Feel better about your next colonoscopy: you’ll die in a state of grace

Let’s see how the War on Cancer that Richard Nixon started is going… “In gold-standard trial, invitation to colonoscopy reduced cancer incidence but not death” (STAT):

For decades, gastroenterologists put colonoscopies on a pedestal. If everyone would get the screening just once a decade, clinicians believed it could practically make colorectal cancer “extinct,” said Michael Bretthauer, a gastroenterologist and researcher in Norway. But new results from a clinical trial that he led throw confidence in colonoscopy’s dominance into doubt.

The trial’s primary analysis found that colonoscopy only cut colon cancer risk by roughly a fifth, far below past estimates of the test’s efficacy, and didn’t provide any significant reduction in colon cancer mortality. Gastroenterologists, including Bretthauer, reacted to the trial’s results with a mixture of shock, disappointment, and even some mild disbelief.

… So Bretthauer, of the University of Oslo and Oslo University Hospital, and several colleagues started one a decade ago, recruiting more than 80,000 people aged 55 to 64 in Poland, Norway, and Sweden to test if colonoscopy was truly as good as they all believed. Roughly 28,000 of the participants were randomly selected to receive an invitation to get a colonoscopy, and the rest went about their usual care, which did not include regular colonoscopy screening.

The researchers then kept track of colonoscopies, colon cancer diagnoses, colon cancer deaths, and deaths from any cause. After 10 years, the researchers found that the participants who were invited to colonoscopy had an 18% reduction in colon cancer risk but were no less likely to die from colon cancer than those who were never invited to screening.

Five colonoscopies will cost our society (private insurance or Medicaid/Medicare) about the same as 5 cruise vacations. Is it still worth getting 5 colonoscopies before finally dying (maybe of colon cancer)? Wouldn’t we be better off if we invested these resources in something enjoyable? “Pfizer CEO Albert Bourla tests positive for Covid-19 again” (CNN) can inspire us. His reported COVID-19 symptoms were exactly what same-age rednecks who never got any shots or pills reported. However, unlike the rednecks, he followed the Science and, pumped full of multiple “vaccine” shots and an experimental pill, went through COVID-19 in a state of grace.

Now colon cancer screening can go through the same statistical mill as breast cancer screening via annual mammograms. Here in the U.S. we convinced ourselves that annual X-rays were helpful. Then we realized that the improved 5-year survival rates for breast cancer were primarily due to treating “patients with breasts” (formerly known as “women”) for cancer when they didn’t have cancer. Since these victims of overdiagnosis never had cancer to begin with, they were unlikely to have died of cancer 5 years later. “Benefits and Risks of Mammography Screening in Women Ages 40 to 49 Years” is a 2022 article explaining the settled Science:

The American College of Obstetricians and Gynecologists (ACOG), American College of Radiology (ACR), American Cancer Society (ACS), National Comprehensive Cancer Care Network, and U.S Preventative Services Task Force (USPSTF) all reach different conclusions about when and how often to recommend screening mammography. Each organization places different relative weights on the benefits and risks of screening and uses different standards for evidence.

15 thoughts on “Feel better about your next colonoscopy: you’ll die in a state of grace

  1. My colonoscopy detected stage 2B cancer which surely would have killed me if left untreated but which was successfully treated with surgery, chemo, and radiation once we knew about it. So in my case it was definitely life-saving.

  2. Didn’t get much out of that story besides coloscopies still being necessary but maybe medical studies in general not being very useful. The lion kingdom suspects starting at 45 is unnecessary unless you’re really out of shape.

  3. Like a lot of the doctors quoted in the article, I’m a little surprised by the study’s results but that is because I’ve been told – as many men have – that colonoscopy is the preferred route so to speak. “Let’s get in there and look around.”

    But if the stool testing is just as good, or almost as good – and much less costly – we should change the way they are prioritized: do the lab tests first, and then, if anything is detected, the more invasive, uncomfortable and expensive procedure comes next.

    Especially if you’ve already had one colonoscopy and it has come back “clear.” Next time you do the lab test instead as a follow-up, not another colonoscopy.

    Into the statistical mill we go! Somewhat related: I still find it fascinating that “medical errors” (the polite way of saying: Malpractice) are still the third leading cause of death in the United States, something like 250,000 a year “excess deaths.” In a kind of backhanded way, I wonder if this doesn’t serve as a kind of justification for “overtesting” – if you’re killing a quarter of a million people a year because of “medical errors” surely you want to do every test possible to make sure you don’t make a mistake – but that number is stubbornly high!


