By Ronald D. Collier, MD, MBA, FACS, FCCP
I would like to submit this letter for consideration for publication.
I read with great horror a number of articles in the lay press questioning the effectiveness of a colonoscopy. These articles stated that there is a value to a colonoscopy, but it may not be as much as previously thought. As a surgeon and intensivist, who comes from a family with a significant family history of colon cancer, I read the basis article in the New England Journal of Medicine. The conclusions were based on approximately 84,000 participants between ages 55 and 64 who were randomly selected to either be invited or not invited to have a colonoscopy. Of the 28,000 who were invited to have the colonoscopy, only 11,000 actually had the colonoscopy, and the remaining 56,000 had “usual care” with no colonoscopy.
Of significance, the study was conducted in Norway, Sweden, and Poland. Countries with a presumably different genetic background, diet, and societal risk factors than in the United States, where the incidence of colon cancer is increasing and being detected at an earlier age, especially in specific communities within the United States. Also, there are no screening guidelines in these countries, whereas the United States has recently decreased its screening recommendations from age 50 with no family history to age 45 with no family history and to age 40 if there is a family history.
Furthermore, in the article, the authors state that if all of the people who were invited to have a colonoscopy had had one done, then the statistical benefits of colon cancer detection and colon cancer death would have been much greater. Lastly, the endpoints were colon cancer detection. Given the theory that cancer evolves from slow growing polyps, surveillance of these polyps is necessary to decrease the incidence of colon cancer, and detection of cancer at initial colonoscopy should not be the sole endpoint. Having had my own colonoscopy 2 weeks ago, after polyps were found on my initial, both of which were biopsy proven benign, I can say that a negative finding is a good finding. Having a very close relative having had an advanced adenoma on colonoscopy, I am frightened to think what may have happened, had their colonoscopy been deferred. Since this relative is below the age of 55, they would never have received a colonoscopy at all in these countries, whether a part of the study or not.
Having read an obituary of one of my high school friends who died in his 40s of metastatic colon cancer, I cautioned my family in writing to ignore these lay articles, and proceed with their colon cancer screenings as per their physician. When people tell me they hate the bowel prep, I tell them that one night of an inconvenient bowel prep is minimal compared to an open low anterior resection with end colostomy which could be for life. While I am sure this study has value for someone somewhere, I would encourage readers to proceed with colon cancer screening either by colonoscopy or stool DNA as per their primary care physician recommendations.