The Great Colonoscopy Debate - Cifu Mandrola Prasad | Per Protocol | ITT | Overall survival | CRC !
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- čas přidán 9. 10. 2022
- Vinay Prasad, MD MPH; Physician & Associate Professor
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My Grandfather's Doc wanted him to have a colonoscopy at age 85. Grandpa, a wise man, responded, "At my age, I'm not looking for trouble." He lived to 96.
I love your grandpa, my kind of guy.
My mother had one at 86. She was anemic. Her colonoscopy was perfectly normal...she was just taking too much aspirin. She lived a healthy life until 98.
I can't help but wonder what effect the constant barrage of advertising for meds does to people as well? That can't be good for our psyches to have 80% of all ads talking about sadness, pain, problems, and issues - especially self-diagnosed problems that urge people to go looking for pills as a solution. I likened this overwhelming negativity and focus on poor health and problems to being at a festive wedding and getting cornered by an elderly relative who wants to tell you all about their aches and pains and their latest surgery or doctor's visit - that's the way CZcams feels. I think it's gross.
I have read that people in their 80s and above should not have screening colonoscopy. Risk outweighs benefit. I am younger than that, but I will never participate in colon screening, or any form of screening for that matter.
@@louisemcelhill5748 The last time I went for a mammogram twenty years ago they told me it wouldn't hurt. It really, really hurt. And when I told the nurse it really hurt, she told me that it didn't. Of course my pain was anecdotal, and we all know now how the medical community and the powers that run it feel about anecdotes.
I loved the comment about the 95 yr old who hadn't seen a Dr in 40 yrs and the thought being that's probably why he made it to 95. My step Dad was the same way but was 78 when he started having health issues and passed at 83. Still a good long life.
I totally laughed out loud at the 94 year who hasn't seen a doctor in 40 years
I was never sick a day in my life until I got health insurance!
When you're 82, 83 is not a long life. On the other hand, my sister worked with a highly renowned internist who was considered a great diagnostician, and he said, "if you look long enough you will find something." At some point, enough is enough.
@@marthamagee2055 good timing.
I thought 83 was a good long life too. But lost my mom in Feb at 81 and I feel that she should still be with us for at least 10 more years. And the closer I get to that age the more I feel that I want more years than that.
PLEASE cover mammograms and breast cancer SOON!
Yes! And vs other diagnostic procedures..thermography/ultrasound
Great debate. And great to see physicians debating data and real life medicine instead of telling their “opponents” they are terrible people.
Had first colonoscopy @ age 45, negative. Scheduled soon for #2 at age 61. Yes, I'm "overdue". Recently I submitted an OTC FIT stool test: negative. Called GI M.D.'s office re: negative FIT and no shocker, was advised I should have colo anyway. With no family history, I question going through with this invasive procedure which is not without risk despite the discussion in first 5 minutes of video of it's "safety".
As a nurse, I CRINGED every time I had to give the preps to my patients. Absolutely horrible. Most patients were gagging that fluid down.
Then comes the anesthesia as if it's surgery.
No thanks.
I use Colo-guard every three years. No prep, no anesthesia...done at home.
Something shows positive on that, fine, I'll go thru the hell of the colonoscopy.
Otherwise, I'll pass!
Sometimes I think these docs just see $$$$$$ and not patients.
I agree. Way too much "money" in "preventative" medicine. $$$$$$$$$$
I’d rather have an NG than drink that. The doctor thinks I’m being dramatic but I’m serious.
@@JenniferAguiartampa Agree! Such nonsense and just a money maker IMHO.
Colo Doctors needs to buy BMW SUV for wife, Diamonds for Wife, and all the treats those wives need. Did the Wives marry the man or the $$$.
We were told if we use the CGuard and it is positive, you get a colonospopy, and nothing is found it will be a $6000 bill. This information came from our health insurance company.
Dr. Sifu (sp) must have all Medicare patients because a diagnostic colonosopy is $6000 or so. And one polyp on a screener makes it diagnostic. You can't say money doesn't matter as more and more workplaces have high deductible insurance plans. Doctors never know how much things cost. Marty Makary would have been good to join this convo.
DR ADAM CIFU with a " C". You haven't got one second to look at the header and get his name right?
I cringed when he said that. He’s def not the MD for the underserved.
it is always about money... and money is a HUGE factor for patients. Often, if a polyp is found and removed, the patient gets a huge bill (no longer screening test).
So true! What about relationships between medical-device makers and physicians?
