Controversies and Progress in Colorectal Cancer Screening
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- čas přidán 25. 07. 2024
- Colorectal cancer is one of the most common cancers in the U.S., so last month’s NEJM NordICC Trial stirred up enormous media attention and controversy about the optimal strategies for colon cancer screening. Douglas Corley, MD, PhD, a leading cancer epidemiologist and clinical gastroenterologist, will bring us up-to-date on the newest colorectal cancer screening trials, explain potential population-level effects of different screening methods, and tell us how we might decrease disparities in colorectal cancer incidence and mortality.
Speaker:
Douglas Corley, MD, PhD, is a clinical professor in the Division of Gastroenterology at UCSF and a cancer epidemiologist and gastroenterologist at Kaiser Permanente Northern California (KPNC). He directs the Delivery Science and Applied Research program for The Permanente Medical Group, which coordinates rapid cycle, clinician-led research and implementation across KPNC. He was the national steering committee chair for the NCI Population-based Research Optimizing Screening Through Personalized Regimens (PROSPR) consortium, just completed a term as editor-in-chief of the specialty’s leading journal, Gastroenterology, and co-led the Screening and Prevention Working Group for the NCI’s Cancer Research Network.
Note: Closed captions will be available within 48-72 hours after posting.
Program
Bob Wachter: Introduction
00:02:20-00:52:12 - Douglas Corley, MD, PhD, (Professor, Division of Gastroenterology at UCSF Health)
00:52:14-01:00:49 Q&A
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What about specific populations, like African Americans. Recommendation has been 45 for them for a while. Is colonoscopy preferred in that group between 45-50?
There is an interest in years of life saved - a fast growing carcinoma aged 45 vs a slow growing carcinoma at aged 80 assuming younger persons have faster growing carcinomas .
Then there is the extension to family screwing if an early age carcinoma is found .
The worst part of all this is the complete disregard for the patient. It's all academic, but nobody is talking about the suffering that results for the patient. At some point that has to be addressed.
Tell me about it, took me more than a week to kind of recover from the mess, the last time, they didn't complete the last "bend" on me and I bet they REALLY tried, because I was sore and messed up for a long time. I am scheduled again in 3 years. It's the best in veterinary medicine for sure. I knew people who would get them in the old days with NO anesthesia!! My brother once had a compound fracture of his elbow, when he was a little kid, bone sticking right out - no anesthesia for him none, not all.
They told my mother to take a walk, when she came back another person there told her "don't ever let that bastard touch that kid again" and proceeded to describe the Dr. Mengele treatment my brother got, horrible.
All the assholes in the world are not lying sedated on a table I'll tell you. I can tell you they are not too interested in wound problems after bypass either, I had more chest pain after the operation than I ever had before, before there was basically none, now the damn thing gives me pain any old time, sleep on your side, pain, sleep on your other side, pain, sit there minding your own business, pain. All from the wound scars. Hell, I had to go online and research that problematic taboo.
Reminds me of Repatha and getting 11 on the LDL - how wonderful - well bullshit on that, they don't want to autopsy the brains on people with that kind of LDL after several years, to say nothing of the little boost in enzymes on your liver panel, does not pay to look to close. LDL is never low enough for the cardiologist, - apparently marmoset and caveman levels are not low enough.
@@johnjon1823 I'm sorry all that happened to you.
@@jessman8597 Thanks, it's just life and the price of living to see grandchildren so it's all worth it. Best wishes!
@@johnjon1823 But that doesn't make it ok. You still deserved better than that.
@@jessman8597 Thanks for your kind thoughts. Best wishes!
Screening colonoscopies are very controversial. Dr Corley has a significant ‘conflict of interest’ in that colonoscopy and flexible sigmoidoscopy is a major part of his practice and consequently a major part of his income.
Why wasn’t this declared or better still, why wasn’t a more neutral speaker used?
You mean like someone who doesn't do colonoscopies at all? That would be hard since it's such an essential part of the field. There are of course statisticians who might present the data (although they will have their own biases as has everyone) but since this is a presentation by professionals to professionals there are huge benefits to having a speaker who actually knows the real life applications. It's not a perfect analogy but imagine a talk to football coaches about coaching by someone who has neither coached nor played before - they would have less bias but also a more limited understanding of the topic.
Shouldn't a proctologist actually perform a colonoscopy. I had one done when I was 40. Is a gastroenterologist as qualified as a proctologist?
A proctologist treats diseases of the anus and rectum. A gastroenterologist is trained in diagnosing diseases of the entire GI tract including the colon. So the short answer is no, there is no reason to insist on someone with a focus on the anus and rectum doing your exam.
On an individual level it depends on your provider's experience and areas of practice. A gastroenterologist with a special interest in pancreatic disease might not perform as many colonoscopies as a gastroenterologist specializing in inflammatory bowel disease and a proctologist might be more interested in some areas than others and might be doing more therapeutic procedures than diagnostic ones. As mentioned in the presentation, one of the tools we use to assess quality is the adenoma detection rate which is the percentage of screening procedures a provider performs thar detect at least one adenoma (adenomatous polyp).