Do you need a colonoscopy?Doctors talk efficacy after controversial study

For people aged 45 to 75 who are recommended to have colorectal cancer screenings to prevent colorectal cancer, you may see something new, Groundbreaking study published in the New England Journal of Medicine Screening methods have been found to have little or no reduction in risk of death, so there is some leeway.

Not so fast, experts say. There are several reasons for this study. Colonoscopy — I may not have answered that question.

First, if you haven’t read about the research yet, let me give you some details.

New Study Finds Colonoscopy Has Little Impact on Colorectal Cancer Death Risk

In a trial involving 84,585 European participants 55 to 64 years old With a median follow-up of 10 years, the researchers randomly assigned 28,220 of the participants and invited them to undergo colonoscopies, while the rest continued their normal lives (control group ). Of the group who underwent colonoscopy, only 11,843 (42%) were offered.

During follow-up, 259 participants who underwent colonoscopy developed colon cancer, compared with 622 in the control group of 56,365 members. These findings translated to a 0.98% risk of developing colon cancer in the colonoscopy group compared to 1.2% in the control group. The risk of dying from colorectal cancer was 0.28% in the colonoscopy group compared to 0.31% in the control group. The risk of death from any cause was 11.03% in the colonoscopy group and 11.04% in the control group. The researchers concluded that for every 455 people invited to be screened, one death from colorectal cancer would be prevented for her.

However, it is important to note that the above findings are based on an analysis that includes: Everyone The colonoscopy group also includes people who did not actually accept the invitation to undergo a colonoscopy.

When researchers compared only those who had colonoscopies with members of the control group, those who had colonoscopies had half the risk of death as the control group. Still, those who decided to get colonoscopies may have had symptoms that persuaded them to get screened for colon cancer, so the findings may not tell the whole story either. .

So do you still need to have a colonoscopy?

Otis Brawley, Ph.D., professor and cancer screening expert at the Johns Hopkins School of Public Health, said: in Baltimore.

People with a positive stool test are recommended to have a colonoscopy to determine if the positive test indicates actual cancer.

“The strongest evidence that screening works comes from annual stool testing clinical trials,” said Brawley. “The way we have come to recommend colonoscopy is that over a decade of positive stool results, 43% of those who had a stool test had a colonoscopy. I was advised to be tested.”

Gastroenterologists believe that 43% are close to 50%, and if 50% of people get colonoscopies, they do 100%, says Brawley.

There is no doubt that screening of any kind saves lives, said Brawley. But the public is overestimating how many lives have been saved, he added.

“Studies show that screening can prevent one-third of deaths from colon cancer,” said Brawley. “Two-thirds of people still die from colon cancer.”

The reason, Brawley said, is that some cancers grow so quickly that they can reach a very late stage with 10 years between colonoscopies. In addition, some polyps are flat and overlooked by medical professionals who perform colonoscopies, he added.

We now have 30 years of data on people using stool testing. Brawley hopes that if the authors of the new study follow the participants for another 10 or 20 years, their data will show that colonoscopies are lifesaving.

The lack of improvement in mortality was “somewhat surprising” for Dr. Jason Dominitz, professor of medicine at the University of Washington School of Medicine and executive director of the National Gastroenterology and Hepatology Program at the Veterans Health Administration in Seattle. Dominitz co-authored an editorial that accompanied the new report, suggesting a number of reasons why the study did not show improvement in mortality, including too short a follow-up period.

“Part of the reason is that the rate of colonoscopies was much lower,” Dominitz said. “Colonoscopy is ineffective if it is not performed. This study shows that colonoscopy significantly reduces cancer incidence and ultimately reduces mortality. It will lead to a decline.”

Because the study was structured around inviting people to undergo colonoscopies, some physicians were more concerned with the public’s fear of colonoscopies than with the effectiveness of surgery. It states that it clarifies

“What this study shows is that many people are hesitant to go for a colonoscopy, but those who do have a lower mortality rate from colorectal cancer. That means we need to step up our efforts to educate people about the importance of colonoscopies!” murmured Dr. Leonidas Platanias, Director of the Robert H. Lurie Comprehensive Cancer Center at Northwestern University.

“A more appropriate title for this study might have been ‘Colonoscopies prevent cancer and death only if people do it’.” We must recognize that it is about the invitation to have a colonoscopy,” added Fola May, Ph.D., associate director of the UCLA Kaiser Permanente Center for Health Equity. twitter.

The bottom line, according to Dominitz, is: “Don’t cancel your colonoscopy.”

The paper is part of a series of ongoing studies that “help fill a knowledge gap about the efficacy of colonoscopy, but do not change the fact that colon cancer screening saves lives.” said Dr. Benjamin Rebwall, a gastroenterologist and associate. Professor of Medicine and Epidemiology at Columbia University Bagueros School of Medicine.

“People planning to undergo a colonoscopy are strongly advised not to be dissuaded by the results of this study,” Lebwohl said. “No test is perfect. A common maxim in our community is that the best tests are the ones that are completed. The question of whether screening can save lives has been settled. The remaining question is: Should a colonoscopy be the first test?”

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