Most guidelines recommend that people screen once ever 10 years for colorectal cancer starting at age 50 and up until they turn 70. But researchers have recently determined that some people only need to undergo one colonoscopy in their lifetime, though some in the medical community warn against taking this new finding any further than speculation.
In a study published in the Annals of Internal Medicine, researchers found that those who tested negative for colon cancer in their first colonoscopy lived just as long as those who received the recommend follow-up colonoscopy every 10 years or sought alternative screening.
The findings were based on a computer model, whose "patients" either received no additional screening or underwent one of four follow-up screening tests from 60-75: the regular colonoscopy every decade; a CT scan of the colon every five years; or two types of annual stool tests, fecal immunochemical testing or fecal occult blood testing, according to the study. If the hypothetical patients followed all rescreening procedures to a T, Knudsen said:
"...the model predicted 7.7 to 12.6 cases of colorectal cancer per 1,000 people over their lifetimes, and 2.4 to 3.5 deaths from colorectal cancer per 1,000 people, depending on the rescreening method used. In contrast, the model predicted 31.3 cases per 1,000 people, and 11.9 deaths among those who received no further screening."
"Right now there is no colorectal cancer screening test that will reduce your risk of colorectal cancer to 0. Our study found that rescreening with any method after a negative colonoscopy substantially reduces colorectal cancer risk compared with no further screening," lead study researcher Amy Knudsen of Massachusetts General Hospital told Huff/Post50. "That you get screened again appears to be more important than which rescreening approach you opt for."
The computer-based nature of the findings is what has some in the medical field weary. "The single most limiting factor of such simulation models is the power and accuracy of the assumptions," Alan G. Thorson, president of the American Society of Colon and Rectal Surgeons, told Huff/Post50. "Regardless of the strengths or weaknesses of the assumptions used in this study, it is still a single study. Screening guidelines are established based on a review of all available pertinent literature, never on a single study. While this study may play an important role in the screening guidelines development process it should not be used, and patients should not be encouraged to use it, in making personal screening decisions. Suggesting such represents an irresponsible use of the medical literature."
Knudsen said she hoped the study "will provide more information to patients and their doctors about the options available for rescreening after a negative colonoscopy.
"Rescreening with colonoscopy or CT imaging of the colon prevents more cases of colorectal cancer than rescreening with fecal occult blood tests. Colonoscopy is invasive, while CTC and the fecal occult blood tests are not. The risks of complications are higher with colonoscopy, you may need to take a day off from work to have it done, and you need someone to drive you to and from the procedure.
"However, colonoscopy is screening and treatment at once, since detected adenomas can be removed right then and there," she continued. "With all of the other tests, if you have a positive test result you have to have a colonoscopy in order to realize any benefit. And finally, fecal occult blood tests have to be performed regularly in order for them to be as effective as other options. In light of these differences, it’s clear that no one test will be right for everyone. You should talk with your doctor to decide which approach is best for you given your risk and your preferences. No test is effective unless it is done, so opting for an approach that you’re willing to comply with is key."
It seems like modern medicine is trying to find a way to make the business around colonoscopies as relatively painless as possible. A Mayo Clinic in Phoenix recently required patients to take four pills instead of two or more liters of laxatives to prep for a virtual colonoscopy. More than 1,000 readers rejoiced at the news, with one saying, "unconsciousness was a blessing" compared to the "seven pints of the foul brew" one typically has to throw back in preparation for the test.
Electrocardiograms, better known as EKGs, made the Choosing Wisely list. The painless test is "done routinely during a physical, even when there is no sign of heart trouble," <em> <a href="http://www.nytimes.com/2012/04/04/health/doctor-panels-urge-fewer-routine-tests.html">The New York Times</em> reports</a>.
Proton Pump Inhibitors
These strong drugs prescribed for severe heartburn often make their way into the hands of of those with only a slight case of discomfort. "High doses of [proton pump inhibitors], and taking them for a year or longer, has been linked to an increased risk of bone fractures. Long-term use might also deplete magnesium blood levels, which, in turn, can trigger muscle spasms, irregular heartbeats, and convulsions," <a href="http://consumerhealthchoices.org/wp-content/uploads/2012/05/ChoosingWiselyHeartburnAGA2.pdf">Choosing Wisely reports</a>.
