Screening for colon cancer (or colorectal cancer, bowel cancer)

[Montecfo]

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Originally Posted by RetiredHappy That has been my experience with my GI doctor as well. He said colonoscopy is the gold standard. In reality, a colonoscopy screening is only as good as the doctor who is doing it. GI doctors do miss seeing growths because it is based on what they see and their interpretation. Both FIT and Cologuard use quantative measurement. I was told by my GI doctor that Cologuard can have false positive. Heck I will take false positive over false negative. If Cologuard is positive, I can always have a colonoscopy to further diagnose. I told my PCP that I am not going to have a colonoscopy unless I am getting a positive with Cologuard. He had been pushing for colonoscopy but he agreed that they are all good screening options. He has no issue with our continued use of Cologuard.

I think you are validating colonoscopy as the gold standard via your stated strategy.

[RetiredHappy]

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Originally Posted by Montecfo I think you are validating colonoscopy as the gold standard via your stated strategy.

I see it as getting multiple data points. The GI doctor would know to look harder for growth with a positive FIT or Cologuard test. Several people whom I know had clear colonoscopies, only to find out that they had colon cancer a couple of years later.

[Montecfo]

Quote:

Originally Posted by RetiredHappy I see it as getting multiple data points. The GI doctor would know to look harder for growth with a positive FIT or Cologuard test. Several people whom I know had clear colonoscopies, only to find out that they had colon cancer a couple of years later.

I see the logic there. I think you take some risk if you are doing the Cologuard in lieu of colonoscopy as it is less effective, though also not invasive.

But your strategy assumes doctor is not competent. So maybe find a well regarded doctor.

I do like Cologuard for folks at below average risk. And I have owned the stock for quite a while, Exact Sciences (EXAS).

[sengsational]

The comment about colonoscopy effectiveness to detect problems "is as good as the doctor performing the procedure" is probably a pretty good way to look at it.

They actually time and track the process of retracting the cope. If it's getting close to tee time, the doctor might get the scope all the way in, take that all-important picture of the cecum (the $ shot), then yank it out without looking too closely. They also track "ademoma detection rate", but as with most things in the medical field, there is no official reporting requirement, so as a shopper, we're left in the dark. Some practices will publish their data, and those are probably the ones you should use.

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An adenoma detection rate is a reportable quality measure that indicates the proportion of screening colonoscopies performed by a physician who detects at least one histologically confirmed colorectal adenoma or adenocarcinoma. Professional societies recommend adenoma detection rates of 15 percent or higher (female patients) and 25 percent or higher (male patients) as indicators of adequate colonoscopy quality.

[RetMD21]

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Originally Posted by Montecfo I think you are validating colonoscopy as the gold standard via your stated strategy.

No the colonoscopy is to confirm and then remove polyps. None of the approaches with noninvasive testing end there. Are really invested in colonoscopy as a gold standard ?

[Montecfo]

Quote:

Originally Posted by sengsational The comment about colonoscopy effectiveness to detect problems "is as good as the doctor performing the procedure" is probably a pretty good way to look at it. They actually time and track the process of retracting the cope. If it's getting close to tee time, the doctor might get the scope all the way in, take that all-important picture of the cecum (the $ shot), then yank it out without looking too closely.

And then they just put stock photos of your colon in the report?

[Montecfo]

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Originally Posted by RetMD21 No the colonoscopy is to confirm and then remove polyps. None of the approaches with noninvasive testing end there. Are really invested in colonoscopy as a gold standard ?

I am just staying fact-based. I am not sure why you would want to avoid a free procedure once a decade which is best able to detect cancers at the highest level.

And if found, remove them.

Unless you believe you are at very low risk or have a great fear of doctors.

People who would do nothing if colonoscopy were only choice should definitely do Cologuard. That is what it is for. Less effective but easier.

And far better than nothing.

