Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
A virtual colonoscopy does not miss anything according to the data vs a colonoscopy. See the data above I posted on the topic.
You seem to imply the best alternative is a colonoscopy. But there is no definitive data showing a colonoscopy is a better risk/benefit than a sigmoid as we don't have any randomized controlled studies and we won't until the mid 2020's so you can't make such a statement. On the topic:
"Screening colonoscopy has the potential to prevent colorectal cancer of the entire large bowel but is associated with higher costs, discomfort, complication rates, and capacities needed. Given that colonoscopy is recommended and offered for primary screening in an increasing number of countries, it is important to know its relative effectiveness compared with sigmoidoscopy. The only randomised controlled trial to assess the impact of screening colonoscopy (compared with no screening) on colorectal cancer incidence and mortality started recruitment in 2009, and the first results on reduction of colorectal cancer incidence and mortality are not expected before the mid-2020s.1"
And in your own words, you are also forgetting to mention the risk part in a traditional colonoscopy except for the mention of radiation risk for a virtual. Risk/reward must be taken as one as the NEJM mentions here. And mentioned above in the first few sentences in the BMJ content:
Yes, if a polyp is found by another testing method, a colonoscopy could very well be recommend. But given the other methods have less risk/far less risk, and everyone who has a colonoscopy doesn't need a polyp pinched, it's valid to consider the alternatives first, not go for the jugular right off the bat so to speak.
Yes, it's a personal choice and one must make their own choice, and most importantly, weigh risk/reward. Most trust their Dr. blindly and look at none of this data. That to me is the most important part of the picture....be an informed patient.
What do you not understand about the fact that sigmoidoscopy cannot find polyps or cancers in the ascending, transverse, and proximal descending colon? The scope does not reach that far!
Sigh ...
From your own source:
"Compelling and consistent evidence from randomised controlled trials and observational studies suggests that screening sigmoidoscopy and screening colonoscopy prevent most deaths from distal colorectal cancer. Observational studies suggest that colonoscopy compared with flexible sigmoidoscopy decreases mortality from cancer of the proximal colon.This added value should be examined in further research and weighed against the higher costs, discomfort, complication rates, capacities needed, and possible differences in compliance."
"The extension of life through screening colonoscopy is two or three times longer than the extension achieved through flexible sigmoidoscopy or fecal occult blood test, respectively. Although a large number of colonoscopies are required to screen the U.S. population, relatively few colonoscopies need to be invested per year of life expectancy saved."
"Colonoscopic screening can detect advanced colonic neoplasms in asymptomatic adults. Many of these neoplasms would not be detected with sigmoidoscopy."
Patients found to have polyps at sigmoidoscopy may have more dangerous conditions in the colon not visualized. they are then referred for colonoscopy. However:
"Asymptomatic persons 50 years of age or older who have polyps in the distal colon are more likely to have advanced proximal neoplasia than are persons without distal polyps. However, if colonoscopic screening is performed only in persons with distal polyps, about half the cases of advanced proximal neoplasia will not be detected."
As far as complications from colonoscopy are concerned, most of those are related to polypectomy. If people with polyps found on CT colonoscopy and people with distal polyps on sigmoidoscopy end up having colonoscopies, then you have not really avoided the risks of colonoscopy at all.
Also, polyps are common, occurring in 30 to 50% of adults. That means that potentially 30 to 50% of people who have CT colon studies will still need a colonoscopy.
What do you not understand about the fact that sigmoidoscopy cannot find polyps or cancers in the ascending, transverse, and proximal descending colon? The scope does not reach that far!
Sigh ...
From your own source:
"Compelling and consistent evidence from randomised controlled trials and observational studies suggests that screening sigmoidoscopy and screening colonoscopy prevent most deaths from distal colorectal cancer. Observational studies suggest that colonoscopy compared with flexible sigmoidoscopy decreases mortality from cancer of the proximal colon.This added value should be examined in further research and weighed against the higher costs, discomfort, complication rates, capacities needed, and possible differences in compliance."
"The extension of life through screening colonoscopy is two or three times longer than the extension achieved through flexible sigmoidoscopy or fecal occult blood test, respectively. Although a large number of colonoscopies are required to screen the U.S. population, relatively few colonoscopies need to be invested per year of life expectancy saved."
"Colonoscopic screening can detect advanced colonic neoplasms in asymptomatic adults. Many of these neoplasms would not be detected with sigmoidoscopy."
