We need more barriers to colonoscopies

Remember, every colonoscopy you can delay or deny improves Executive Compensation.

United Healthcare to require pre-authorization for some colonoscopies (usatoday.com)



Just say “NO!”

Apparently the mortality from colonoscopies is not compensated by the reduction in mortality from diseases it diagnoses.

The Captain


I doubt you’d be saying NO! under the circumstances described in the linked article


I’m not a doctor, but I’m pretty sure this is false. Way way way false.

Risks associated with colonoscopy in a population-based colon screening program: an observational cohort study - PMC.


You are reporting deaths attributed to colonoscopies and I have no reason to doubt those numbers. The report I read compared these (or similar) numbers to survival rate for people who did not have colonoscopies and died from the not-diagnosed disease and found no benefits in survival rates. Sorry but I don’t have a link to the article which I read several years ago.

The point made by the article was that there was no improvement in survival rates with and without colonoscopies. If one thing didn’t kill you the other did. A less invasive diagnostic method would be great, something like ultrasound.

How did you arrive at the triple false conclusion?

The Captain


Captain it is a bad choice at times for an 80 plus year old to have a colonoscopy. The probe can rip the large intestine. The wall gets thinner with age.

I have not been following this thread. Calling things medically in this forum is not such a great thing. I get we are older and curious but we most of us are not a doctor in the office seeing anyone here.

Oh lord … it’s a false comparison. You can’t compare “people who had colonoscopies” to “people who didn’t have colonoscopies”, because they are dissimilar groups. Take me, for example, I’ve been having colonoscopies since my early 30s, probably every 3-5 years. That’s because my father had colon cancer at a young age (very early 50s) and the docs recommended it. Two decades later, he took the genetic marker test (paid close to $1500 for it) because some of my siblings refused to have a colonoscopy. Turns out that he doesn’t have the marker, so I dropped down to the usual frequency for colonoscopy.

The population for most people having colonoscopies is selected or even self selected so it isn’t random at all. Even if you find a population that’s random, they will all be over 55 (because that’s the age it was recommended for a widespread population), and over 55 on average have many more ailments than under 55 anyway (“if one thing didn’t kill you …”).

Finally, colonoscopy as a tool really does work for the most part. It identifies potential cancers and allows early treatment. And colon cancer treatment is among the most successful when it comes to cancers. That’s the key - early treatment. Same applies to breast cancer. Other cancers that are difficult to get an early diagnosis of, like brain, pancreas, etc, have much lower success rates.


Yes. I can attest to this. I had a cousin and a cousin-by-marriage who both died in their 70s from colon cancer. Not exactly prematurely (as I would certainly have thought a few decades ago) However, death is not the only outcome.

They were both diagnosed in their mid-late 60s. Not by screening colonoscopies, but by the symptoms of advanced disease…my actual cousin from severe anemia from frequent bleeds (he thought he had piles) and his BIL when his sudden onset severe constipation developed into being unable to even pHart! The sort of thing that you’d associate more with a century or so back rather than a couple of decades or so.

In spite of screening colonoscopies being recommended for their age groups and totally FREE thanks to the NHS, neither of them bothered … belonging as they did to the era/educational background/understanding etc that subscribed to the notion that you only go to the doctor if you have symptoms of “something”.

Like I said, not a totally premature death but their last decade plus of life (of sorts) involved managing their colostomies, chemotherapy etc…all stuff that would’ve been prevented by a more timely diagnosis


I’ll put in a vote for Cologuard.


Hear hear!

I have to schedule my second one now age 60. See if the same doctor who did it last time is around. Time to make that call.

Ask about Cologuard, really! If you were clean last time, which I presume you were since it has ben 5 years, then an at home test with no nasty prep is definitely the way to go unless something shows up.


Perfectly fine…as a screening tool for colon cancer. Reading the actual article, it looks as if these new requirements are extending towards diagnostic endoscopies for other conditions and to include other orifices.

I am going to let my actual doctor work on any of these decisions.

:grin: :grin: :grin:

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[quote=“intercst, post:1, topic:92762”]
every colonoscopy you can delay

Not sure I’d advertise my work as “the Theranos that works”, kind of like saying your care is the Yugo that runs.


Anyway, IF the hype becomes true, some screening tests will go by the wayside. Until then, I wouldn’t base my medical care choices on if I’m increasing executive compensation. FWIW, colon cancer used to be an “old persons” disease but more and more is being found in younger people in their 30s/40s. Initial thoughts because of crappy diet and exercise habits. Who would’ve though.


Denis Burkitt did.

Back in the early 70s, we had him as a guest speaker at one of our dental student society meetings. Well advertised, which turned out to be a bit of a mistake.

Us dental students and faculty etc drifted along …expecting to hear a lecture on Burkitt’s Lymphoma…only to find our lecture theater packed out with what looked like the whole of the medical school. Opening slide was of a big pile of poop and that was the theme…the decline of roughage in the diet, lack of exercise and not squatting to poop (which, apparently, was the norm in Uganda etc)

He made it a surprisingly entertaining talk.