" NO MAN CAN SERVE TWO MASTERS
YE CANNOT SERVE GOD AND MAMMON"
Book of Matthew
I am 71 years old with no reason for colonoscopy and I have never had it. Dr. H. Gilbert Welch has suggested for years that colonscopy didn't make sense for non symptomatic people. I tell my primary care doctor NO every year and will continue to do the same. This study confirms my position.
This study doesn't support that notion at all, for the reasons Adam described. The people that actually GOT the colonoscopy in this study were 30% less likely to get colon cancer and 50% less likely to die from colon cancer without any perforations or other obvious harms being done. This discussion is ONLY about a high level nation-wide recommendation - because more people will (theoretically, we don't know) opt for a flexible sigmoidoscopy vs. a full colonoscopy. On an individual basis however, you are still better off getting the colonoscopy, and the data in this study supports this.
High quality evidence right here.
@@mollieanne I don't get colonoscopies - I'm in my 30s. We need more studies, sure, I'm just saying that the notion in the original post is not supported by this study (it claimed the opposite). Please continue to do as you wish.
As a 49 yr old female, I wasn’t interested in a colonoscopy and did a FIT. Also, tired of doctors pushing mammograms.
I know what you mean. The last time I had a mammogram (pre covid) I had just gotten over a cold and had swollen lymph glands, my doc freaked and ordered a mammogram. I told the tech about just getting over a cold. She said I was right after completing the test.
That was 10 yrs ago. One thing or another will happen death is 100% inevitable
Agreed
Excellent discussion with just a bit of humor. A lot to think about. Dr. Mandrola and his philosophical and pragmatic point of view added a lot to the discussion.
Canadian guidelines for people of average risk, ages 50-74, is a FIT test every couple years. If there’s an abnormal result then a colonoscopy is recommended. Colonoscopy is only recommended off the bat for those with family history or higher risk. Quite different than the current “standard of care” in the US.
The USPSTF currently recommends offering colonoscopy *or* flexible sigmoidoscopy *or* HSgFOBT *or* FIT *or* colonography for routine CRC screening purposes, presumably based on the clinician's judgment about which would be acceptable as well as other factors.
@@kodowdus Is the USPSTF trustworthy? I don’t know about this organization.
@@vivaciousom5347 The fact that the average person probably knows more about the "non-profit" American Cancer Society and its recommendations (that tend to involve *more* use of expensive screening procedures than the USPSTF's recommendations) than s/he knows about the panel of experts who directly advise the U.S. government on preventive services guidelines is probably the most important thing to know about them.
@@kodowdus Thanks for your reply.
My mom died with colon cancer at 75. I am 54. I have had one colonoscopy 8 or so years ago. It was normal. Since then I’ve learned that most gastrointestinal clinics do not clean the instruments properly by using peracetic acid. Instead, they use the autoclave, which can leave a residue from previous patients that can be deposited into the next patient when the little grabber thingy is ejected. Pardon the layman’s terms. I tried calling around to find an office that was cleaning their equipment properly and when I would ask if they used peracetic acid they would clam up and act like I was trying to expose them on the news.
How high are the risks of perforation & infection from previous patients’ poop particles or worse? I’m not trying to be flippant. It is a serious but awkward topic.
Really liked this discussion. Dr Mandrola was great and wish he had had more time to talk 😊
Hubby had a normal colonoscopy at a surgical center -- we have a high-deductible insurance plan. It was over $5,000! We paid the surgical center, the GI doctor, the anesthesia doctor, etc. Plus, the prep is the absolute worst.
We also have a very high deductible. Wow. I did not know this.
Oh lord
Watched 17 minutes of the one hour video. I already wasn’t going to have this test, but this supports my decision.
Do the poop test though. It caught my cancer at stage 1. No chemo, surgery only. I had zero symptoms.
@@tpwonder99 Ty Trish, I did the Colongaurd ~ it was negative
@@carpenterfamily6198 I just had a negative FIT test, I'm 61 with 1st negative colo at age 45. GI doc office tells me I should still have the colo. Trying to decide what to do.😞
@@chk6111 If you had a negative colonoscopy at age 45 AND you are at average risk for colon cancer (no primary relatives with colon cancer) AND you had a negative FIT test at 61 then I would feel comfortable about just doing stool tests from here on out.
I experience cognitive dissonance every time I hear a doc downplay the risks of bad events with colonoscopy. My colleague’s husband experienced a perforation during his colo at our local hospital. He developed sepsis and died within the week.
And how can he not believe those numbers? 40% of patients get the exam…
I worked with very low income patients and we couldn’t get routine colonoscopies for the few patients that were willing to get the procedure!!
There were multiple barriers… he is living in a bubble..
He sounds like a very pleasant physician.. but out of touch with reality
@@idapn3732 I agree. my father-in-law couldn't get a colonscopy and at the time, we didn't realize it was because of cost. Had we known, we would have paid. He died of colon cancer two years later.