Patients found to have polyps at sigmoidoscopy may have more dangerous conditions in the colon not visualized. they are then referred for colonoscopy. However:
"Asymptomatic persons 50 years of age or older who have polyps in the distal colon are more likely to have advanced proximal neoplasia than are persons without distal polyps. However, if colonoscopic screening is performed only in persons with distal polyps, about half the cases of advanced proximal neoplasia will not be detected."
As far as complications from colonoscopy are concerned, most of those are related to polypectomy. If people with polyps found on CT colonoscopy and people with distal polyps on sigmoidoscopy end up having colonoscopies, then you have not really avoided the risks of colonoscopy at all.
Also, polyps are common, occurring in 30 to 50% of adults. That means that potentially 30 to 50% of people who have CT colon studies will still need a colonoscopy.
I will still prefer the colonoscopy. I do think it should be done by someone experienced who does them frequently, which to me means a GI specialist.
We got that Suzy, you prefer the risk/reward of the colonoscopy. Though it actually sounds like you focus on the potentialreward and none of the risks of the procedures. Remember, we don't have a randomized controlled trial yet to know which is better in a RISK/REWARD context between a colonoscopy vs a sigmoidoscopy vs no screening. And you ignored in my last post the conclusion from the NEJM on the risk aspect of a colonoscopy but that's your right of course.
So let me rephrase what you asked me in the first line of your post and ask you the following:
What do you not understand about the fact that risk is just as an important factor as potential reward and we don't have a randomized controlled trial yet to tell us this conclusion?
Sigh....
You are not taking into the account the risk of the procedure, just focusing on what one might "miss" with the sigmoid......"the scope doesn't reach up that far". I like to take the rose colored glasses off myself once in a while. So does science.
And observational studies doesn't = randomized controlled, which again, won't be complete until the 2020's comparing the ****RISK/REWARD*** of the colonoscopy vs the sigmoidoscopy vs no screening:
"Screening colonoscopy has the potential to prevent colorectal cancer of the entire large bowel but is associated with higher costs, discomfort, complication rates, and capacities needed. Given that colonoscopy is recommended and offered for primary screening in an increasing number of countries, it is important to know its relative effectiveness compared with sigmoidoscopy. The only randomised controlled trial to assess the impact of screening colonoscopy (compared with no screening) on colorectal cancer incidence and mortality started recruitment in 2009, and the first results on reduction of colorectal cancer incidence and mortality are not expected before the mid-2020s.1"
Notice the risk factor("complications") being mentioned in the first few sentences of the above text that is so important in such a study, not just the potential benefit you keep speaking of. But you'll have to wait until the 2020's. Until then, your observational/"won't go up that far" belief doesn't cut it in the science world of risk/reward. The above randomized control trial when completed will give the answer.
And the study you referred to, quoting just the conclusion:
You forgot to highlight how small the extension of life was between the 3 procedures, so the "2 to 3 times longer" you highlighted is very small. From your source:
"RESULTS:Colorectal cancer decreases the life expectancy of U.S. residents aged 50 to 54 years by 292 days and those aged 70 to 74 years by 70 days. Screening with fecal occult blood tests extends expected lifetime of the 2 age groups by 51 and 12 days, respectively, whereas screening with sigmoidoscopy leads to increases of 86 and 21 days. Colonoscopic screening increases expected lifetime by 170 and 41 days, respectively. The number of colonoscopies needed to save 1 year of expected life ranges from 2.9 to 6.0, depending on the type of screening regimen used."
That's such a small number of days/a few months of life gained between the 3 procedures, from the lowest to the highest. And yes, once again, this study doesn't focus on the risk of the procedure for gaining such a small life increase of a few months.
We got that Suzy, you prefer the risk/reward of the colonoscopy. Though it actually sounds like you focus on the potentialreward and none of the risks of the procedures. Remember, we don't have a randomized controlled trial yet to know which is better in a RISK/REWARD context between a colonoscopy vs a sigmoidoscopy vs no screening. And you ignored in my last post the conclusion from the NEJM on the risk aspect of a colonoscopy but that's your right of course.
So let me rephrase what you asked me in the first line of your post and ask you the following:
What do you not understand about the fact that risk is just as an important factor as potential reward and we don't have a randomized controlled trial yet to tell us this conclusion?
