:
One thing to consider on a cologuard test. We found out this summer that if a cologuard test is taken instead of a colonoscopy and it comes back positive the colonoscopy afterwards is no longer considered a preventative procedure by the insurance company and is no longer fully covered. So we now have to pay the copay and the 20% of the total bill.

What's your life worth? A few thousand?

quote:

Originally posted by MNSIG:

quote:

Originally posted by ZSMICHAEL:
No. Cannot remove polyps either. Often cannot tell until the surgeon opens up the area. Endoscopy cuts down on exploratory surgery which was far more invasive.

Only a tiny fraction of polyps ever develop into cancer. Less than 5% by most accounts. I have no doubt that companies like Cologuard would prefer people go with their product, but I wouldn't discount the motivation of surgical centers and GI docs out of hand. Personally, I've been doing Cologuard since I turned 50. Even if the sensitivity is slightly less, it gives you three opportunities every ten years to catch that early cancer vs one every ten years.

I believe there are only 3 countries (Germany, Switzerland, and Austria) in addition to the US where colonoscopy is used as a standard screening tool.

I have them every 36 mos, the (same) doc always finds polyps and removes them. I guess the risk is mostly anesthesia (propofol ?) and the surgeon making a mistake. I asked the doc what the polyps were and how taking them out is a good thing, he said colon cancer comes from polyps, and removing them actively prevents the cancer. Makes sense to me, but I don't know if that's the biggest story for colon cancer or not.

quote:

Originally posted by Blume9mm:
Is the cologuard mentioned the poop in a bucket and then ship it to California? (which has so many jokes available you don't know where to start)

That's what I chose to do. Not sure which is a better option but it sure seems like checking for Cancer cell DNA is a more modern approach than ramming a camera up your ass.

There is something perversely satisfying about that whole Cologuard procedure. When you drop it off at UPS, do they know what's in there? Anyway, I had 4 colonoscopies and one Cologuard over 21 years and as weird as the Cologuard procedure seems, I prefer to not undergo anesthesia any more than I have to at my age.