Study Shows Limitations Of Colonoscopies

CBS Evening News: Procedure's Effectiveness May Depend On Where In The Colon The Cancer Starts, New Research Finds

(CBS)  Colonoscopies have long been considered the gold standard for colorectal cancer screening - 90 percent effective in detecting the second leading cancer killer of men and women in this country.

But a new Canadian study suggests the procedure may detect polyps and early cancers only 60 to 70 percent of the time , reports CBS News medical correspondent Dr. Jon LaPook.

According to the study, whether a colonoscopy saves a life may depend on exactly where in the colon the cancer starts

"It seemed to prevent two-thirds of the deaths from left sided colon cancer," said Dr. Nancy Baxter of the University of Toronto. "But it didn't seem to prevent any of the deaths from right-sided colon cancer."

One possible explanation is that polyps on the left side of the colon are more likely to be raised and easy to detect, while those on the right side tend to be flatter and easy to miss.

The results are being debated by doctors. Only about 30 percent of the colonoscopies in this Canadian study were performed by gastroenterologists.

"We don't know the quality of the colonoscopies, the skill of the examiners, the preparation of the patients, the completeness of the colonoscopies," warned Dr. Sidney Winawer of the Memorial Sloan-Kettering Cancer Center.

Other studies have found doctors who rush through the procedure can miss polyps. It's also important for patients to follow the instructions for colon cleansing to the letter.

And even if colonoscopies are less accurate than previously thought, they're still the best way to prevent colon cancer.

"Colonoscopy can reduce mortality from colon cancer," Winawer said.

Colon cancer screenings are recommended for most people starting at age 50. Patients should choose experienced doctors and make sure that they follow their doctors' directions to the letter when preparing for the procedure.

[brainteaser2]

Colonoscopies are fine - the hard part to figure out is why they have become so expensive. The procedure is basically a med school skill level. A few simple and inexpensive drugs are used so why the big bucks??? We need to take the hot air out of many medical procedures so they are affordable.

[godofredo29]

What part of "minimally invasive" do these doctors not understand? We men are already familiar with this song and dance with cystoscopies (where the doctor forces a large probe up your ***). They want more people to have colonoscopies? Then make them safer and easier! And, by safer, I mean no waking up after one of these only to discover you''ve had a colostomy because the probe pierced your colon and you had to have part of it removed. And, it surely has to be possible to effectively cleanse the colon without the draconian tactics they use now. "Make it pleasant and they will come!"

[liptonlight]

It''s easier to die than to take MoviPrep

[mitch5511]

MRIs are better!

[saraplumber]

But to answer your question, I have already instructed and presented my family with a living will. I am DNR, no feeding tubes, no intubation, no life saving attempts. Keep me comfortable and let me go to the maker.

How much $$ do you want your children giving to saving your life instead of leaving it for them/

Posted by docpeter1953 at 10:57 AM : Dec 17, 2008
----------
I wasn''t talking about unnecessary or not useful live saving measures. Many chronic diseases (i.e. diabetes) can be treated with medications - medications which are costly. Or, what happens if you develop a tear in your aorta; an expensive surgical procedure can be performed which will save your life.

I don''t know the answer; there are always trade-offs involved. The latest treatments and procedures are going to be expensive. So, the trade-off may be between offering access to the best, most high-tech care, or offering affordable care to everyone.

[j_flood]

Please stop quibbling about the health care systems and focus on the need to have colonoscopies!

Had one two weeks ago - they found a small tumor in the notorious ''right'' side and I''m in for surgery on the 19th.

Please focus your comments on the value of colonoscopies not on salient comments.

[docpeter1953]

Seriously though, let''''''''''''''''s worry about getting adequate health care for all Americans instead of advanced care for those who can afford it.

Posted by gce65 at 03:39 AM : Dec 17, 2008
----------------
Are you sure about this? What happens if you get stricken with an orphan disease that requires lifelong, expensive medication? Or need an expensive procedure to repair your heart?