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I think you must have misread the article. Executive Compensation is increased if the insurance company makes it harder for you to get a colonoscopy. I’m not advocating that people not get one.

Executive Compensation is also increased by Cologuard. Obamacare provides free colon cancer “screening”, but the patient has the choice of Cologuard or a colonoscopy. Your health insurance CEO would prefer you get Cologuard.

Colonguard is about one-quarter the cost of a colonoscopy. But if you come up “positive” on Cologuard, you need to confirm the result with a colonscopy which is now no longer a “screening procedure” because you’ve had a positive test for colon cancer, and you get billed for the cost of a “diagnostic colonoscopy”. That’s why the most cost effective decision for the patient is to “man up” and get the “free colonoscopy” when it’s offered.



The value of colonoscopy as a screening tool over the Cologuard test is even greater than that. In keeping with one of my popular themes…of identifying the early departure from healthy homeostasis before disease status is reached as opposed to early detection of the disease once it’s developed. Colonoscopies allow identification and removal of suspicious looking polyps before they’ve even become cancerous. Actual prevention vs early treatment.

I’ll take that, TYVM. If someone has a hard time handling a pre colonoscopy bowel prep (a big source of complaint) it’d be a good idea to imagine dealing with a colostomy bag.


Out of interest, Mark, what was these siblings’ reaction to the possibly false reassurance of your dad’s negative genetic test …seeing as absence of evidence isn’t evidence of absence? You’d think that, if your dad was willing to pony up that sort of money because he was worried, they’d at least put his mind at rest by doing a screening test. You can probably tell I’m a singleton. My BIL is a lot like this…probably worse, him being a PhD and all.

My husband’s older brother (76) hasn’t had a colonoscopy in spite of two of their cousins developing it (husband does, of course) He also hasn’t had any screening for aortopathy even though we’ve told him that whatever as yet undetected genetic cause of dh’s aortic aneurysm, the daughter has inherited it. His attitude is “something is going to kill you”…and the other canard, “I haven’thad any problems”. OK, I guess if your current existence isn’t worth living…but another decade or so of an existence not worth living is another option to consider with preventable disease. All that aside, when your worried relatives (and relatives with good cause to know) aren’t enough to sway a decision that’s so easy to make, it looks to me like a “don’t care” attitude. Like I said…you can probably tell I’m a singleton

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My siblings didn’t want to have a colonoscopy in their 20s and 30s and 40s, but now that they are all 50+, they have regular colonoscopies as recommended. I started in my early 30s (I’m only 20 years younger than my father).

Pure stupidity and bullheadedness.

We’ve noticed that perhaps breast cancer and colon cancer may be related somehow. In my dads family, nearly all the females have had aggressive breast cancer. His mom, my grandmother, died of [breast] cancer at age 64. Two of his cousins died of breast cancer younger than 60. And many of the other women relatives have had breast cancer treatments of various types.

My dad was misdiagnosed for two years with diverticulitis (diverticulosis?) but finally went to a different doctor that immediately ordered tests for colon cancer. Result was stage 4 cancer. Less than a week after diagnosis, he had a few feet of cancerous colon removed, and then began chemotherapy that ran for about 9 months. And now, about 30 years later he’s fine! Docs even reduced his colonoscopy schedule from once every 6 months to once a year, and I think they recently reduced it further to once every two years.

The doctor that misdiagnosed him for two years also misdiagnosed himself - he started huffing and puffing when climbing stairs, so he prescribed himself “more exercise” and “lose weight”. He began jogging, and indeed did lose some weight, and seemingly got into better shape, he usually did one circle around the neighborhood of running, but felt extra good one day and decided to do two of those circles. Midway on the second circle, perhaps 100-150 yards from my parent’s house, he collapsed on the street with heart failure, and died on the spot. In his early 40s. With 3 kids in the house. Turns out his arteries were substantially blocked and he required some sort of treatment (angioplasty? Valve replacement?) before embarking on a vigorous exercise program.

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This wasn’t a rare occurrence when I was back in middle/high school. Over the years a few classmates were called out of a class, someone would come to pick up their bags and stuff and they’d be off school for a couple of weeks. Father had a heart attack and either died on the spot or on the way to hospital. First symptom of coronary artery disease they’d shown. Still not as rare as it ought to be even today…but you’ve read that before, right :wink:.

'Twas a good week for my daughter. Not only snagged a new pupper but had her follow-up visit with the new PCP and her bloodwork has turned out to be top notch. Including the worrisome Lp(a) so, pending any dramatic change following menopause or a lifestyle change to overeating and lounging about (not so likely as she’s almost as vain as I am) the only cardiac issue could be her dad’s gift of the aortopathy.

At least, she can keep a better eye on that than most anyone. Ironically, when she first got her state of the art mobile echo equipment, she gave it a test drive on our dogs, the baby (as she was at the time), son in law and me…but didn’t bother with herself and gramps. That was a big omission, when you look back!

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