Is colonoscopy worth the risk?

This article was previously published on October 16, 2019 and has been updated with new information.

Knowing your potential risk of developing cancer can help you weigh the risks versus benefits of different tests for your condition. According to the American Cancer Society,first More than 16.9 million people in the US have a history of cancer. At least 1.9 million new cases will be diagnosed by 2022, excluding diagnoses of carcinoma in situ (non-invasive cancer).

Society estimates that 609,360 people will die from cancer by 2022, which is about 1,670 people die every day. The four most common types include lung, breast, prostate, and colorectal cancers. One of the screening tests commonly ordered to rule out colorectal cancer is colonoscopy.

Colorectal cancer can start in the colon or in the rectum, but the two are grouped together because they share many of the same features.2 The society estimates that by 2022 there will be 106,180 newly diagnosed cases of colon cancer and 44,850 new cases of rectal cancer. Although it remains the third leading cause of cancer-related deaths in men and women, the rate has been declining for several decades.3

According to the Colorectal Cancer Alliance,4 Five-year survival rates are on the rise and there are more than 1 million colorectal cancer survivors in the U.S. Know your risk factors and make lifestyle changes to prevent cancer development colorectal cancer is the basis of the most recently published Rapid Recommendations. BMJ Initiative.5

In many cases, routine colonoscopy is not necessary

The 2019 Practical Guide is published in The BMJ6 recommends that doctors use a tool to estimate an individual’s potential risk for developing colorectal cancer over the next 15 years. The team recommends that only people with a risk of 3% or higher should have screening tests.

Current guidelines recommend screening for everyone over age 50, regardless of their individual risk. At age 50, this number is usually less than 3%.7 The international panel reviewed the scientific evidence and research data to assess the risks versus benefits of colonoscopy.

They found that their recommendations could be precisely applied to healthy people aged 50 to 79, who are expected to live another 15 years. The Centers for Disease Control and Prevention recommends colorectal cancer screening for people over age 50.8

Using data from across the US, they found that the number of people updating their screening results increased by 1.4% from 2016 to 2018, accounting for an additional 3.5 million people.

In addition to asking if screening makes a difference in health outcomes, the BMJ initiative team also tries to discern the best type of test used to screen for colorectal cancer.9 They recommend that people with a 3% risk or higher over the next 15 years can choose one of four screening options.

The first is a fecal immunochemical test (FIT) done annually, or every two years depending on their risk factors. Patients could also choose a colonoscopy alone or, on the weakest recommendation from the team, a single colonoscopy.

Chances of cancer versus screening risks

From examining their evidence, the team believes that annual FIT, colonoscopy, or colonoscopy could reduce the incidence of cancer while biennial FIT may not have an effect. to 15-year morbidity. They wrote:

“Based on the benefits, harms, and burdens of screening, the panel inferred that most people informed of a 15-year risk of colorectal cancer of 3% or more were likely to choose screening.” screening and most people with a risk less than 3% are likely to decline screening. Given different values ​​and preferences, optimal care will require shared decision-making.”

The team determined that the risks associated with colorectal cancer screening outweigh the benefits in many cases. For example, the risk of dying from a colonoscopy from a single source was 1 in 16,318 evaluated procedures.ten In the same analysis, the researchers also found 82 people had serious complications.

Colonoscopy risk-free

Although colonoscopy is thought to help find early-growing tumors, one study reported a diagnostic missed rate of 17%.11 Other risks associated with colonoscopy include worsening stool patterns and contributing to the growth of colorectal polyps or tumors.

Colonic perforation during examination has an incidence of 0.2% to 5% and is widely recognized as a serious complication associated with high morbidity and mortality.twelfth The risk of perforation increases with the age of the patient and the presence of two or more other health conditions. One study found that 51.9 people per 1,000 people with a perforated colon died within the first 14 days.13

Dysbiosis can occur after using strong laxatives in preparation for a colonoscopy. A study published in Cell14 suggest that even a short course of laxatives can trigger an immune response. Animal model studies15 The treatment eliminated one family of beneficial gut bacteria and allowed another to flourish. Even two weeks after taking the laxative, the bacteria decreased in diversity.

Many experts agree that you should choose the lightest level of sedation possible, or none at all, because general anesthesia increases risks. People with sleep apnea, obesity, high blood pressure, or diabetes are at higher risk from anesthesia.16 Across the United States, 34.4% of people who underwent a colonoscopy used anesthesia.17

The use of anesthetics was associated with a 13% increased risk of complications within 30 days of the procedure and was specifically associated with an increased risk of colon perforation and/or stroke. The risk of complications varied by region, with those in the Northeast reporting a 12% increase in any complication, but among those performed in the West, the figure rose to 60%.

Researchers who conducted a study found an increased risk of aspiration pneumonia.18 Again19 sought to determine if the procedure could be successfully completed without any sedation. Patients were selected for colonoscopy without prescribing and then evaluated immediately after the procedure, two and five days later.

The researchers asked about pain severity and were willing to review the procedure without sedation. When asked, only 5% felt no pain; 41% had mild pain; 34% said they had moderate pain and 20% said they had severe pain. However, regardless of the level of pain experienced, 73% were willing to repeat it without sedation, and only 18% said they would require sedation next time.

Device pollution Another risk of colon cancer

Download interview transcript

The real risk of undergoing an endoscopy of any kind is the possibility of improperly sterilizing the flexible bronchoscope. David Lewis, Ph.D. and I discuss this in the short video above. One problem is the inability to completely clean the inside of the lens.

Lewis describes a problem he says doctors often face. During the examination, the doctor may not be able to see through the bronchoscope and unsuccessfully attempt to flush it using an air/water channel because it is obstructed by human tissue from a previous examination. .20 The scope must be retracted and another scope used.

Because the endoscope has sensitive equipment attached, it cannot be sterilized by heat. Unfortunately, manufacturers have not made a scope capable of being heat sterilized. As Lewis pointed out:21 “We can put a rover to Mars, we can certainly build a flexible endoscope that can be inserted into an autoclave.”

These expensive instruments are not disposable but need to be disinfected between each patient. Lewis reports that up to 80% of hospitals are sterilizing flexible endoscopes with glutaraldehyde (Cidex). On examination, he found this complicates the process because it does not dissolve tissue in the endoscope but preserves it.

As sharp biopsy instruments are run through the tube, patient material from previous testing is removed and potentially carried into your body. This is why it is important to find a clinic or hospital that uses peracetic acid to thoroughly disinfect the device by dissolving the proteins present in the flexible endoscope. Before scheduling an endoscopy, call to ask how the device is disinfected between patients.

Adjust lifestyle choices to reduce colon cancer risk

Like many other cancers, colorectal cancer is usually preventable. Research shows that only 5% to 10% of all cancers are caused by genetic defects, while the rest are related to environmental and lifestyle factors.22 The Mayo Clinic writes that one-third of the most diagnosed cancers in the US could be prevented through diet and nutrition, that is, with plenty of fresh fruit and vegetables.23

The extent to which diet contributes to cancer deaths varies by type of cancer, which the researchers found is linked to 70 percent of colorectal cancer cases.24 For example, long-term exposure to chlorinated drinking water can increase the risk of leukemia, colorectal cancer, and bladder cancer.

There are several strategies you can use to reduce your risk of developing this potentially deadly disease as it is influenced by diet, vitamin D levels, exercise, and alcohol consumption.

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