There is always that chance which is less than 1%, perhaps .05. Of course if you are in that percentile it sucks. I think they are even getting safer today with new instruments and technology.
Exactly. When he said, “Let somebody else decide where to put the money.” So what’s he going to do? Keep ordering diagnostics for no reason? Physicians play a big role on healthcare funds. He just wants to win at something & he’s failing miserably. Dr. Prasad’s intelligence is undeniably superior. Sorry.
How many times can you cut off Mandrola?
Thank you, Dr. V Prasad for all you do! Stay humble.🙏🏽😇
Love having the back and forth and arguments from both perspectives as I ended up agreeing with a lot of points made by Adam
Thank you, Dr. Prasad, for this discussion. My first colonoscopy, I aspirated under anesthesia. *Never been sicker and almost lost my job.* No pathology found. Second time - am I obedient or a sucker?- no pathology found and I warned the anesthesiologist I am trouble. Third time, I had symptoms to check out and was diagnosed with microscopic colitis. I was told to come back in ten years (I was 66). I will not go back unless I have symptoms.
So sorry , Wow!
I am a pretty smart person- studied at an Ivy League and all. I am all about health and wellness. I jump off cliffs on ski's drive motorcycles, etc. The point is, I am not afraid of much. I was almost excited to get a Colonoscopy when my doc recommended it. Why not- if it can save my life right? NOT SO FAST. After doing my due diligence, as I always do, my decision is NO WAY. Some suffer lifelong complications, deaths, etc. All Cause Mortality is no lower from what I understand. I could not justify the risk- not even a little. If I did, it would be the Sig. FYI, this is not advise to anyone.
To turn the tables, you should have a repeat meeting of the three of you to discuss possibly unnecessary cardiology treatments/procedures including statins and stents for stable angina patients.
Add life vests and ablation to this
Yea Please !
An important point is that it’s possible that Adam’s patients are self screening. Vinay mentioned this briefly. Basically, he is seeing patients who are coming to the doctor. This can’t be extrapolated to the entire population. There could be just as many patients in his area who do not go to the doctor regularly, and thus, are less likely to receive a colonoscopy.
Just saw the video regarding the article. Looking forward to the discussion. Everyone subscribe. This is gold!
Did they talk about diet to avoid meeting any of these doctors?
They did not.
I appreciate this conversation and would like to see this same conversation format with dialysis and nephrology…
That's a good point from Adam, that the main benefit from colonoscopy is polypectomy is higher quality of life over treatment options for stage 1 colon cancer
I can say that I would not want to be a patient of that internist. From this discussion, he seemed to be a doctor who would dictate to patients rather than discuss with them. For some people, perhaps that is what they prefer in a doctor. I have had issues with mammography and really have little interest in getting any more.
Many specialists have this attitude. He isn't the worst I've encountered.
I am coming back to comment.
I really appreciated this discussion, liked Adams more philosophical question around screening altogether
I absolutely loved this discussion, and have such respect for these doctors. I only wish I had more background in statistics and epidemiology so I understood more of what they were saying. I am reminded of Dr. Gil Welch's book OVER-DIAGNOSED which educated me about this whole subject and has kept me from many a mammogram.
over a 5 year period, the death rate in that field has remained the same despite new tests and technology. i think it's different with colon cancer.
Use the classic inter-ocular test -the effect has to be so large it “ hits you right between the eyes”…if it doesn’t…
As an IM resident, thank you for this video and for your channel, really. It has been very helpful!
I enjoyed this :) Vinay enjoys a 'discussion' as much as I do. he could show a little more restraint from interrupting though and it is clear that he does not listen intently but rather spends more time crafting his response than considering the point made by another speaker.
Youth
@@marthamagee2055 - A single word explains so much.
His brain is running at 1000mph, lol.
@@marthamagee2055
And prob how his brain works. He’s also passionate which is always a plus. No matter what he arranged and invested the time and money to set this up, then editing and posting so big kudos and thx for that.
@@StrategicWealthLLC
Not always. One perspective.
Love love actual debates
Hospitals are using colonoscopies as a cash cow , promoting them so,e,y for financial reasons, in the best tradition of the medical business. What business wouldn’t advocate and encourage a simple procedure that pays them well and for which everyone is a candidate !…Local hospital the GI docs don’t see patients, the NP do that… the Docs spend all their time doing these heavily reimbursed endoscopic procedures !
