Colon screening controversy: Doctors say look at the data and don’t skip it
A new study on colon screening stirs controversy. This research could have negative health implications. It was welcome news for people who just don’t like the idea of a colonoscopy. A new study appears to show that colorectal cancer screening is not necessary.
But the doctors say not so soon. Looking more closely at the data, experts are urging people not to cancel their appointment.
dr Salina Lee is a gastroenterologist at Rush University Medical Center.
She knows screening firsthand, finding and removing polyps that can develop into cancer. Regular check-ups detect cancer early.
“Early stage colon cancer causes no symptoms at all. The most common symptom is nothing,” she said. “Logically, one can assume, and that’s true, stage by stage, if you find a cancer early, you can offer better treatment options and a cure.”
However, a study published in the New England Journal of Medicine questioned the screening. The researchers looked at patients from Poland, Norway and Sweden and found that the 10-year risk of colon cancer in study participants who underwent colonoscopy was lower, but only by 20%, less than in previous studies. Study authors say colonoscopy did not significantly reduce cancer mortality rates.
“It means that when groups were compared between patients who were invited to screening for colorectal cancer via colonoscopy and those who were not invited to screening, there was no significant difference in death from cancer,” Lee said. “This is one of the primary endpoints and a very important endpoint.”
US doctors agree that the numbers in this new study are misleading.
Colonoscopies were not performed on some study patients. Others were invited to undergo the scan, but only 42% actually received a colonoscopy. Nonetheless, information from all of these so-called colonoscopy groups was included in the analysis.
“And if you have a low participation rate, that will change the results,” Lee said. “If you actually look at the effect of patients who underwent screening colonoscopy, the decrease in colorectal cancer death rate was 50%. It was significant when you look at the patients who actually took the test.”
The patient population is also important.
“In the United States, the demographics, particularly in the urban centers, will not look like Norway, Sweden and Poland,” Lee said.
Age also plays a role. This study looked at 55-64 year olds, ages too late to begin colon screening for meaningful protection from death. In the US, a colonoscopy is recommended at age 45. Doctors say it saves lives.
“Colon cancer affects one in 20 people, it’s just so common,” Lee said. “It is the fourth most common type of cancer worldwide. It is the second leading cause of death.”
Bottom line, doctors say more research is needed as this latest European study contradicts what research in the United States has been showing for years. Colon cancer screening is effective in reducing deaths from colon cancer. And now there are other options. Discuss them with your doctor, don’t do without a colonoscopy entirely.
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