The risk is the primary reason the age for first colonoscopy is so high. Even with cologuard it's not typical before 40 unless you have family history.
There's also risks of false positives/negatives for some tests which complicate matters as well.
> The risk is the primary reason the age for first colonoscopy is so high
What? I have a hard time understanding this, what is your primary reference.
Colonoscopies take a lot of resources and GI docs are in high demand—these seem much more plausible limiting factors than undefined 'risks' inherent to the procedure.
Those are also factors for sure, but the the risks from complications aren't undefined. Even cheap and non invasive screening carry risk due to false positives inviting unnecessary downstream procedures.
Not an MD but have worked in cancer prevention for a while in a software capacity.
You can link to the figures directly for PMC articles.
My point is that the risks aren't the limit for how we think about testing (though they exist), but instead the low marginal improvement in diagnostic yield and life expectancy.
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%.