When it comes to lower back pain, doctors shouldn't use M.R.I.s within the first six weeks of a patient's complaints unless "red flags are present," <a href="http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_Amer_Acad_Fam_Phys.pdf"> according to the American Academy of Family Physicians</a>.
That flareup of sinusitis -- an inflammation of the sinuses -- probably doesn't need a round of antibiotics for treatment, the report found.
"Women older than 65 who have had several normal Pap tests can stop having the test," <a href="http://consumerhealthchoices.org/wp-content/uploads/2012/05/ChoosingWiselyPapTestsAAFP.pdf">according to Choosing Wisely</a>.
Now doctors are advised to not use this test "as a routine follow-up for mild, asymptomatic native valve disease in adult patients with no change in signs or symptoms," <a href="http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_Amer_Coll_Cardio.pdf">according to the Choose Wisely report</a>.
Getting imaging tests like CT scans for headaches are not terribly helpful. "Research shows that for people with a normal medical history and neurological exam, imaging tests are unlikely to reveal a more serious underlying problem," <a href="http://consumerhealthchoices.org/wp-content/uploads/2012/04/ChoosingWiselyHeadachesACR.pdf">according to the Choosing Wisely report</a>.
Bone Density Imaging
If you don't have a high risk for weak bones (70 years old for men and 65 for women), you may want to demur if your doctor recommends bone density imaging. The test can lead to a diagnosis of osteopenia, a condition with risky drug prescriptions that can lead to side effects such as thigh fractures and abnormal heart rhythms, <a href="http://consumerhealthchoices.org/wp-content/uploads/2012/05/ChoosingWiselyBoneDensityAAFP.pdf">the Choosing Wisely report found</a>.
Exercise Stress Test
Besides being expensive, an unnecessary exercise stress test "can produce inaccurate results that trigger follow-up tests that can pose risks," the report found.
Surveillance Testing (Biomarkers)
While this form of testing can help colorectal cancer sufferers, doctors are now advised not to use it on breast cancer patients who are being treated with "curative intent." "False-positive tests can lead to harm through unnecessary invasive procedures, over-treatment, unnecessary radiation exposure, and misdiagnosis," <a href="http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_Amer_Soc_Clin_Onc.pdf">the report found</a>.
"Kidney disease doctors are urged not to start chronic dialysis before having a serious discussion with the patient and family," <a href="http://www.nytimes.com/2012/04/04/health/doctor-panels-urge-fewer-routine-tests.html"><em>The New York Times</em> reports</a>.
Acid Reflux Medicine
"The American Gastroenterological Association is urging its physicians to prescribe the lowest doses of medication needed to control acid reflux disease," <a href="http://www.nytimes.com/2012/04/04/health/doctor-panels-urge-fewer-routine-tests.html"><em>The New York Times</em> reports</a>.
If a patient isn't exhibiting any heart and lung disease symptoms, chest radiography should not be performed. "Preoperative chest radiography rarely provides any meaningful changes in management or improved patient outcomes," <a href="http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_Amer_College_Phys.pdf">the American College of Physicians found.</a>
White Blood Cell Stimulating Factor
For patients with neutropenia (a condition characterized by "<a href="http://www.mayoclinic.com/health/neutropenia/MY00110">an abnormally low count of neutrophils</a>, white blood cells that help your immune system fight off infections"), doctors shouldn't inject white blood cell stimulating factor to stave off fever if they have a less than 20 percent risk for this complication.
Colorectal Cancer Screening
Patients don't need to have a "repeat colorectal cancer screening (by any method) for 10 years after a high-quality colonoscopy is negative in average-risk individuals," <a href="http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_AGA.pdf" target="_hplink">advises the American Gastroenterological Association</a>.
If a patient with <a href="http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002128/">Barrett's esophagus</a>'s first endoscopy reveals zero signs of cell change, doctors should only use an endoscope once every three years, the report found. "If these cellular changes occur, they do so very slowly."