Why are physicians not ordering annual Stool Tests?

[kinoons]

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

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

Nothing deadly at that moment in time. I have cared for patients who followed the colonoscopy screening recommendations and still developed undetected cancer until I found it in the ER as a large mass with metastasis. It isn’t common, but it happens. It’s imporntant to remember screening is only one tool. Self awareness for symptoms or signs of cancer is also imporntant.

According to the study, which I did not misquote, there was no statistically significant difference in overall survival in either group. On average, after ten years, participants died at the same age regardless if they received a screening colonoscopy or not. They didn’t necessarily die of colon cancer, but they died none the less. Isn’t the purpose of screening to help people live better and longer overall?

The USPST review was of observational and modeling studies, as acknowledged in the article you linked to. Observational data is nearly always riddled with bias. For example, patients who chose to get a colonoscopy may be more complaint with not smoking, exercising, or consuming less alcohol. Observational data tries to acccount for this, but it’s difficult at best. Modeling data is a guess of what might happen when you pick the variables. Neither are good ways of performing medical research. Anyone remember the Covid models of 2.2 million deaths early in 2020? [1] How close to right did they get that one? This is why RCTs are the gold standard of medical research. Yes they can be wrong, populations involved must be considered, and RTCs too need to be replicated, but they’re they’re best tool we have at the moment.

The nature article also makes the mistake of focusing on relative risk reduction vs absolute risk. An 50% reduction in cancer risk sounds like a lot.

However, an absolute risk reduction of 0.15% doesn’t sound that great.

So it all depends on how you spin it to your patient. On one hand you can tell the patient I can reduce your risk of death from colorectal cancer by 50% and they will undoubtedly jump on board.

On the other hand you can tell your patient you can take their risk of death from colorectal cancer from 3 in 100 to 1.5 in 100 and perhaps they will pause before they leap.

Both are true, but one lacks perspective. Now imagine you’re a GI doctor who gets paid to do scopes. Imagine you’re a surgery center or hospital that has multiple dedicated procedure rooms and dedicated teams to performing colonoscopies. Perhaps the physician group has ownership interest in the hospital/procedure center. Which side of the coin do you think they will present to the patient.

Researchers will try and church up their results by offering a per-protocol analysis (if everyone participated in the invitation for screening in this case). Like Dr. Prasad I disagree with that approach. The real world is never perfect. Medical professionals must acknowledge that patients do not always do what we want.

You also conveniently overlooked the part of my post discussing that colonoscopy is not without possible real complications. Somewhere between 1 in 10,000 and 10 in 10,000 have bleeding and perforation. (The nature article puts the number at 3 in 10,000 for perforations) No doubt some complications will be fairly mild, others are life threatening. If that number is on the high side you’re nearly entirely erasing the benefit of the colonoscopy screening.

1. https://www.cato.org/blog/how-one-model-simulated-22-million-us-deaths-covid-19

 

[drrich2]

On the other hand you can tell your patient you can take their risk of death from colorectal cancer from 3 in 100 to 1.5 in 100 and perhaps they will pause before they leap.

You make a good point; I'd follow up with a couple of caveats.

1.) Watching somebody die of colon cancer can change a person's perspective on the significance of 1.5 in 100 less likely. Granted, to follow up your broader argument, they'll die of something else if colon cancer doesn't get them, and it might not be a walk in the park, either.

2.) A number of medical interventions don't look all that good if you compute the NNT (number needed to treat), the number of people you subject to that invention on average to prevent one bad outcome (e.g.: stroke, death). So if you take a statin for heart attack and stroke prevention, and look up the NNT, it may seem like a long shot.

But that's not the only intervention a person makes for their health. A colonoscopy, periodic physician visits with blood pressure monitoring, keeping their weight down from what it might otherwise be, for some taking a statin, etc...

Many things we routinely do probably won't make a big difference in our lives; seat belts are a fine example. But many of us do these things.

 

[NW Dive Dawg]

In my opinion, when it comes to your flipp'n life...... Ignore this thread and just ask your doctor the simple question of which is best. A colonoscopy or a mail in stool analysis!

 

[DandyDon]

In my opinion, when it comes to your flipp'n life...... Ignore this thread and just ask your doctor the simple question of which is best. A colonoscopy or a mail in stool analysis!

That'll work. With regard to my original question, one might ask why neither has not been suggested before, or not. And for the folks not getting annual exams, start now and be sure to include one of those.

 

[BoundForElsewhere]

has anyone considered the fact that maybe some us just like having things shoved up our rectum?

No judging, please.

 

[kinoons]

You make a good point; I'd follow up with a couple of caveats.

1.) Watching somebody die of colon cancer can change a person's perspective on the significance of 1.5 in 100 less likely. Granted, to follow up your broader argument, they'll die of something else if colon cancer doesn't get them, and it might not be a walk in the park, either.

2.) A number of medical interventions don't look all that good if you compute the NNT (number needed to treat), the number of people you subject to that invention on average to prevent one bad outcome (e.g.: stroke, death). So if you take a statin for heart attack and stroke prevention, and look up the NNT, it may seem like a long shot.

But that's not the only intervention a person makes for their health. A colonoscopy, periodic physician visits with blood pressure monitoring, keeping their weight down from what it might otherwise be, for some taking a statin, etc...

Many things we routinely do probably won't make a big difference in our lives; seat belts are a fine example. But many of us do these things.

I agree with a lot of what you said. Even more so the population you’re looking at matters. Take statins for instance. For primary prevention of heart attack the NNT is 60, however for secondary prevention, the NNT is 39.

Aspirin is another. For primary prevention the NNT is an abysmal 1,667. That number drops to 77 for secondary prevention. This is why we’re seeing providers move away from aspirin for primary prevention.

What are the odds that your medication will help you get better?

Although we think if a doctor prescribes a medication that it's going to help, a lot of therapies benefit very few patients.

www.statnews.com

To come back to the colonoscopy discussion; if you have risk factors then screening more frequently or with colonoscopy vs another method may be the right answer. OTOH if you’re young, healthy, and without risk, then foregoing colonoscopy for another test (or perhaps no testing) may be the right answer for you. That’s a discussion you and your doctor should have about your individual risk.