In regards to the anonymous East coast Physician ….”Relative risk obscures the very low absolute benefit.” Yes, where have we been also able to apply that one lately? It is obvious many doctors have forgotten what this implies or have chosen to ignore it because if they didn’t, they would have to change their mind on the very thing the establishment has been pushing for 2 years. How he describes what think about colonoscopy has too many similarities to the mandated product as well, with all of the same critiques of thought applied.
Dr P! Excellent content! Shawn Baker is giving you a mention for this informative vid!
🥩💪🤙
After listening to the entire conversation: I’m with Dr P on starting small and working my way up to the big show! I don’t want any of it but, if i don’t have a backdoor emergency; give me the shorty poke.
If a test requires general anesthesia, I want no part of it.
It's not general anesthesia.
I was due for my 5 year repeat colonoscopy (history of polyps on 1st screening), but had to postpone due to a pinched nerve that made being on my left side impractical (and my pain doctor said no). However no other screening possibilities were offered. If I really needed a 5 year follow up, why weren’t other screening methods pushed? I think the motivation wasn’t my well being but getting the procedure done for the protocol’s sake! I realize I still needed to be scoped to remove any other polyps, but if the concern was really for colon cancer, other means of screening absolutely should have been the priority!
Please more debates; I loved Dr. Adam’s perspective that he brought. Finally seeing some logos in medicine is nice.
Finally seeing some "peer review" in these videos is also nice(!).
@That Guy. What does “logos” mean in your remark.
@@vivaciousom5347 “logic and reason “
I agree. I was concerned after covid that we were no longer allowed to have different opinions. This is nice to see
@@ThatGoodBarbequow did logic & reason turn into logo? What or where is the “go” from?
Vinay for Surgeon General! Lets go! 😄
My loved one died age 77 from this pointless medical test. She lived alone and had dizziness issues at times. Was on blood thinners. Doctor GP Stupid sent her home with the picoprep so she fasted and drank the mix. It made her sick so in the night she got up to vomit in the toilet. Stood up. Fainted and fell, hitting her head on the side of the bath. Nobody knew what had happened to her as she lay there slowly bleeding to death inside her head. She was still alive but unconscious when she was found hours later. The hospital refused to treat just said she was brain dead. She lingered on for 4 days without treatment in the emergency department. They refused to operate to clear the subdural haematoma. They said hurry up agree to switch off the machines we need the bed for someone else. That was before the pandemic. It was just a routine test so no actual reason to get it
What a horrifying story. So sorry.
You forget that people who don't want colonoscopy can ger CT colonography, which is apparently as sensitive as colonoscopy for detection of polyps and cancer, and even cologuard is quite sensitive.
great discussion. Very enlightening
thank you Dr Vinay , Im with you 🙏 FIT should b a part of annual check ups
Very educational. Thanks
Vinay, PLEASE would you talk about statins and their use in people with high LDL but no other risk factors?
Yes please! Thank you so much 🙏🏼🌟
Yes, I very much want this as well
I seen a lot of patients code in colonoscopy in the hospital. I know a person young healthy who had internal bleeding in the colon after and almost died. I had one screening and they told me I wasn't clear enough to see everything. I did all their prep. I have Celiacs and IBS C. I have never had another one since.
Lori, are the adverse events you describe accurately described, studied and written up in the medical journals?
@@earthangel2524 I am an RN. Every procedure has risks and stuff happens. If is facts and I don't have the statistics but you can Google it. Meaning I can't tell the the percentage rate of these things happening. I am sure it is small but sucks if it happens to you.
Lori. Yeah, it's all about risks vs. benefits. I'm a fan of Dr. Rita Reberg's thinking on over testing and over treating. I never had a colonoscopy and never will.
Looking forward to the day when they change this procedure. Mine was absolutely awful, start to finish. I don't want another one. I would be open to the flex sig.
The USPSTF currently recommends offering colonoscopy *or* flexible sigmoidoscopy *or* HSgFOBT *or* FIT *or* colonography for routine CRC screening, presumably based on the clinician's judgment about which would be acceptable as well as other factors.
@@kodowdus Do you work for USPSTF??? You are promoting them on every comment!
I really appreciate this conversation b/c I was not even aware of the ‘ flex sig ‘
@@kcventures720 I am a public health professional at the *state* level whose work requires me to determine whether or not public health guidelines are being understood by the general public (and determine what sources of misinformation might be out there, whether it be well-meaning but misinformed clinicians or something else).
I worked in an office that did sigs. It was awful. I’ll never have one.
Loved this debate!
How would this discussion change in a patient with risk factors for colon cancer?
Drinking the GoLightly gave me extremely high blood pressure for several days And I'm in excellent health. I'm not having another one of these procedures.
