Remember, every colonoscopy you can delay or deny improves Executive Compensation.
United Healthcare to require pre-authorization for some colonoscopies (usatoday.com)
intercst
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Just say âNO!â
Apparently the mortality from colonoscopies is not compensated by the reduction in mortality from diseases it diagnoses.
The Captain
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I doubt youâd be saying NO! under the circumstances described in the linked article
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Iâm not a doctor, but Iâm pretty sure this is false. Way way way false.
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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 donât 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 didnât 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
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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 ⌠itâs a false comparison. You canât compare âpeople who had colonoscopiesâ to âpeople who didnât have colonoscopiesâ, because they are dissimilar groups. Take me, for example, Iâve been having colonoscopies since my early 30s, probably every 3-5 years. Thatâs 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 doesnât 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 isnât random at all. Even if you find a population thatâs random, they will all be over 55 (because thatâs the age it was recommended for a widespread population), and over 55 on average have many more ailments than under 55 anyway (âif one thing didnât kill you âŚâ).
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. Thatâs 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.
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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 diseaseâŚmy 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 youâd 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 âsomethingâ.
Like I said, not a totally premature death but their last decade plus of life (of sorts) involved managing their colostomies, chemotherapy etcâŚall stuff that wouldâve been prevented by a more timely diagnosis
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Iâll put in a vote for Cologuard.
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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.
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Perfectly fineâŚas 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.
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[quote=âintercst, post:1, topic:92762â]
every colonoscopy you can delay
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Not sure Iâd advertise my work as âthe Theranos that worksâ, 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 wouldnât base my medical care choices on if Iâm increasing executive compensation. FWIW, colon cancer used to be an âold personsâ 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 wouldâve though.
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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 âŚexpecting to hear a lecture on Burkittâs LymphomaâŚonly 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 themeâŚthe 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. Iâm not advocating that people not get one.
Executive Compensation is also increased by Cologuard. Obamacare provides free colon cancer âscreeningâ, 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 âpositiveâ on Cologuard, you need to confirm the result with a colonscopy which is now no longer a âscreening procedureâ because youâve had a positive test for colon cancer, and you get billed for the cost of a âdiagnostic colonoscopyâ. Thatâs why the most cost effective decision for the patient is to âman upâ and get the âfree colonoscopyâ when itâs offered.
intercst
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The value of colonoscopy as a screening tool over the Cologuard test is even greater than that. In keeping with one of my popular themesâŚof identifying the early departure from healthy homeostasis before disease status is reached as opposed to early detection of the disease once itâs developed. Colonoscopies allow identification and removal of suspicious looking polyps before theyâve even become cancerous. Actual prevention vs early treatment.
Iâll take that, TYVM. If someone has a hard time handling a pre colonoscopy bowel prep (a big source of complaint) itâd be a good idea to imagine dealing with a colostomy bag.
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Out of interest, Mark, what was these siblingsâ reaction to the possibly false reassurance of your dadâs negative genetic test âŚseeing as absence of evidence isnât evidence of absence? Youâd think that, if your dad was willing to pony up that sort of money because he was worried, theyâd at least put his mind at rest by doing a screening test. You can probably tell Iâm a singleton. My BIL is a lot like thisâŚprobably worse, him being a PhD and all.
My husbandâs older brother (76) hasnât had a colonoscopy in spite of two of their cousins developing it (husband does, of course) He also hasnât had any screening for aortopathy even though weâve told him that whatever as yet undetected genetic cause of dhâs aortic aneurysm, the daughter has inherited it. His attitude is âsomething is going to kill youââŚand the other canard, âI havenâthad any problemsâ. OK, I guess if your current existence isnât worth livingâŚbut 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) arenât enough to sway a decision thatâs so easy to make, it looks to me like a âdonât careâ attitude. Like I saidâŚyou can probably tell Iâm a singleton
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My siblings didnât 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 (Iâm only 20 years younger than my father).
Pure stupidity and bullheadedness.
Weâve 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 heâs 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 âmore exerciseâ and âlose weightâ. 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 parentâs 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 wasnât 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 theyâd 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 theyâd shown. Still not as rare as it ought to be even todayâŚbut youâve read that before, right 
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'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 sheâs almost as vain as I am) the only cardiac issue could be her dadâs 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 meâŚbut didnât bother with herself and gramps. That was a big omission, when you look back!
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