Sigh....
You are not taking into the account the risk of the procedure, just focusing on what one might "miss" with the sigmoid......"the scope doesn't reach up that far". I like to take the rose colored glasses off myself once in a while. So does science.
And observational studies doesn't = randomized controlled, which again, won't be complete until the 2020's comparing the ****RISK/REWARD*** of the colonoscopy vs the sigmoidoscopy vs no screening:
"Screening colonoscopy has the potential to prevent colorectal cancer of the entire large bowel but is associated with higher costs, discomfort, complication rates, and capacities needed. Given that colonoscopy is recommended and offered for primary screening in an increasing number of countries, it is important to know its relative effectiveness compared with sigmoidoscopy. The only randomised controlled trial to assess the impact of screening colonoscopy (compared with no screening) on colorectal cancer incidence and mortality started recruitment in 2009, and the first results on reduction of colorectal cancer incidence and mortality are not expected before the mid-2020s.1"
Notice the risk factor("complications") being mentioned in the first few sentences of the above text that is so important in such a study, not just the potential benefit you keep speaking of. But you'll have to wait until the 2020's. Until then, your observational/"won't go up that far" belief doesn't cut it in the science world of risk/reward. The above randomized control trial when completed will give the answer.
And the study you referred to, quoting just the conclusion:
You forgot to highlight how small the extension of life was between the 3 procedures, so the "2 to 3 times longer" you highlighted is very small. From your source:
"RESULTS:Colorectal cancer decreases the life expectancy of U.S. residents aged 50 to 54 years by 292 days and those aged 70 to 74 years by 70 days. Screening with fecal occult blood tests extends expected lifetime of the 2 age groups by 51 and 12 days, respectively, whereas screening with sigmoidoscopy leads to increases of 86 and 21 days. Colonoscopic screening increases expected lifetime by 170 and 41 days, respectively. The number of colonoscopies needed to save 1 year of expected life ranges from 2.9 to 6.0, depending on the type of screening regimen used."
That's such a small number of days/a few months of life gained between the 3 procedures, from the lowest to the highest. And yes, once again, this study doesn't focus on the risk of the procedure for gaining such a small life increase of a few months.
I am aware of the risks. However, sigmoidoscopy screens only about a third of the colon or less. Would you go to an eye doctor for an exam and have him check only one eye? An ear doctor and have him look at only one ear? I want the entire colon screened. Virtual colonoscopy might find polyps in a third to half of the people tested, who then still need a colonoscopy. That's not a trivial number.
Frankly, I would not be willing to participate in a randomized trial comparing screening vs no screening, because the observational evidence favoring screening is clear and consistent.
The difference in the number of "days of life saved" between colonoscopy and the other screening methods is huge statistically.
I would encourage anyone for whom colonoscopy has been recommended to discuss the pros and cons with his doctor, choose an experienced GI specialist to do the procedure, and realize that any other screening test may still entail (a significant percentage of the time) still having a colonoscopy.
Tip for women: if you have had any pelvic surgery, particularly a hysterectomy, ask if use of a pediatric scope might be a consideration. Sometimes scar tissue from the surgery will reduce the mobility of the colon and make it more difficult to advance the scope.
Would you go to an eye doctor for an exam and have him check only one eye? An ear doctor and have him look at only one ear? I want the entire colon screened.
I sure would, if I had a significant chance of getting an eye or ear punctured/serious complication from said procedure.
Quote:
Originally Posted by suzy_q2010
However, sigmoidoscopy screens only about a third of the colon or less.
For me, to exist on this earth for an extra few months to take on such a risk? That's not a "huge" gain in real world numbers in my world to take on such risk.
"RESULTS:Colorectal cancer decreases the life expectancy of U.S. residents aged 50 to 54 years by 292 days and those aged 70 to 74 years by 70 days. Screening with fecal occult blood tests extends expected lifetime of the 2 age groups by 51 and 12 days, respectively, whereas screening with sigmoidoscopy leads to increases of 86 and 21 days. Colonoscopic screening increases expected lifetime by 170 and 41 days, respectively. The number of colonoscopies needed to save 1 year of expected life ranges from 2.9 to 6.0, depending on the type of screening regimen used."
Breaking in down to real world numbers:- From getting a colonoscopy to not getting one, one who's 70-74 yo adds 70 days to their life.- From getting a colonoscopy to not getting one, one who's 50-54 yo adds 292 days to their life.