Colonoscopy is almost always done under anesthesia, which is not given by anesthesiologists, and research has shown that the the depth easily goes down to general anesthesia with potential risks of death and cognitive impairment in the elderly. I tried to make an appointment for the procedure asking for a doctor who would do it without me under anesthesia, I was unable to do so.
My wife died under general anesthesia, which was unnecessary, during a partial arthroscopic meniscectomy, which research has shown to be a useless operation, anesthesia is not “safe.”
Gastroenterologists can and do run the scope fast with a patient under anesthesia, potentially missing cancer and increasing the risk of perforation, which may not be observed by the operator, resulting in pain, bleeding, and death at a later time… which is unlikely to be connected back to the procedure.
I woke up early in mine, and I know someone who was awake the entire time because the anesthesia did not work. Believe us, you would not want to have one without anesthesia.
I'm so sorry to hear about your wife. As with all herbs or medicines, they can effect different people different ways. That's why I feel strongly about individualized medicine vs standard of care. How disappointing you were unable to find a Dr willing to do it without anesthesia. I've had 2 without. I refused to do it with. Wasn't to bad.
@@sufyb6432 The same thing happened to me. I'll never do it again.
It's usually propofol (really quick acting sedative) or versed (benzodiazepam). There's more worry about perforation or infection than the sedative.
I had no anesthesia for my screening, it was very uncomfortable, produced a lot of cramping and pain during procedure, no pain post procedure but did get the chills and flu like symptoms two-days after
At age 40 I had a colonoscopy/endoscopy due to ongoing unknown stomach pain. They ended up finding and removing two precancerous polyps. I was otherwise generally healthy and was not over weight. I was very surprised and thankful. It was only one day off from work. You don’t prep until after work the day before the procedure.
Don’t like the guy in the blue. No harm to colonoscopy? Perforation and other adverse events don’t count? Cost to society doesn’t count?
If colon cancer run in the family the " doctor in blu" is absolutely correct....maybe we should be more selective on prescribe it..
but often we have no health Information from our ancestors.
Prevent colon cancer by eating clean, no processed meats or junk food. 💪
As little fiber, plant oils and carbs as possible. Processed meats have zero affect, that is just epidemiological BS.
i'm ok them . all i eat is junk food. 80% pizza , chips, beer, whisky.
I think moderation is key. 1-2 slices of pizza are fine from time to time.
@@pas_du_tout time to time ~ like a couple of times a year ?
This discussion should be in the “required listening” category for informed consent purposes.
All the numbers and percentages are confusing. All the unnecessary testing is causing unnecessary stress, false positives and killing people. How about prevention by eating healthy, exercise, normal weight, stress management, proper sleep, drinking lots of water and a purposeful life?? After just shopping at Kroger I would have to say that most people are overweight or obese. 😮
Yes..and doctors often do not address the needs of changing life style habits but just prescribe tests and meds blindly
Full anesthesia for a colonoscopy. Meaning you need someone ELSE to drive you there and take you home and observe you. Someone you trust with your life. I went for Sigmoid because I want to be aware of what is going on. They said everything looked pink and healthy, come back in ten years. I was 50. Not everyone wakes up from anesthesia. So that alone is an additional risk.
No not needed. Had my colonoscopy w/o sedation. Sedation is to avoid ~30 seconds of discomfort when colon is pump up with air. Have no idea why physicians push sedation for procedures that don't need it. Dental work is far more uncomfortable than a colonoscopy, and have never been sedated for that either.
I really enjoyed the Propofol, TBH. I was awake, asleep and then awake. No grogginess or after effects.
@@stevec8861 When I had my sigmoid thing they required sleep for the full deal. Dental work doesn't bother me. But no root canals or anything. It was very uncomfortable the thing I had done, pumped air inside me for that also. Told me not to hold in any gas, but I'm not going to release that with a person sitting RIGHT THERE. Geez So I guess being asleep, you might let those out. It's been over 10 yrs since I went in though.
Just recently learned that a friend succumbed to his battle with colon cancer. younger than me. Very active, flat stomach, ate healthy, cardio and strength training and managed stress, drank lots of coffee which is supposed to help. No idea why he got it. Damn. About 3 years ago, I didn't get to say goodbye.
@@karenkaren3189 could you drive yourself home?
Actually full anesthesia would be on a ventilator. There isn't even pre-op clearance required for a c-scope. It's akin to sedation dentistry.
"That's crappy"was a good answer. How many are really going to check stools for blood or abnormalities.
I enjoyed the banter 😂 so rare for these kinds of discussions
Good vid per usual. My GP has been pushing Colonoscopy for years, and I have avoided it. This recent study further supports my lack of interest. What I think I will do is get a flexible sigmoidoscopy done. Many screening tests are waste of time, as mentioned in this vid.
