Does a colonoscopy work if you don’t get one? Evidence from an EU study of American endoscopists

A colonoscopy is a popular method of cancer screening that involves looking for suspicious growths, called polyps, and cutting them out. Sometimes slow-growing adenomas would turn into cancer if they hadn’t been removed, so by looking periodically and removing any of them the procedure serves as both a screening tool for Cancer and an intervention to prevent a tumor from developing in first place.

“A colonoscopy will only work if a patient gets one,” says Bret Petersen, a gastroenterologist at Mayo Clinic and president of the American Society for Gastrointestinal Endoscopy, a leading group of GI doctors. Petersen says it’s important to focus on the outcomes of the people who actually underwent the procedure, which was about 42% of participants who all lived in European countries, including Norway and Poland.

The American Cancer Society has weighed in on the study, too, also pointing to the high number of participants who didn’t get the procedure. The Chief Scientific Officer at the ACS says that it is hard to know the value of screening tests when the majority of people in the study do not get it done. It was found that those who were screened had a 31% reduction in risk.

Adults across the United States are being diagnosed with colon and rectal cancers at younger ages, and now 1 in 5 new cases are among those in their early 50s or younger, according to the American Cancer Society’s latest colorectal cancer report.

Some doctors point out that the methods used by endoscopists have improved over the past few years, when compared to the European study.

The author says he’s aware that his paper is being critiqued. But he pushes back against the idea that endoscopists didn’t find the expected levels of polyps. “In the two countries that contributed the highest number of participants, which is Norway and Poland, the detection rate, which is the quality metric for finding polyps, was 30%, which is well above the current threshold for good quality,” says Dr. Michael Bretthauer of the University of Oslo in Norway. The detection rate in Sweden was lower, so fewer people participated in the study. “So I don’t think that that argument is valid.”

Screening of colorectal cancer cases and deaths in the United States, according to a new study from the Kaiser Permanente and the American Cancer Society

The U.S. preventive Services task force has several different methods of colorectal screening recommended, which include colonoscopies, sigmoidoscopy, stool-based tests, and other methods.

Patients at Kaiser Permanente opt for the FIT tests more commonly. Sometimes, the biggest hurdle is remembering to take the test, so Corley says at Kaiser they mail the stool-based tests to patients and then keep contacting patients, until tests are sent back.

Each screening approach “has its pluses and minuses,” Corley says. A colonoscopy is likely to be recommended if the stool sample test is positive. Colonoscopies do carry small risks, including the risk of a perforation or tear in colon, bleeding at the site of a biopsy (if the doctor removes a polyp or takes a biopsy), and potential side-effects from sedation during the procedure.

“Anecdotally, it’s not rare for us now to hear about a young person with advanced colorectal cancer,” said Dr. William Dahut, chief scientific officer for the American Cancer Society. Last year, Broadway actor Quentin Oliver Lee died at the age of 34 after he was diagnosed with stage IV colon cancer, and in 2020 “Black Panther” star Chadwick Boseman died at the age of 43 of colon cancer.

Dahut doesn’t want to blame anyone for their cancer diagnosis. It is hard not to consider that a diet related to colorectal cancer is possible, when you see something occurring in a short period of time.

Looking forward, the researchers estimate that there will be 153,020 colorectal cancer cases diagnosed in the US this year and an estimated 52,550 colorectal cancer deaths, with 3,750 of them – or 7% – among people younger than 50.

For the new report, researchers at the American Cancer Society analyzed data from the National Cancer Institute and the US Centers for Disease Control and Prevention on cancer screenings, cases and deaths.

Rebecca Siegel, senior scientific director of research at the American Cancer Society and lead author of the report, said it’s alarming to see how quickly the whole patient population is shifting younger even though numbers in the overall population have shrunk. “The trend toward more advanced disease in people of all ages is also surprising and should motivate everyone 45 and older to get screened.”

There were significant differences between whites and blacks. The researchers found that colorectal cancer cases and deaths were highest in the American Indian/Alaska Native and Black communities. The data shows that death rates from colorectal cancer were higher in Black and American Indian men than they were in White men.

The Screening Age of Colorectal Cancers and the Importance for Primary Care Physicians to Be Screened at an Older Age

The age to start screening was recently lowered to 45, but we need to understand more why we are seeing an increase and we are interested in that as well.

Mendelsohn says she has seen an increase in advanced colorectal cancers and diagnoses among her younger patients, and she says to watch for symptoms such as rectal bleeding, abdominal pain and changes in bowel habits.

To be able to evaluate patients quickly, it is important that they are aware of the symptoms. If you’re at an older age, please get screened.