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Colon Cancer Screening: The Guidelines and Controversy

Dave Sharkis, MD
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When it comes to colon cancer screening, colonoscopy isn't the only answer. The best test most patients is the one they are most likely to have completed.

 

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Ian L., Dr -

There are no figures for deaths from colonoscopy ..Levin Tr in annals of internal medicine 2006 reported on 16,318 patients over 40 from Jan 1994 - July 2002 in a Kaiser Permanente Study
Ten deaths occurred within 30 days -one was attributed to colonoscopy .
Extrapolating if there are 15 million colonoscopies in the USA per year there will be 750 deaths from colonoscopy within thirty days .
In Wikepedia death rate is described as varying from 1in 3300 to 1 in 330000 so the figures are elusive .
Death rate extrapolating on these figures for fifteen million colonoscopies vary from 15 - 1500 .
Unclear .
As for average risk the "spanner in the works" are obesity smoking high barbecue meat intake alcohol and smoking .
Here a lot of cancer is RectoSigmoid so FIT DNA stool test plus flexible sigmoidoscopy and double contrast enema covers a lot .
Intuitively cancer prevented between 35-60 ought have total mortality benefit .

Paul H. -

Overall, another excellent podcast, making the remarkable point that FIT testing or FOBT testing is almost as good as colonoscopies for detecting colon cancer, all at a fraction of the cost and with fewer significant side effects. Allow me to bring up one point which, in my view, muddied the analysis of this issue.
Andrew believes that there is no overall all-cause mortality benefit from colorectal screening, but then suggests that screening 1000 people leads to 22-24 fewer colorectal deaths and 234-260 life years gained. Doing the math suggests that each one of these individuals screened and saved from colorectal cancer lives, on average, about 11 years longer. When this benefit is averaged out over the entire screened group, the life time gained per screening may be only 3 months, but the findings are very significant for those who were screened, found to have colon cancer, and whose lives were subsequently extended by over a decade. Andrew then speaks about the potential harm of bowel perforation due to colorectal screening (1:2500 individuals screened), stating that for the specific individual screened who then subsequently develops a bowel perforation, the chance of harm is 100%. This strikes me as a subjective way to interpret this data. In the first case, the apparent gains of colonoscopies are minimized by averaging them into the entire screened group, but in the second case the potential harms are magnified by focusing only on the individual harmed and ignoring the screened group.

Ian L., Dr -

I believe that if you find by sigmoidoscopy a 20 mm Villous Polyp in a person aged 50 you likely have saved at least ten years of their life .

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Aspirin Loses Its Tenure Full episode audio for MD edition 174:59 min - 82 MB - M4AHippo Primary Care RAP November 2016 Summary 388 KB - PDF

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