[harllee]

Many of my friends who have had colonoscopies have polyps removed as part of the colonoscopy and they are told that those polyps likely would have turned into cancer. What I don't understand about the Cologuard test is whether it detects polyps that are not yet cancerous but could develop into cancer. Seems to me that one of the benefits of a colonoscopy is that the polyps are removed before they are cancerous.

[rodi]

BIL had never had a colonoscopy because he thought it was icky. Last summer, in his mid 60's, he had some issues (constipation) that was bad enough to send him to the doc and he ended up getting his colonoscopy. Stage 3 colo-rectal cancer. He died in April.

I was on the frequent scope plan for a while - had some minor blood in my stool and mentioned it, when asked, at a physical. Was referred to a sigmoidoscopy... Polyps too big to remove with that limited scope were found. Had to prep again for a full colonoscopy. 5 polyps (benign) were removed. I was only 42. Had to rinse and repeat at age 47 and 52... both were polyp free so back on the 10 year track... except - I had an iron deficiency that was unexplained and primary doc referred me again (age 56). GI doc thought he saw something at the top of my intestines that he couldn't identify - so once again I got to prep twice because they did a follow up colonoscopy/endoscopy combo. Nothing found. (Thank goodness.)

But... as I mentioned in another thread on PSA tests... My family is a 'cancer cluster'... so if a doctor suggests a cancer screening - I'm going to say yes.

I really think family history should play a role in the guidelines. I'm doing a bit more aggressive mammograms because of my mother's ovarian cancer. (risks of breast and ovarian cancer are related). I am advising my sons to do PSA screenings when the time comes because of my cousin and father's prostate cancer history. My husband is getting more frequent colonoscopies given his brother's colorectal cancer.

[sengsational]

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Originally Posted by Cobra9777 The GI office is telling her that it's coded as diagnostic not preventative due to the polyp 5 years ago. ... Does anyone know more specifics about this? Is is up to the discretion of the GI office how it's coded? Is it the type or number of polyps?

You're not the only one confused. It's our lovely medical system doing what it does best: obfuscation about costs.

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Originally Posted by Montecfo And then they just put stock photos of your colon in the report?

Mine was timestamped. From cecum to "the end" was 7 minutes and 39 seconds.

[RetiredHappy]

Cologuard claims to detect about 50% of polyps.

[harllee]

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Originally Posted by RetiredHappy Cologuard claims to detect about 50% of polyps.

On the other hand a colonoscopy detects over 90% of polyps. Why would anyone risk their lives on cologuard?

[Montecfo]

Rodi,

I'm saddened for your loss! Certainly a cautionary story.

On your personal experience my internist used to tell me that 85 percent of polyps are found on initial colonospies.

So first one being clean is good sign. Can ease nerves on subsequent ones.

Family history does play a role in frequency guidance.

All the best.

[Montecfo]

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Originally Posted by sengsational You're not the only one confused. It's our lovely medical system doing what it does best: obfuscation about costs. Mine was timestamped. From cecum to "the end" was 7 minutes and 39 seconds.

So were there stock photos on your report? How much time is the correct amount in your opinion?

[RetiredHappy]

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Originally Posted by harllee On the other hand a colonoscopy detects over 90% of polyps. Why would anyone risk their lives on cologuard?

Very simply... my best friend's mother died after her colon got perforated during a colonoscopy. Another very close friend has a clip permanently inserted into his colon after a botched colonoscopy and he almost died. Another person had a ruptured spleen from a colonoscopy and similarly had to be operated on.

[Montecfo]

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Originally Posted by RetiredHappy Very simply... my best friend's mother died after her colon got perforated during a colonoscopy. Another very close friend has a clip permanently inserted into his colon after a botched colonoscopy and he almost died. Another person had a ruptured spleen from a colonoscopy and similarly had to be operated on.

A tragedy for sure. But statistically isn't this a bit like not wearing a seatbelt because your cousin got "thrown clear" of the car and survived a crash not wearing one?

[RetiredHappy]

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Originally Posted by Montecfo A tragedy for sure. But statistically isn't this a bit like not wearing a seatbelt because your cousin got "thrown clear" of the car and survived a crash not wearing one?