    Humor: Uncle Vinny’s Prostate Exam by Anthony Rodia Comedy:

    • Another fascination from the article I link to from 2017: “At the same time less than 10 percent of medical errors are reported.”

      Unless I’m wrong, that means the real number for “excess deaths” attributable to “medical error” may be more than 10 times higher in the USA – more like 2,500,000. I guess it is possible that reporting has become much much much much much much much much much better in five years, but I tend to doubt it.

      Am I wrong?

  4. Colonoscopies have been discredited for a while, but it’s hard to “kill” a procedure that makes that much money. There’s a risk of perforating/puncturing the colon which negates most of the potential “benefit”…

    • Colonoscopies are good for cleaning intestines because they require prior a couple of days abstaining from food and drinking laxatives. Every McDonalds – frequenting individual needs this procedure at least once in a decade.

    • @Anonymous: > “Every McDonalds – frequenting individual needs this procedure at least once in a decade.”

      Or just avoid them entirely, no big loss! McDonald’s food has become so tasteless and over-processed (with only maybe one or two exceptions) that I’m surprised they’re still in business. I’ll bet you could take a Big Mac + fries and leave them in a room-temperature kitchen cabinet for a month, warm them up in a microwave, and they’d taste the same as the day you bought them. McEmbalmed. And the bastards don’t even give you a couple packs of ketchup with your fries unless you specifically request it.

      I wish I could move to South Korea. They still know how to make good food inexpensively. Everyone who works at a McDonald’s in America is thinking about what gender they’re going identify as by the end of their shift(s).

    • Gino is correct. Colonoscopies are in the bloodletting league. This study isn’t that bad, there are studies saying colonoscopies lead to worse outcomes. Also it is gross how they can’t clean the scopes very well because of the cameras and bits built in. Medicine is business and making customers sicker is good business. Cue the ‘your colonoscopy protects me’ whining.

  5. “And the bastards don’t even give you a couple packs of ketchup with your fries unless you specifically request it.”

    Avoid the ketchup – it’s more unhealthy than the fries.

    “Everyone who works at a McDonald’s in America is thinking about what gender they’re going identify as by the end of their shift(s).”

    I’m aware that McDonald’s (and the other fast food restaurants) seeks to hire felons; and from the dozens of Youtube videos I’ve seen, too many McDonald’s employees violent and anti-social.

    • I’m back in our Parisian AirBnB and can weigh in via blessed Internet! You will be pleased to know that there is a McDonald’s within a few minutes’ walk from the gates of the Versailles Chateau. I did not go into this fine establishment today, but I was tempted to try to get an unsweetened iced tea at least from the touchscreen kiosk. Pictures to follow from Versailles. You won’t be surprised that I was able to capture the Followers of St. Fauci in their simple surgical and cloth masks, protected from whatever aerosol viruses that the HVAC system (last upgraded in 1698) did not filter out, while jammed into one of the most crowded places on Planet Earth. Someone marched them to Versailles at gunpoint, which is why they couldn’t stay home and save lives?

    • yes, Yes, YES I’ve been waiting for more snarky mask pictures. Haven’t had my fill (“Phil”?) yet, so keep ’em coming. Let me guess — there are people everywhere that wear non-N95 masks?!? I won’t believe it unless you show us even more pictures. Someone wearing a mask at the Eiffel Tower. Someone wearing a mask at the Louvre. Someone wearing a mask at Versailles.

      When you look back at your trip pictures on this blog 10 years from now you won’t remember other people’s obsession with the mask but rather your obsession with their obsession with the mask. An odd hobby, but being an idle rich will do that to you.

      Whatever gets you going…or keeps you feeling superior to these people that have been traumatized by millions of deaths…

  6. A few years ago, age 50 was the year to get your first colonoscopy, then every ten years. Lately, I’ve been seeing recommendations to start at age 45.

  7. googling the topic,

    Why is colonoscopy “recommended” and “routine” but bronchoscopy is not ?

    “What is the number 1 cancer killer?
    What were the leading causes of cancer death in 2020? Lung cancer was the leading cause of cancer death, accounting for 23% of all cancer deaths.

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