- A fecal occult blood test extends life of a 50-54 yo 51 days and a 70-74 yo 12 days.
- A sigmoidoscopy extends life of a 50-54 yo 86 days and a 70-74 yo 21 days.
- A colonoscopic screening extends life of a 50-54 yo by 170 days and a 70-74 yo by 41.
So comparing the lowest rated test to the highest, a 50-54 yo gains an extra 119 days of life and a 70-74 yo gains 29 days.
Again, in my world of living longer/life gained, not the statistical world, is insignificant in my view. Plus again, this doesn't take into account risk and the quality of life one might have if a complication occurs from a more invasive test procedure. Risk/reward.
"Second, the study looked only at death from colon cancer and not from all causes. The physician James Penston, a consultant to England's National Health Service, argued in the British Medical Journal last October that all-cause mortality is a better measure of the value of screening, both because attributing cause of death can be unreliable and because screening itself can be harmful.
"Invasive procedures may have fatal complications, while overdiagnosis—that is, the identification and treatment of tumors that otherwise would have caused no disease—may also result in death," Penston stated. According to Penston, meta-analysis of four randomized trials involving 300,000 people found that tests for bowel cancer did not reduce overall mortality rates."
"Another analysis of British data on colon cancer, by the watchdog group Straight Statistics, concluded that screening 1,000 patients for 10 years will prevent two deaths from the disease. Meanwhile, colonoscopies lead to "serious medical complications" in 5 out of every 1,000 patients, according to a 2006 report in the Annals of Internal Medicine.Given these risks, my guess is that a rigorous examination of colonoscopies will find that their benefits do not outweigh their downside."
I've opted for the in-home kit over the colonoscopy as I have yet to find a facility out east that will either provide colonoscopy shorts or a same-gender team to preserve modesty & dignity.
So far nobody offers the shorts for those wanting to preserve their modesty. Nor will they allow a man to come for the test wearing a pair of boxer shorts backwards.
The test is not a sterile procedure it's a clean procedure so their is no reason not to allow the boxers if they won't provide the shorts or a same-gender team to do the test.
So I've opted for the in-home test. As my pcp said it's better than not doing anything.
One thing they can do for everybody taking this test is dump the adult colonoscope in favor of the thinner-diameter pediatric colonoscope. Some gastrointestinal doctors have already made the switch over & made their patients that take the test with just pain mitigation much happier.
It's extremely hard on the east coast to find a doc that will do the procedure without sedation.
Most places use a versed/fentanyl cocktail. Versed to wipe your memory of the event and the fentanyl for pain. They say it puts you to sleep. It really doesn't. It's called twilight sedation. It makes the patient more compliant so the doctor can finish quicker & get the next one in.
The other drug they are starting to like more is propofol. That will knock you out & you won't remember the procedure.
I'd like to find someone myself who is very experienced doing non-sedation procedures. Will act for the patient on modesty concerns. And use the pediatric colonoscope as it's smaller than the adult version. Friends have done the test with both scopes & like the pediatric colonoscope better because they say it goes in easier & when it loops in the colon it's not as bad as the adult version.
If and until I find someone, I will just do the in-home FIT test each year at physical time to satisfy my PCP who really wants me to get the test.
reneeh63:
It's extremely hard on the east coast to find a doc that will do the procedure without sedation.
Most places use a versed/fentanyl cocktail. Versed to wipe your memory of the event and the fentanyl for pain. They say it puts you to sleep. It really doesn't. It's called twilight sedation. It makes the patient more compliant so the doctor can finish quicker & get the next one in.
The other drug they are starting to like more is propofol. That will knock you out & you won't remember the procedure.
I'd like to find someone myself who is very experienced doing non-sedation procedures. Will act for the patient on modesty concerns. And use the pediatric colonoscope as it's smaller than the adult version. Friends have done the test with both scopes & like the pediatric colonoscope better because they say it goes in easier & when it loops in the colon it's not as bad as the adult version.
If and until I find someone, I will just do the in-home FIT test each year at physical time to satisfy my PCP who really wants me to get the test.
Regards,
Soul
I had my colonoscopy done without sedation and it was done with a pediatric colonoscope, but that was in Reno. I wore a hospital gown and yeah the doc saw my behind, but I'm not sure how he would have put the scope in if he hadn't been able to.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
