Why are physicians not ordering annual Stool Tests?

[happy-diver]

I was working on a stool for a good part of the morning and some of the afternoon

 

[DandyDon]

You must be in the medical field as you seem to know enough to cherry-pick publications well and become dangerous.

As to the lack of benefit from colonoscopy, it’s been nicely broken down by Dr. Vinay Prasad.

Yet, with all these limitations, the per-protocol analysis (the best-case scenario), found that the risk of death from colorectal cancer was 0.15% in the invited group vs 0.30% in the usual care group. This is a 50% reduction in relative terms.

I'm impressed with anything that reduces deaths by half!

In absolute terms, the risk difference is 0.15% or 15 per 10,000.

I can imagine a small city of 10,000 that happen to discover a way to save 15 citizens from suffering and early death producing big headlines and maybe statues. Numbers are just numbers but if you work with people who have names and lives, it's more impressive. I guess that you care more about statistics than people.

 

[inventor]

We have doctors on SB, so if you'd like to identify as one and tell me, thanks.

Colonoscopies are rough, I know. I've done a couple when I should have done several over the years. They can catch colon cancer in the earliest stages when it's relatively easy to cure, but few do them. Stool Tests are easy tho, and can tell a person if they need to do a colonoscopy.

There's a volunteer fireman in my small farm town in his 40s with colon cancer, like my brother 30 years ago. We used to think it was a disease of the older folks, but maybe it was just missed before. It's possible in the 20s. They had a benefit today, $10 for BBQ sandwich, chips, and soda. I picked up four, delivered three to my brother's house, and we gave them $120. It was not good BBQ, but oh well.

I remember the hard times my brother went thru decades ago and they barely saved him. The after-effects of all the chemo and radiation he endured then are taking a severe toll on him now, but he's still with us, mostly. Some of the neighbors really pitched in then, driving him 75 miles to treatment and back every day so he could be at home at night while I took care of a few hundred cattle on wheat pasture alone even in blizzards. We did what we could, the cattle actually fared well under my care, and he survived. You'd think that we'd all learn from his problems and all give our colonoscopies every five years, but nope. One of the neighbors who helped the most didn't and then came down with colon cancer too, and I only did a couple. Many haven't at all. Colonoscopies are tough tho with the night before cleansing and all, as well as expensive, so I understand the challenge there.

But over-the-counter kits are available for home stool testing. The kits, available in most pharmacies, cost about $5-$35. The Colon Health Check Test is $35 and takes about five minutes to complete. The test screens for early signs of colon cancer and checks for blood in the stool. Professional labs offer stool culture testing services for about $40-$100. How Much Does Stool Testing Cost? - CostHelper

And everyone over 20 years old should get one yearly...!!

I'm working on it.

 

[BoundForElsewhere]

Just to round out the discussion, there is also the Pill Cam:

Atrium Health Navicent Gastroenterology & Hepatology. Pill Cam®

This thing travels the entire alimentary canal and is the only way to get a look at the whole inside of the intestinal tract.

​

It can't take biopsies or linger for a better look.

That was the closest thing to American politics I've seen. Simultaneously fascinating and disturbing.

 

[Joneill]

No, there has not been a blind study with a thousand people doing the fasting and laxatives every five or ten years, put to sleep, but given a dummy experience to pretend that they were examined as that would cruel.

No need to do that - just study a controlled group that does screening colonoscopies vs a similar group that doesn’t.

Why would you think the “no colonoscopy”subjects would need to do the prep work???

 

[Lorenzoid]

I can imagine a small city of 10,000 that happen to discover a way to save 15 citizens from suffering and early death producing big headlines and maybe statues. Numbers are just numbers but if you work with people who have names and lives, it's more impressive. I guess that you care more about statistics than people.

I don't know if kinoons "cares more about statistics than people," but I think it's a good thing to have both perspectives here. There is the perspective that we have as individuals, in which we would like to diagnose and treat at all costs, and there is the societal perspective in which we weigh the costs and benefits over a huge population.

In the recent thread about guidelines for returning to diving after Covid, I mentioned that I would do the maximum to look after myself regardless of the guidelines, which are aimed at a larger population. Same sort of thing here. If we're the type of people who prefer to do the maximum, rather than follow guidelines intended to help insurers and governments determine what to spend a pool of money on, we have that choice.

 

[kinoons]

You must be in the medical field as you seem to know enough to cherry-pick publications well and become dangerous.



I'm impressed with anything that reduces deaths by half!

I can imagine a small city of 10,000 that happen to discover a way to save 15 citizens from suffering and early death producing big headlines and maybe statues. Numbers are just numbers but if you work with people who have names and lives, it's more impressive. I guess that you care more about statistics than people.

Imagine in a small city of 10,000 that they spend $30,000,000 ($3k a person per scope) every 5-10 years to save 15 citizens.

Now think of what other healthcare or public spending that $30,000,000 (or 20M, or 10M, depending on what cost you want to use) could be used on and better the lives of all 10,000 people instead of just 15 of them.

It also happens to work out that those 15 still die at the same age, just of something else beside colon cancer.

That’s the rub. Based on those numbers screening colonoscopy not only cost a whole lot more than other interventions, but the same number of people die eventually anyways.

As to the cherry picking - please, post cites to randomized controlled studies showing colonoscopy improves overall survival. Yes there is non-randomized studies. I also agree that a Nordic population isn’t the same as the US, so more research is certianly needed, but I think there is a lot of meat left on the bone to the discussion about how helpful screening colonoscopy actually is.


Edit - let’s also not forget that colonoscopy is not a benign procedure. 9985 people will miss work, poo their brains out, spend money, and feel like crap with no benefit. Somewhere between 1-10 of those 10,000 screened will have post scope bleeding and possibly perforation of the colon. That’s obviously not good. [1] [2]

1. Adverse events related to colonoscopy: Global trends and future challenges

2. Complication Rates in Colonoscopy Screening for Cancer: A Prospective Cohort Study of Complications Arising During the Procedure and in the Ensuing Four Weeks

 

[DandyDon]

I don't know if kinoons "cares more about statistics than people," but I think it's a good thing to have both perspectives here.

Good point.

 

[brsnow]

I prefer to get clarity on who funds studies before I read them, this isn’t just for medical studies. It helps to read with that understanding.

 

[DandyDon]

Now think of what other healthcare or public spending that $30,000,000 (or 20M, or 10M, depending on what cost you want to use) could be used on and better the lives of all 10,000 people instead of just 15 of them.

It also happens to work out that those 15 still die at the same age, just of something else beside colon cancer.

That’s the rub. Based on those numbers screening colonoscopy not only cost a whole lot more than other interventions, but the same number of people die eventually anyways.

Except those 15 will not dive at the same age. Your chosen study which you misquoted from really doesn't convince me that all of the studies that show beneficial results are wrong. You remind me of the Youtube doctors who were posting not to get the Covid jabs two years ago. Do you have a YT channel?

I like this article better...

Colonoscopies save lives. Why did a trial suggest they might not?

A major clinical study raised questions about one of the most celebrated cancer-screening procedures available, but a close look at the data tells a different story.

www.nature.com

let’s also not forget that colonoscopy is not a benign procedure. 9985 people will miss work, poo their brains out, spend money, and feel like crap with no benefit.

Yeah, it's stressful, but not that bad, and it's reassuring to know there's nothing deadly going on down there.