The USPSTF recommends flex sig once every five years as an *alternative* to standard colonoscopy once every ten years.
@@kodowdus but no one knows this. Colonoscopy is the only thing they ever mention🤑
@@ThatGoodBarbequ If that's the case, then I would submit that primary care physicians who provide preventive clinical services in the U.S. need to be convinced to take their jobs more seriously. (I'm guessing that PCPs working directly for the "socialized" national health care service in the U.K., on the other hand, would tend to be well-informed on the latest preventive clinical services guidelines.)
@@kodowdus let me rephrase - it’s not to knock any provider. I was just making the comment that it’s been my observation that GI doctors advertise colonoscopy for colorectal cancer screening. Literally on billboards
@@kodowdusThe PCPs in the network I worked for get bonuses for every patient who gets all the recommended screening tests. They're under the gun from higher up.
This was very informative and entertaining. You all are so funny!
Good discussion, I got a colonoscopy 11 years ago....and dr. wants me to do another, and all i need to do is schedule it, been playing telephone tag awhile with this. Im on the fence about getting another one, so still researching this. Im doing all I can diet and nutritionwise with prevention on any cancer, so think i'm pretty good. I'm open to be convinced if the benefits of a colonoscopy outweigh the risks. Thanks for any help.
Beautiful talk! Ultimately, I believe these test are rudimentary. Data that includes molecular make-up of patients plus social data (nutrition, smoking, Etoh, exercise, sex partners, environment) will lead to target screening/risk score, i.e., family history of x leads early screening in x. In some cases left sided colon adeno ca maybe worse than right sided colon ca. Difficult to know if the pt presenting for the first colonoscopy and there is a big right/left sided colon ca, could this have be prevented by an earlier colon screen? What are the risk factors? Higher resolution is definitely needed to improve outcomes. VP go lightly and ride the electric eel. It is not that bad. VP you are talking about cost…what is the cost chemotherapy?
Great conversation, ty
Great Discussion. How do we see more of this kind of program?
gastroenterologist often says... what if... that question starts research. so we need more. everyone pays extra for the test...as its all costs. not just what doctor gets!
Not even thinking of having a colonoscopy, mammogram, etc.etc. My brother was very ill for months after having a prostate biopsy procedure. Had two bouts of a terrible infection caused by the procedure. Docs get used to telling people what they need, even when shown the test doesn't help.
40:42 it's all about the money 💰
I would be curious to know the benefit to people for which the colonoscopy found and removed a polyp. Is there a cost/benefit analysis for those who have a polyp removed, and are recommended to have the procedure repeated more often than every 10 years?
I am not a doctor. My father-in-law died of colon cancer. He had been hospitalized two years earlier and never had a colonoscopy. He was discharged without a diagnosis but died two years later of colon cancer. Why not a colonoscopy? Inadequate insurance? My husband did have colonoscopies because of his history, did have polyps removed, and as a result had testing more often than the 10 year mark. I think his last colonoscopy was clean. He never did get colon cancer. The dying process in any disease is brutal, but from what I've witnessed, cancer deaths are dehumanizing. My husband finally succumbed to kidney failure. He struggled longer than his father, but the suffering was not comparable to the suffering of his father. If one could avoid cancer and its treatment, why not?
In the UK we are all offered a bowel cancer treatment its offered every 2 years to men and women aged 60 to 74. 3 people i know and member of family who had this test were both found to have had cancer and colonoscopy done very quickly and all of them are fine now after treatment. One of them it was her FIRST screening. if she hadnt done it she might not be with us now. So its quite normal in the UK. ALSO all 3 not one of them had the normal symptoms for bowel cancer.
My question is: Why should anyone have to go through treatment if they could have avoided it? The treatment is brutal and often leaves patients with long-term side effects.
It’s a horrible test that’s invasive and it was a lot longer than one day! Had I known there was any other option I would have done it. It took two months for me to feel “normal” again.
@6:30 "If you offer flex sig you're going to bump it up"
The USPSTF currently recommends offering colonoscopy *or* flexible sigmoidoscopy *or* HSgFOBT *or* FIT *or* colonography for routine CRC screening, presumably based on the clinician's judgment about which would be acceptable as well as other factors.
I think Vinay is way way off on what people will prefer:
We do colonoscopies precisely because no American wants to come to their doctors office for a messy unsedated procedure after having given themselves two enemas at home an hour earlier THEN possibly being told "yep you are going to need a colonoscopy, I found a polyp.
Another great confounder in all of this is that everyone ends up getting a colonoscopy anyway for other purposes in modern society. They have IBS or a bleeding hemmorhoid. There is a lot of crossover from the no screening group into the screened.