On the contrary. Your analogy is for someone who had not gotten screened and say, hey see I don't need screening and I have not died from colon cancer.

These are close friends of mine who had botched procedures. Our pool guy (owner) 's uncle is some big shot doctor at Cleveland Medical Center. Our pool guy said his uncle told him that the risk of colonoscopy going wrong is much higher than most people realize and he has never had a colonoscopy done himself. His advice to our pool guy is to have Cologuard every year. If insurance does not pay for it yearly, then just pay out of pocket. Remember that colonoscopy is used as a screening option and a polyp removal procedure. For people with regular colon cancer risk, there are 2 other screening options which are non-invasive. We make our own health care decisions.

[harllee]

Almost all my friends have colonoscopies at recommended intervals (and I would guess that at least half have polyps removed) and I have never heard of anyone that has had a botched colonoscopy. I would think that a botched colonoscopy is very very rare. On the other hand a colonoscopy that finds a polyp is very common. Yes we all have to make our health care decisions. I hope that folks reading this thread get some sort of colon screening and if it were me I would definitely get a colonoscopy.

[daylatedollarshort]

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Originally Posted by RAE Interesting study, but my guess is that swapping the traditional Western Diet with just about ANY diet that is lower in processed junk foods would have achieved a similar result. Here is the Western Diet as they described it: "people in South Africa ate an “American” high-fat, low-fiber diet: Foods included beef sausage links and pancakes for breakfast; hamburger and French fries for lunch; and meatloaf and rice for dinner." This diet is high in ultra-processed grains (pancakes, burger buns); industrial seed oils (french fries); and sausage links are a processed meat product. And my guess is that the condiments on the burgers contained some unhealthy ingredients as well, like soybean oil. Ketchup on the fries contains high fructose corn syrup. Maple syrup (probably fake) on the pancakes would contain lots of either sugar and/or high fructose corn syrup. Replacing those things with just about ANY unprocessed, whole foods would certainly improve the diet, and probably reduce the risk for colon cancer. So I don't necessarily think the takeaway message from this study should be that Americans should eat less fatty foods, or that we should eat exactly like Africans do. What we should be doing is replacing unhealthy fats (industrial seed oils) with healthy fats, and seeking out whole foods (vegetables, even baked potatoes, fish, grass-fed meat) rather than junk foods such as french fries and processed meat products.

Your reply got me interested in seeing if there were other studies like this. I found this one: Rarity of colon cancer in Africans is associated with low animal product consumption, not fiber - PubMed (nih.gov),

"The low prevalence of colon cancer in black Africans cannot be explained by dietary "protective" factors, such as, fiber, calcium, vitamins A, C and folic acid, but may be influenced by the absence of "aggressive" factors, such as excess animal protein and fat, and by differences in colonic bacterial fermentation."

The nutritionfacts site says colon canceris extremely rare in native African populations, more than 50 times lower than rates of Americans, white or black.

I find it curious that my health insurance company sends me constant reminders to have a colonoscopy but none to tell me to change to a diet that would lower my colon cancer risk 50 times over.

[Montecfo]

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Originally Posted by RetiredHappy On the contrary. Your analogy is for someone who had not gotten screened and say, hey see I don't need screening and I have not died from colon cancer. These are close friends of mine who had botched procedures. Our pool guy (owner) 's uncle is some big shot doctor at Cleveland Medical Center. Our pool guy said his uncle told him that the risk of colonoscopy going wrong is much higher than most people realize and he has never had a colonoscopy done himself. His advice to our pool guy is to have Cologuard every year. If insurance does not pay for it yearly, then just pay out of pocket. Remember that colonoscopy is used as a screening option and a polyp removal procedure. For people with regular colon cancer risk, there are 2 other screening options which are non-invasive. We make our own health care decisions.

Yes we make our own health decisions. But my point is no number of anecdotes, however tragic, can overcome the actual data.

This is just the science behind the medicine.