Posted by saraplumber at 09:35 AM : Dec 17, 2008
____________________

Sorry, had a computer hiccough.

But to answer your question, I have already instructed and presented my family with a living will. I am DNR, no feeding tubes, no intubation, no life saving attempts. Keep me comfortable and let me go to the maker.

How much $$ do you want your children giving to saving your life instead of leaving it for them/

[docpeter1953]

Seriously though, let''''''''s worry about getting adequate health care for all Americans instead of advanced care for those who can afford it.

Posted by gce65 at 03:39 AM : Dec 17, 2008
----------------
Are you sure about this? What happens if you get stricken with an orphan disease that requires lifelong, expensive medication? Or need an expensive procedure to repair your heart?

Posted by saraplumber at 09:35 AM : Dec 17, 2008

[docpeter1953]

From the above article, ''But a new Canadian study suggests the procedure may detect polyps and early cancers only 60 to 70 percent of the time ... Only about 30 percent of the colonoscopies in this Canadian study were performed by gastroenterologists.''
_______________________

Can we say ''correlation'' here? It would seem evident that, if, 30% of doctors performing colonoscopies were NOT trained to do so it would account for the 60% - 70% of detecting early CA and polyps. Looks like the MDs covering each other''s a$$es.

[docpeter1953]

Why would anyone expect a Gold Standard in colonoscopies. This profit driven industry that is control by the physicians that control the tests may be beyond fixing. It reminds me of the boxing industry, it can not be clean up.

Posted by baileycc at 09:38 AM : Dec 17, 2008
__________________________

I do hope you are not really serious. Colonoscopies are a better predictor of CA than MRI or Barium enemas, or CT scans. With colonscopies the polyps are visually viewed and removed, sent to a lab for dissection and evaluation for CA -no, not polyps are malignant. MRI and CT cannot do this prodedure. Also, thgere are many times when something is read as ''normal'' when in fact there is something there.

Why would anyone expect a Gold Standard in colonoscopies. This profit driven industry that is control by the physicians that control the tests may be beyond fixing. It reminds me of the boxing industry, it can not be clean up.

[saraplumber]

Seriously though, let''''s worry about getting adequate health care for all Americans instead of advanced care for those who can afford it.

Posted by gce65 at 03:39 AM : Dec 17, 2008
----------------
Are you sure about this? What happens if you get stricken with an orphan disease that requires lifelong, expensive medication? Or need an expensive procedure to repair your heart?

[saraplumber]

Only about 30 percent of the colonoscopies in this Canadian study were performed by gastroenterologists.
------------
Who the heck was performing these colonoscopies, then? The local auto mechanic?

[perrycbs1]

Many people who have insurance coverage in the US "refuse" to have this test done. I recently had my first inspection which led to a lot of discussions among people I know. I estimate between 1/3 and 1/2 of the people I have talked with have decided not to do this procedure.

I also know that the hospital does a certain number of these procedures on people without health insurance. Of course, they can''t do all people without insurance.

Overall - makes me really wonder how effective this procedure is in reducing the cancer rate in the US. Obviously - it does wonders for those who use it. But, more people will die early than what easily could be.

[mtminds]

Good point. Compared to other "modern" nations, the US has the highest number of citizens that cannot afford any health care.

[gce65]

Seriously though, let''s worry about getting adequate health care for all Americans instead of advanced care for those who can afford it.

We''re the only industrialized nation in the world that treats our health care as a for-profit business, a model that has failed miserably.

[gce65]

Colonoscopies are limited? I thought they could see well past Uranus! :)

[rhs648]

Only 30% of the procedures were performed by gastroenterologists. Is this the result of the Canadian socialized medicine? If so, we need to carefully think about whether we want universal health care controlled by the government. I have a PPO rather than an HMO. HMOs may be fine for the masses but is not good enough for my family. We do not want a plan that requires us to see certain doctors or requires permission to see a specialist.