Very sensible.
Have had one colonoscopy. Didn't have sedation, and have no idea why anyone would, just to avoid thirty seconds of initial discomfort when colon is pumped up with air. There is no pain if or when a polyp is removed. Dental work is far more uncomfortable and have never been sedated for that. So why do physicians push unneeded sedation for colonoscopy that lengthens recovery time? Agree the day before prep is worse part of colonoscopy. Oh, if you're a CF carrier (~5% of European ancestry people), you'll likely need a more aggressive prep, so make sure to ask beforehand if you're a known CF carrier. Don't want to have GI doc tell you during procedure that your prep isn't sufficient and you have to repeat the whole ordeal!
Ok so do we get one or not?
I have been persuaded previous to listening to this talk that the colonoscopy protocol in our country is driven by our fee for service model and not science; even though the doctors who promote it aren't necessarily bad people. I learned a couple of things from this talk. One; you can die of infinite causes of which colon cancer is one; and that there is little reason to centralize this particular procedure for health. Two; if you test positive for one of the other screening tests, then the colonoscopy becomes a medical procedure not a screening and in that case you are actually targeting a true risk of dying from possible colon cancer. Dr Cifu states there are no risks for colonoscopy; I don't believe that as I don't believe the perforations that lead to complications likely get recorded as death from the perforation. So I think saying there are no risks to colonoscopy is disingenuous. I really feel avoidant of going to doctors in general these days when I know their main goal is to convince me to get a colonoscopy and a mammogram.
1000 $ at cecum! wonderful! More data, rather than "I feel" .
Thank youse
Thank you
Everyone where I live gets colon cancer including young adults. I know dozens getting polyps removed for a while. People DO get tested per Dr orders more than suggested imo.
Also you have to check up into iliium where crohns often lives. Into small intestine.
Vinay will you please discuss Novavax and myocarditis risk as compared to other vaccines? Thank you!
I mostly agree with Dr. Cifu.
The topic is colonoscopy so the argument of colon cancer as a % of total causes of death is moot.
3 points of contention are:
Cost
Accuracy
(Dis)comfort
Side effects
Those can all be improved.
In Japan FIT and something like Grail exists and used successfully. Likewise it’s improving in cost and accuracy with time. A test I took 3 years ago now costs less than it did then plus includes more. I pay cash as it’s easier than using insurance and it’s not inexpensive but I think it’s worth it.
For future video interviews, please try to get the audio volumes closer together.
Today’s episode I will term “Goldilocks audio levels”
Dr Sifu(sp.?) was to low or soft. ⬇️👂
You, Dr. Prasad, it was way too loud!!! 🙉📢
Dr. Mandrills was was just right. 😊👍
The answer is for doctors to explain the results of this study to their patients, make sure they understand absolute vs relative risk reduction, and understand the all-cause death statistics. Then the doctor can either recommend, or not recommend based on their own opinion, but leave it up to the patient. That includes not pushing too hard if the doctor thinks they should get the scan. There is still room for a doctor's opinion having value outside of this study. Having a family history of colon cancer for example, that may not be accounted for in this study.
No one not even the patient has an hour to spend in the clinic
I'm sure colon cancer is terrible, and I certainly hope I never get it. But one thing that should be mentioned more often is that colonoscopy's blow.
lotas fun.
I think the most important question is how non-invasive surveillance techniques (Cologaurd/FIT) compare to colonoscopy- I would guess the minimal benefits of colonoscopies basically become statistically insignificant. I - as a physician and a patient- am much happier with a stool specimen every 3 years than a minor surgical procedure (which only screens every 10 years!)
Thats why I clicked on this, I do a fit test every year and was wondering if that was ok? I have had different doctors tell me different things. But then just read yesterday somebodies comment that a fit test will only find cancer after you have it and you will need the awful treatment, but a colo finds it before you get cancer. if this were true then I'd get one. But of course if i had a positive fit test then I would get one quickly which a lot of people still won't do. They make it sound like oh my god! we found a polyp. But from what I know most of these will never become cancerous.
I have little insight into the risk numbers for colonoscopy. I would, however, like to see non-death-related harms evaluated. For example, a treatment (even if successful) which would require a colostomy is something I would very much like to avoid.
That's an important point that's missing from Vijay's argument, i.e., that *quality adjusted* years of life gained from screening would be an even better endpoint to look at than just years of life gained.
When they talk number and data, which is understandably necessary, the individual is not considered. I assure you Dr. Prasad will have a colonoscopy when he reaches that questionable age.
QOL, Quality of Life, is very often left out of the conversation/research .
