The risk of serious complications like major bleeding or perforation is closer to 40-80 per 10,000, significantly higher than the roughly 3-5 per 10,000 annual chance of actually having colorectal cancer for low-risk groups.
My doctor says that since Cologuard catches a large percentage of those 3-5 per 10,000 without any of the colonoscopy risk, the marginal benefits from colonoscopy really aren't justified since FIT+DNA testing is almost as good, at least for low-risk cohorts.
Very few things in medicine are zero risk. I wish more doctors would help balance the risk of doing A vs. the risk of doing B vs. the risk of doing nothing.
It's all Bayesian conditional probabilities, considering your own individual risk factors, and considering the false positive rate and false negative rate of each test.
not who you asked but the perforation is 3-5 per 10,000; cardiovascular issues is 52 per 10,000, polyp removal carries risks of bleeding or perforation, and underlying patient physiology.
RESULTS Among the 30,818 records identified, 82 population-based studies from 24 countries were included, involving a total of 38.5 million colonoscopies. The estimated incidence per 10,000 colonoscopies was as follows: gastrointestinal AEs, including perforation (5.15; 95% confidence interval [CI] 4.19-6.34, I2 = 99%), bleeding (18.39; 95% CI 13.53-24.99, I2 = 100%), and splenic injury (0.61; 95% CI 0.43-0.85, I2 = 93%); nongastrointestinal AEs, including cardiovascular events (52.11; 95% CI 18.67-144.59, I2 = 100%), respiratory events (4.26; 95% CI 0.73-24.99, I2 = 100%), and deaths related to colonoscopy (0.18; 95% CI 0.10-0.34, I2 = 74%). Subgroup analyses yielded partially divergent findings. The majority of the included studies exhibited a low to moderate risk of bias.
just ask any AI, i don't got time to play tic-tac-toe with the NIH.gov website gating me behind click bus images for 10 minutes
You are hardly describing "serious complications" ('bleeding', and 'respiratory events' are very non specific, and the fact that this is an uncited meta-analysis across nations makes the whole enterprise suspect), even less so since your source averages 24 countries while we are speaking about US colonoscopy recommendations.
My source is not seeing one perforation each week at work.
> just ask any AI
These do not give reliable answers, as I am sure you know
First, the study looks at people who had a positive screening Cologuard/FIT test. These are not normal people!
Second, the test looks at DEATHS WITHIN THIRTY DAYS of the procedure. In fact, the article goes on to say that there are ZERO deaths related to the actual procedure. ZERO.
This is funny. I've had an unbelievable string of bad doctors / clinics... almost as though something is wrong with medical care around here.
Couple of years ago the latest doctor who I fired started talking colonoscopies. I asked some basic questions like how do they get paid? How much do they get paid? Who inspects their facilities?
He took great umbrage at the notion that the doctors were getting "bounties" for nipping pieces of tissue for lab review, refused to discuss that. (Tell me you know something without telling me you know something.) He also took umbrage at the notion that his clinic wasn't "clean" and that it was inspected regularly... didn't say by whom.
So here's the deal. Here in Washington State, USA his clinic gets a "wet work" inspection, just like a slaughterhouse or restaurant, as part of the occupancy / doing business license. But there is no ongoing inspection, and fuck no there is no "safe to eat here" poster in the window of his clinic.
It gets more interesting when you start looking at the datasets an inquiry like that turns up. Like: how many deaths / hospitalizations are there per 1K procedures? Actuarily we have a number. Now clinics, at least the ones doing things on a regular basis, have to report adverse events leading to hospitalization: the reporting rate is impossibly lower than the actuarial rate, complications leading to hospitalization are not being reported. But.. there's more! The State collects "foreign contamination" stats from pathologists; you can look at this by pathologist, if they do enough of them. The majority of pathologists scoring colonoscopy samples report ZERO foreign contamination; among the pathologists actually reporting, the rate for presence of foreign contamination is around 25%.
I tend to let Feynman, Fermi, and Bayes guide my inquiries generally in that order. Part of the process is generating good questions; another part of the process is generating good actionable questions (tailored to the moment). Questions which are obvious, which are "horseshoes and hand grenades" type questions, based on what we know now. Follow things a little bit, test it, see where it's soft.
In this case I called public health and building inspection agencies and asked them what sort of ongoing inspections there were for clinics and other medical facilities. That turned up databases online, and keywords which turned up other databases.
What was the germ (pun intended) of this inquiry? Several years earlier, sitting in the waiting room of a different clinic, and the linen supply company pushes a cart through (gets buzzed through to the back) to collect the dirty linen, wearing gloves. Like they did this every day. Many years ago, the memo taped to the doors to a lab wing at a biotech: "gloves must be removed when greeting visitors". Various reports over the years concerning improperly sterilized dental instruments.
My doctor says that since Cologuard catches a large percentage of those 3-5 per 10,000 without any of the colonoscopy risk, the marginal benefits from colonoscopy really aren't justified since FIT+DNA testing is almost as good, at least for low-risk cohorts.
Very few things in medicine are zero risk. I wish more doctors would help balance the risk of doing A vs. the risk of doing B vs. the risk of doing nothing.
It's all Bayesian conditional probabilities, considering your own individual risk factors, and considering the false positive rate and false negative rate of each test.