Why are physicians not ordering annual Stool Tests?

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In my case, while I was working, the company where I worked required me to do one every 5 years from 50 to 65. The first one I did failed as I (in common with a percentage of other people) have what is known as a long and redundant colon - so the mechanical device doesn't reach all the way. So the preparation is the same but the procedure is different. It's done using a tomography with contrast. Pro = no anesthetic needed. Contra - they stick a tube up your butt with low pressure compressed air to expand the whole colon like a balloon, so that after the exam, for the next 3 - 4 hours you'll be releasing the excess pressure. Really funny the reactions of the people going down with you in the elevator after the exam. Now that I'm retired and on a private medical scheme they only cover the conventional colonoscopy, not the virtual one and it's expensive.
 
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+ 1 for this. 👆

I have done colonoscopies since I turned 53 years old. The prep was hard on my first one, but no polyps found, so I don’t have to come back for the next one 5 years later. On my second one, the prep got easier, but they found a polyp, so I had to come back 2 years later. On my 3rd one, the prep got much easier and they found no polyps, so I didn’t need to come back until 5 years later, which is sometime this year.
I checked my record with my Gastroenterologist, it turns out that I had colonoscopy done in 2010, 2015, and 2020,. So it’s done once for every 5 years. My next one will be in 2025.

The 2017 one was for upper endoscopy.
 
I don't think it'd been five years since my last colonoscopy so I asked my PA for a cologuard. Boy those are pricey. Glad that Medicare covers them. It came back abnormal so I asked her to refer me to a specialist in Lubbock so my daughter could drive me to & back as well as let me sleep the anesthesia off at her house. I got the idea that he didn't think much of stool tests when we talked, but we set up the exam.

That clinic certainly is set up for efficiency running patients thru in less than two hours from entrance to exit, several at a time. The laxatives they prescribed didn't work well, unlike my previous experiences, but I followed my prep directions. I think that he had to do extra cleaning, but he gave me a printout of several photos shot in the exam - all clear, no problems. On my exit talk he made it clear that he doesn't care for stool tests, just colonoscopies every five years, but not for me now. If they found any problems at age 80, the treatment would probably be as bad as cancer. Ok, fine.
 
On my exit talk he made it clear that he doesn't care for stool tests, just colonoscopies every five years, but not for me now.

I have seen that a couple of times. Doctors make a lot more money from colonoscopies that writing for lab tests so I can't help but be a little skeptical. In my limited experience, GI and cardiologists are so far behind current research it is frightening. Sadly, that may also be true of the other specialties.

To be fair, there were over 900,000 biomedical research papers published last year alone.
 
Doctors make a lot more money from colonoscopies that writing for lab tests so I can't help but be a little skeptical.
Well, there's reason to wonder there, but the total charges for the doctor, the clinic, and someone else involved was $4,289 while the total approved by Medicare was only $669 (paid by Medicare and my supplement) so I don't see a big profit motive there.

In my limited experience, GI and cardiologists are so far behind current research it is frightening.
Oh really? Well, they're the best I can get and far ahead of what my ancestors could get, all I can do is be grateful.

Four years ago when my 63-year-old home dive bud was hit suddenly with heart failure, he was rushed to one of the two big hospitals in Lubbock and assigned a heart doctor somehow, I don't know who picked that one. The story I got that was the doctor didn't believe in using stents, only bypasses, so he waited a couple of days for such and died. I have no idea which is best, I didn't need either in my chest when I had that angiogram, but I am grateful for my leg stents and how fast I was treated when I went in for problems and a broken one was discovered.
 
What is interesting is ther has never been a study to prove that colonoscopy actually extends or improves life.

It takes the Europeans to run a study, and conclude that the usefulness of a screening colonoscopy is likely very minimal. It’s no better than fecal occult blood testing. [1]

The only method of screening that has even been validated as extending life on a population level is flexible sigmoidoscopy. FIT testing and stool DNA testing has also never been proven to improve overall survival or quality of life.

The study was performed in Northern Europe, so generalization to other populations like the US may be difficult, but it does support the idea that perhaps someone in the US should take enough interest to actually study this since in 2013 colonoscopy cost the US 10 billion annually. [2]

1. Colonoscopy-screening does not prevent colorectal cancer as well as previously assumed - Institute of Health and Society

2. The $2.7 Trillion Medical Bill (Published 2013)
 
What is interesting is ther has never been a study to prove that colonoscopy actually extends or improves life.
Ha! I know two personally. If my brother had one earlier, he would have had polyps removed before cancer developed, not having to endure the torture he went thru to beat cancer, and not suffering from the after effects of those treatments years later. Or the volunteer fireman in my small farm town might be alive and raising his kids.