When I started nursing in 1973, there was a surgical procedure being performed those days called AP Resection (abdomino perineal resection). Bad memories of those particular patients stays with you.
Find 1 polyp on a Flex Sig(the Silver Stallion as it was once called) and you just earned yourself a colonoscopy.Scheduled on another day with full prep.Who has polyp ?Seems everyone.A-Fib RVR is the most common arrhythmia detected in Gi Lab btw(my observation)
Am i mishearing this.. Dr. Prasad seems to refer to Cologaurd as a blood based test? It is a stool based test. Is he looking at right data? I am genuinely interested in his take on this test.
I’ve had 4 colo - all perfect. So now I’m thinking I’m done. I asked for flex last time and doc said no (💰?). If I could get flex, I would probably go ahead with it, but full colo… think I’ll pass.
What will be the future of GI practices without a colonoscopy? Fewer residents will take up a GI fellowship because many pursue GI because of the money the procedures bring them.
GI specialists could presumably still make money from mastering the newer technologies coming down the road, such as CT colonography.
A universal healthcare system like we Europeans have would solve that for ya.
@@jananilcolonoscopu4034 How so?
@@trevorpullen3199 Because under a universal healthcare system there's less of a direct link between the kinds of procedures a physician performs, and the amount of remuneration that physician receives. There's more scope to follow your genuine interests as a doctor/surgeon. And that's undeniably positive.
Of course there are always surgeons who are especially greedy, and there's usually a small private healthcare sector for them to move into, even in countries with a far-reaching public healthcare system. But they're very much the minority.
The internal medicine doctor keeps commenting the cost is not an issue. Well, our Medicare dollars are in the tank. When patients have no skin in the game and specialists get reimbursed so easily then you always have to ask the validity of it all.
I had my first and only colonoscopy when I was 60. Results showed nothing of concern. Ever since I’ve struggled with increased bowel issues. My blood family has almost zero cancer, and none among my siblings, parents, and grandparents as far back as we know. I will not undergo another colonoscopy unless the doctors have good reason - far more than routine screening.
It would have been a more interesting study if they also divided people by diet type because even with the low diagnostic difference and survival differences between the groups you do have lots of people that eat terrible diets, on average, with lots of cancer promoting foods like preserved / smoked meats or habits like smoking and drinking.
How would people that treat their bodies fair against the average? I wager much better.
I would love to see that because I believe life style,diet and exercise makes a huge difference.
I know numerous people in their 60's who after having their 1st colonoscopy refuse to ever have another one again. I have a feeling some of them would however be willing to do sigmoidoscopy.
The USPSTF currently recommends offering colonoscopy *or* flexible sigmoidoscopy *or* HSgFOBT *or* FIT *or* colonography for routine CRC screening, presumably based on the clinician's judgment about which would be acceptable as well as other factors.
A sig is much easier.
25:22 🎉 exactly
Really interesting discussion. I have always wondered about this - of all the things to do, why colonoscopy, given the hassle and expense? Right after the test you could be hit by a car.
Yep. Invasive tests like colonoscopy, (which are some of the least potentially harmful invasive screenings, mind you) can't be viewed in total isolation like Adam was trying to do in this discussion. You test to help people. If you're not able to provide evidence that you're actually helping people... why hitch your wagon to that test?
That's why I look both ways when I cross the street.
@@sectionalsofa Ahh, but do you look both ways when someone suggests you should have a colonoscopy? And then run the other way. 😂
So why get your teeth cleaned? We could avoid all screenings and just let nature take its course.
@@franciastone5048 one: getting your teeth cleaned is not "a screening". What on earth possessed you to attempt such an incongruous comparison?
Two: can you cite any evidence base for the benefits vs the harms of visiting the dental hygienist? In other words, are you aware- to any degree- of the available evidence for and against such interventions? If not, why not? I merely ask this to illustrate a fundamental point.
*FIGHT! FIGHT! FIGHT!* _JC
The problem is that one colonoscopy becomes multiple with one polyp ($$$)... depending on your GI. I've had a professor of medicine (GI research) tell me that a polyp does not always mean a 5 year recheck, yet the mainstream physician disagrees. BTW, I went to work (delivery) right after a sigmoid when I was 30.
I always have more than one. My brother died at age 62 of colon cancer. Not even 7 months from diagnosis. Never had one. When found had spread. Once every 5 yrs, not a big deal
Yeah, had one polyp removed. Pathology report said "this type of polyp never becomes cancerous". Yet GI doc is telling me to come back every three years. PC doc says I'm good for ten years. No way am I gonna do that every three years because one zero risk polyp was found.
@@stevec8861 And if you have high deductible insurance, it's thousands of dollars!