Despite chatter about new study, don't skip that colonoscopy, Austin expert says
Are colonoscopies really necessary?
That's the question some people might have asked recently when they heard about a new study published in the New England Journal of Medicine last week.
The study looked at almost 85,000 people from Poland, Sweden, Norway and the Netherlands who were ages 55 to 64 years. About 20% of them went through a screening colonoscopy. The rest did not.
The study followed these people for about 10 years and found an 18% risk reduction for colorectal cancer in people who were in the group that was invited to be screened versus the people who were not invited.
That 18% doesn't seem very high, but Dr. Sanaa Arastu with Austin Gastroenterology said there are things about that study that don't translate to changing recommendations for colonoscopies in the United States.
The study compared the people who were invited to be screened versus the people who were not invited. Only about half of the people who were invited to be screened actually went through the screening process of a colonoscopy. That makes the 18% risk reduction lower than if they compared the people who received colonoscopies with those who didn't.
The study also followed a population of people who have different diets and lifestyles than people in U.S. The population also might not genetically be more at risk than people in the U.S., where colorectal cancer has especially been on the rise among people of color and in younger people.
The study also was done in countries that do not have a system of regular colonoscopies, giving the people doing the colonoscopies less experience finding many polyps than doctors in the U.S. Their detection rates were much less than what we see in the United States, which has a regular screening program, Arastu said.
"They're just not finding enough," Arastu said.
The biggest issue with the study, Arastu said, was it only followed people for about 10 years. Often, polyps can take 15 or 20 years before they become cancerous. The real benefit of screenings was yet to be seen by the people in the study, Arastu said.
Arastu said she doesn't want the study to deter people from getting colonoscopies, especially at a time when many are just now starting to return to getting screened after they shied away during the coronavirus pandemic. Her practice has seen a return to its normal volume of colonoscopies, she said.
"Even with a normal volume, there's still a significant population that needs to get screened," she said.
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When should you get screened for colonoscopies?
The U.S. Preventive Services Task Force and the American College of Gastroenterology issued new guidance last year to lower the recommended age of a first coloscopy because of statistics showing that cases in younger people were on the rise.
The new guidance for first and follow-up colonoscopies is:
Beginning at age 45 and then every 10 years until age 75 for people who have no known risk factors and no family history of colon cancer or polyps. Recommendations vary if a polyp is found during that first colonoscopy, but expect regular colonoscopies at least every five years if one is found.
Beginning at age 40 for people with risk factors such as a family history of cancer or polyps, or a personal diagnosis of inflammatory bowel disease, then at least every five years.
If a family member had colon cancer before age 50, begin 10 years before the age that person was diagnosed (so at age 33 if the person was diagnosed at 43), and then every five years.
Any time if you have symptoms.
Between ages 76 and 85, consult with your doctor about your personal risk factors.
After 85, regular colonoscopy is not recommended.
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Are colonoscopies covered by insurance?
Colonoscopies are covered by insurance but at different rates, depending on whether it's an initial screening with no known risk factors or a screening based on symptoms or known risk factors. Check with your insurer before you schedule to make sure you know whether it is covered at 100% or a percentage of the cost will be covered based on how much of your deductible you've met.
What about those stool kits?
Other screening methods — such as do-at-home collection kits — are usually only given to those people who refuse to have a colonoscopy.
Those other methods have a false positive rate that would require a colonoscopy, but more importantly can have a false negative rate and miss a cancer, Arastu said. They also don't provide the chance to take out a polyp before it becomes cancer.
Those methods are also not for people who have an increased risk because of family history, personal history or other related diseases.
"Colonoscopy is the gold standard," Arastu said. "It's diagnostic and therapy. You get screened and get it out in one gulp."
When Arastu is talking to people who don't want the colonoscopy, she'll try to use logic: "What you're telling me is if there's a precancerous lesion in your body that I can prevent becoming cancer you would rather it progress to cancer than be treated?"
If they say, yes, then she'll leave them alone, but she also might try this tactic: "If you have polyps, that changes what we do for you children. Now we can prevent it in your kids (by screening them earlier)."
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What are colon cancer warning signs?
Most people do not have symptoms until colon cancer has advanced to later stages when the cancer has spread.
Early stages are typically diagnosed by preventive screenings such as a colonoscopy.
The point at which a person is diagnosed has a strong link to survival rates. The five-year survival rates are good if the cancer remains localized (early stages): 91% for colon cancer and 90% for rectal cancer. If it's regionalized, the rates go down to 72% and 73%, and if more cancer is found in a distant location (later stages), those rates are 14% and 17%, according to the American Cancer Society.
Symptoms include:
Signs of blood in the stool, which can be bright red to black depending on where the cancer is.
Anemia.
Changes in stool consistency or bowel habits.
More narrow stools.
Abdominal pain.
Weight loss.
Bloating.
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What about the prep for a colonoscopy?
"A lot of people remember what the bowel prep used to be," Arastu said.
It has gotten better, she said. There are now pills you can take if you can't handle the liquid form of clearing out the bowels. And the volume of that liquid has also decreased.
"Most people have trouble with the hangry," she said — the hunger that comes with being on a liquid diet and then having nothing before the procedure.
Sometimes people will complain of a sore bottom because of the prep, but they can use a barrier cream (think diaper rash) and invest in some good toilet paper, Arastu said.
The actual procedure often feels like a great medicated nap, followed by taking the rest of the day off work or anything strenuous.
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This article originally appeared on Austin American-Statesman: Despite new study, don't skip that colonoscopy, Austin expert says
