Wednesday, September 23, 2020

Cologuard has drawbacks, but better than doing nothing


from Bartholomeo Eustachi: Tabulae anatomicae
     Three times a week is a lot to stand on my little newsprint soapbox, raise a tin trumpet to my lips, and blow.
     So if I expect you to regularly listen, I’d better not sound the same note, but skip from one tune to another. Because repetition is boring. But sometimes a shoe is left dangling, such as when I wrote about the Cologuard colon cancer test on Sept. 8.
     Reaction fell into two camps. Those grateful to learn of this new way to detect colon cancer with a home test. And those concerned with aspects I didn’t address.
     “Your comprehensive article on Cologuard does not cover the most obvious question — how many false positives? False negatives?” wrote Dr. Robert W. Brandstatter, a North Side dentist.
     “We have no real data to help guide patients and clinicians with what to do after a Cologuard test is done,” wrote Dr. Tibor Krisko, a New York gastroenterologist and assistant professor at Weill Cornell Medical in New York City. “If positive, a colonoscopy is clearly warranted (though there is evidence to suggest many people with positive results do not get the all-important, potentially life-saving colonoscopy).”
     The traditional colonoscopy — a doctor snakes a tiny camera into your intestines to look for tumors — has drawbacks. You must go to a hospital, risky in the age of COVID. You’re under general anesthesia, also presenting risks. Doctors might perforate your colon with the probe. The procedure is uncomfortable, time-consuming and expensive. So 40% of adults skip the test, despite its big benefit: detecting cancer when early and treatable instead of advanced and lethal.

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8 comments:

  1. I've had over a dozen colonoscopies I usually don't get any sedation. It doesn't hurt that much & you just go home. I like to watch it on the big screen tv they have as it happens.
    Once I even go paid to get one, they were teaching newer doctors how to do it.

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  2. Over the last several years, my doctor has recommended, strongly recommended, a colonoscopy, which I've successfully put off, relying on my high fiber diet and my regularity to decrease the chances of colon cancer, but with a lurking suspicion in the back of my mind that I might be in for a rude awakening. Thus, when I heard of Cologard, I was delighted: no nasty intrusion, no peril from possible punctures (alliteration accidental) and no danger from anesthesia, which was even more of a worry for me when I had a bad and persistent reaction to a "twilight" drug given for a angiogram recently. I hadn't even thought of the question of how competent and thorough the doctor doing the colonoscopy might be. I'm sold on Cologard. At the age of 78, I'm probably not the best candidate for a colonoscopy anyway. Barring some medical innovation allowing doctors to see the inside of my intestines without sticking a camera up my ass, I'll put my faith in Cologard and its so-far negative results.

    john

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    1. So you've repeatedly put off your doctor's wise advice? John, you've been a lucky man, to put it bluntly. Lucky that you've lived to be 78 without experiencing a miserable death. Some people aren't so lucky. What follows is from my original 3/22/20 post on this blog:

      That way of thinking took the life of a decades-long friend. His doctors told him that being a vegetarian for decades made him so healthy that he could forego routine colonoscopies. He believed it. At his son's graduation, he got very sick, was hospitalized, and the diagnosis was Stage 4 colon cancer. A family doctor had either missed the original symptoms, or downplayed them.

      A huge hometown benefit concert for our musician/songwriter friend lasted twelve hours and featured fifteen bands, but he was too weak to attend. He died nine days later. From diagnosis to memorial service (on what would have been his 63rd birthday) took only nine months. At the end, he looked like he was about 112.

      The community lost a vocal activist, a quiet humanitarian, and a staunch homeless advocate. My wife and I lost a friend, as well as a hair stylist who cut my wife's locks for 38 years, and my own for 24.

      His son was devasted by the loss, and on his blog he wrote a long, long rant about his father and his family's ordeal and he had this advice: If you're over fifty (or even 25), and your doctor doesn't suggest a routine colonoscopy...it's time to find another doctor.

      I was a lot luckier than my friend was...I went 17 years between check-ups...from the age of 50 to age 67. Nothing was found. Same as when they X-rayed my head.

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  3. ...the spinning carnival wheel of wonder you’ve come to expect...

    Ah, I wondered what that feeling was.

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  4. My first was one of the best naps I’ve ever had (I don’t have Clark’s fortitude). As everyone agrees, the prep is worse than the test. My next is scheduled for next week. I’d like to credit you for inspiration, but it’s just time.

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  5. tate, you are fortunate, but could be pressing your luck. Your age would indicate eschewing surgery for a slow growing tumor, like most prostate cancers, but colon cancer would require immediate surgery. Had I not been on a regular colonoscopy schedule, and had no procedures the past twenty years, I would probably not be writing this, as I have multiple polyps every time. The most shocking and relevant item in this second piece, Neil, is that a Cologuard positive result would void insurance coverage. Would that include Medicare? Does that apply to cancer discovered by a colonoscopy? Why would one positive be different than the other. I suspect an Insurance problem for the case sighted here.

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    1. When a colonoscopy is done as part of a regular preventive medicine checkup, it is fully covered, at least as of now. Trump is working to void the ACA which would change that. When it is ordered due to a specific reason it is no longer preventative but diagnostic. And yes, that includes Medicare.
      I had a dual scope earlier this year, endo and colon. It was done at an outpatient facility that was super cautious. My wife had to wait in the car instead of the waiting room. Yes, the prep is horrible but the procedure is a piece of cake.

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