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Old 02-23-12 | 01:46 PM
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Dudelsack
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Originally Posted by icyclist
"colonoscopies reduce the death rate from colon cancer by a whopping 53%"

Do they? I'm not saying we shouldn't have colonoscopies, however:

"The new study did not compare colonoscopy with other ways of screening for colorectal cancer and so does not fully resolve a long-standing medical debate about which method is best. "

However, in another study reported in the same New England Journal of Medicine, as reported in the Washington Post:

"About 53,000 participants were given a colonoscopy or a stool blood test. Both tests found similar numbers of colon cancer cases — about 30 in each group."

So .001 percent of 53,000 had cancer, and the stool blood test worked as well as the colonoscopy. Personally, the blood stool test seems like the one I want to take in the future. However, the colonoscopy was magnitudes better at finding growths in the intestine - they just weren't necessarily cancerous growths.

Also from the Washington Post:

"The study was not a randomized trial that’s the gold standard in medical research."

And there's this, from the NYT article:

Dr. Harold C. Sox, an emeritus professor of medicine at Dartmouth Medical School and former editor of a leading medical journal, Annals of Internal Medicine, said that because all of the patients in the study had adenomatous polyps, it is not certain that the findings would apply exactly to the general population.

In fact, the type of polyp researched in the study is only found in about 15 percent of women and 25 percent of men.

Dr. Sox also said, "the people with polyps were part of a study that provided high-quality colonoscopy, so they may not have been comparable to the general population."

Sox does think, though, that removing polyps will lower mortality rates.

And there was this:

"certain types of polyps are hard to detect and...colonoscopy is better at finding polyps in the lower part of the intestine than in its upper reaches."

So a colonoscopy is better than no test. However, it won't guarantee that we won't get or don't already have colon cancer, it may be no better than the stool sample test, and the results of this study may not pertain to the general population.
Sorry, but the head to head comparisons of colonoscopy and stool hemoccults is settled science and has been for at least ten years.

In a university setting, colonoscopy has also been shown to be superior to other screening modalities, even CT colography. CMS was impressed enough with the figures to pay for preventive colonoscopies but not CT colographies. Anyone who has dealt with Medicare knows that they almost never pay for preventive services, so the colonoscopy data was that dramatic.

Studies questioning detection rates of right colon cancer were seriously flawed by substandard cecal intubation rates.

There are many areas that one may reasonably quibble with colonoscopy, such as age of screening initiation, interval between studies, age to terminate screening, quality of examiners, and so forth. But the utility of screening colonoscopy is so settled that voices to the contrary are best considered deniers.
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