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.
It takes the Europeans to run a study, and conclude that the usefulness of a screening colonoscopy is likely very minimal. It’s no better than fecal occult blood testing. [1]
Where did that come from? I didn't find it in either link you gave.
The only method of screening that has even been validated as extending life on a population level is flexible sigmoidoscopy. FIT testing and stool DNA testing has also never been proven to improve overall survival or quality of life.
Nor that one.
Yes, that's an interesting study. I'd bet that it inspired a lot of discussion among the experts about its flaws. Like this one: "Healthy people between the age of 55 and 64 was randomized into two groups: One group was offered one screening with colonoscopy, the other was not offered screening at all. All the participants in the study were followed for over ten years, to see if colonoscopy prevents colorectal cancer." How dangerous is semantics? So a large group I assume was offered screening. We are left to wonder how many accepted screening. The big killer today is most people don't do stool tests or colonoscopies but wait until it's too late, like my brother and that TV actress.

That one seems to deal with facts better, but then I like the NYTimes. There is too much profit taking in US medical practices. I wonder what more recent studies have uncovered. Nine years is a long time in this field.
 
Ha! I know two personally. If my brother had one earlier, he would have had polyps removed before cancer developed, not having to endure the torture he went thru to beat cancer, and not suffering from the after effects of those treatments years later. Or the volunteer fireman in my small farm town might be alive and raising his kids.

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.

Where did that come from? I didn't find it in either link you gave.

Nor that one.

Yes, that's an interesting study. I'd bet that it inspired a lot of discussion among the experts about its flaws. Like this one: "Healthy people between the age of 55 and 64 was randomized into two groups: One group was offered one screening with colonoscopy, the other was not offered screening at all. All the participants in the study were followed for over ten years, to see if colonoscopy prevents colorectal cancer." How dangerous is semantics? So a large group I assume was offered screening. We are left to wonder how many accepted screening. The big killer today is most people don't do stool tests or colonoscopies but wait until it's too late, like my brother and that TV actress.


That one seems to deal with facts better, but then I like the NYTimes. There is too much profit taking in US medical practices. I wonder what more recent studies have uncovered. Nine years is a long time in this field.

We don’t know for certian if your brother had a colonoscopy earlier if there would have been a better outcome. The polyps may not have developed yet, the prep may not have been sufficient, or the cancer may have already developed. For a single patient you never know, that’s why studies, preferably RCTs, with large populations are needed to make recommendations for the population at large.

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

“The chance of getting (diagnosed with) colorectal cancer in the invited group was 0.98% vs 1.2% in the usual care group. This represents an 18% reduction in relative terms, and an absolute risk reduction of 0.22% or 22 per 10,000.

The chance of dying from colorectal cancer in the invited group was 0.28% vs 0.31% in the usual care group. This 10% reduction in relative terms amounted to a difference in 3 in 10,000 and did not reach statistical significance.

In the invited group, 11.03% of patients died; in the usual care group, 11.04% of patients died.”



So being invited to a screening colonoscopy (42% of those invited got screened) vs not being invited (and not getting a screening colonoscopy off study) results on basically no difference in outcomes. Virtually identical rates of cancer and virtually identical rates of death from all causes. So it would appear that being screened with a colonoscopy gets no better an outcome than not getting screened at all.

Here is the evidence that flex sig offers a reduction in all cause death.

“ Meta-analysis of all of the flexible sigmoidoscopy trials using the individual NORCCAP study cohorts shows that flexible sigmoidoscopy reduces all-cause mortality (RR, 0.975 [CI, 0.959 to 0.992]; P = 0.004; I2 = 0%) at 11 to 12 years (Figure 2). On the basis of the assumed risk for death in the U.S. population of screening age (50 to 74 years), the absolute risk reduction is 3.0 deaths per 1000 persons invited to screening (CI, 1.0 to 4.9) after 11.5 years of follow-up. Sensitivity analysis showed no important change in outcome with use of different random-effects estimators or exclusion of any single trial.”

 
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