The Truth About Colonoscopy

Posted by Ed 10 mths ago

An issue of Information BEFORE Consent

In my practice I frequently get asked this question: Should I get a colonoscopy?
I generally answer like this:
I have long had reservations about ‘routine’ colonoscopy screening based on age. I’ve seen complications and I’ve never been convinced the test is as beneficial for routine screening as promoted, especially in asymptomatic persons with no family history of colon cancer. Afterall, ‘finding it early’ – and then directing someone to surgery and chemotherapy - is not cancer prevention.
Of course, that was often met with skepticism from patients, and with hysteria from the mainstream medical community. Let’s explore this topic - especially since a new 10-year study, released in October 2022 in the New England Journal of Medicine and discussed in Part 2 of this four-part series, has dared bravely questioned this stalwart procedure.
Colonoscopy is the most commonly used method to screen for colon cancer, which is said to account for around 10% of all cancers globally. It is second leading cause of cancer death in men and women [combined] in the U.S. As of 2020, approximately 69% of adults aged 50 to 75 years have had a least one colonoscopy, representing 62.3 million people. Colon cancer is usually diagnosed when a person is in their 60s and it is more common in African Americans. For more stats about colon cancer go here. 

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Ed 10 mths ago

Know the Risks: Be Informed before Giving Consent

What does this study mean in real numbers?
Given that 15,000,000 colonoscopies are performed each year in the US alone, the study points out:

Exam only, no biopsy/polypectomy: Up to 15,000 persons per year (1/1000) can have a serious complication – colon perforation, persistent pain/burning, persistent diarrhea, etc.

Exam with biopsy/polypectomy: Up to 105,000 persons per year (7/1000) can have a serious complication

75,000 persons per year (5/1000) may experience extended bleeding that may result in hospitalization, surgery and/or need for blood transfusion.

15,000 persons per year (1/1000) may have a perforated colon. Small perforations are less likely to cause immediate peritoneal irritation and the diagnosis can be delayed for as long as 30 days, leading to poor prognosis.

A person can even die from a colonoscopy. The reported death rate after colonoscopy is around 0.09%. That sounds like a tiny number, but when applied to 15,000,000 exams per year, up to 13,500 person per year can die as a result of a colonoscopy! 

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Ed 10 mths ago
KNOW the Choices: Other screening options
Here in Part 3, we will review other types of tests available to screen for colon cancer.

  • Sigmoidoscopies - do you qualify?
  • Testing stool for blood or cancer markers: Guaiac test, FIT test, Cologuard test
  • Recent FDA-approved STOOL tests for colon cancer screening
  • Various little-known BLOOD tests approved for colon cancer screening
  • New tests under development 

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