Colonoscopies Not An End All

You may believe that colonoscopies are infallible – get a colonoscopy, get any precancerous polyps removed, and you won’t get colon cancer.

Researchers, however, have recently reported the colonoscopies may miss a type of polyp, a flat lesion or an indented one that nestles against the colon wall. And another Canadian study,  found the test, while still widely recommended, was much less accurate than anyone expected.

In the new study, the test missed just about every cancer in the right side of the colon, where cancers are harder to detect but about 40 percent arise. And it also missed roughly a third of cancers in the left side of the colon.

Instead of preventing 90 percent of cancers, as some doctors have told patients, colonoscopies might actually prevent more like 60 percent to 70 percent.

People should continue to have the test, because it is still highly effective, but one should seek the best colonoscopists by, for example, asking pointed questions about how many polyps they find and remove. People should also be scrupulous in the unpleasant bowel cleansing that precedes the test, and promptly report symptoms like bleeding even if they occur soon after a colonoscopy. Colonoscopies are not a perfect screening test because they depend on the competence of the doctor doing the procedure.

The American Cancer Society says that even if the test is less effective than many had believed, it has no plans to change its recommended intervals between screenings — the test still prevents most cancers, but the expense and risk of the test argue against doing it more often.

The cancer society and the Centers for Disease Control and Prevention also are focusing on developing measurements of quality so that doctors who do colonoscopies can assess themselves and improve.

About 148,000 people will learn they have colon cancer this year, the American Cancer Society reports, and nearly 50,000 will die of it.
The risk of developing colorectal cancer increases with advancing age. More than 90% of cases occur in people aged 50 or older. Other risk factors include having:

Inflammatory bowel disease.
A personal or family history of colorectal cancer or colorectal polyps.
A genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (Lynch syndrome).

Lifestyle factors that may contribute to increased risk of colorectal cancer include:

Lack of regular physical activity.
Low fruit and vegetable intake.
A low-fiber and high-fat diet.
Overweight and obesity.
Alcohol consumption.
Tobacco use.

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