I remember stories earlier in this thread of interval cancers between scheduled colonoscopies and one of a missed dangerous polyp found while repairing damage from a botched colonoscopy. There was also discussion about how to minimize the risk of missed polyps or cancers during a colonoscopy.
So colonoscopy should not be assumed to catch 100% of all cancers or dangerous polyps, which is why FIT each year between scheduled colonoscopies may be worth considering for those using colonoscopy as primary screening.
Also, while true that most cancers take 10+ years to develop, there are also colon cancers which grow quickly. A friend had a precancerous polyp removed and was told to return for follow up colonoscopy in 3 years. Exactly 3 years later, stage 4 colon cancer was found, and he passed away in less than 2 years. His cancer was diagnosed at the center where I worked, and the docs there were absolutely stunned at this development. His physician said he had never seen that before in his career.
Point being that people with a family history of colon cancer might consider doing the FIT tests between colonoscopies.
So sorry about your friend!!! That particular case does sound like a very rare occurrence judging from the reaction of your friend’s docs though.
My concern is how the noninvasive tests are pushed as a good or even better alternative to colonoscopy. Cologuard and over-the-counter FIT are commercial products and are marketed directly to consumers (I see ads on Facebook for example). Managed care can also make it difficult for an individual to choose colonoscopy over the noninvasive tests. My chemo nurse this week was telling me she had to fight her HMO to get a colonoscopy approved instead of Cologuard (“but seeing what I do every day, I’d never rely on those tests”). My docs tell me it is extremely common for them to treat folks like myself with advanced cancer that was not detected on Cologuard or FIT (and I hear a lot of “those tests are worthless”).
I’m a big believer in colonoscopy. My DH had colon cancer, and our daughters were then told to get their first colonoscopy at age 36. My 28 y/o had a colonoscopy/endoscopy for other reasons and the doctor found a precancerous polyp. My 32 y/o was then told to get a colonoscopy, where they found 3 precancerous polyps. Both are supposed to follow up at 3 years, but I hope they will take my advice to get FIT testing in the interim.
USPSTF notes in its recommendation for colorectal cancer screening that when comparing FIT every year versus colonoscopy every ten years, FIT gains 94% of the life-years gained by colonoscopy, and averts 93% of the colorectal cancer deaths that colonoscopy averts – i.e. not “worthless”, except perhaps to gastroenterologists’ business revenue stream. Yes, colonoscopy every ten years is slightly more effective in this respect, but also comes with increased burdens and harms (as well as costs that are not part of this consideration).
Regarding Cologuard (sDNA-FIT), it is as effective as colonoscopy if done every year, but is usually specified every three years due to its high cost. But sDNA-FIT every three years is less effective than FIT every year.
But even if you prefer colonoscopy over FIT as primary screening, you may want to consider FIT yearly between scheduled colonoscopies in order to catch interval cancers, or polyps missed during colonoscopies that progressed to cancer.
My sister and her husband are both over 50 and I was surprised to hear that neither of them have had a colonoscopy. They have HMO insurance and get the FIT test done. Even though they take great care of their health, I’ve gotta say it makes me a little nervous. My spouse and I both got our colonoscopies at age 45 and my spouse has to go back in 5 years because they found a couple little polyps. Like how would my sister even know that for herself?
None of these tests are perfect. And, no GI is perfect either. there is huge variation in their ADR (adenoma detection rate). Some are better than others, some follow guidelines, some rush through and miss things. Be sure to advocate for yourself - ask who has the highest ADR in the group/center. Ask if they have AI polyp detection software loaded. Colon cancer is preventable if caught early!
Another thing I wanted to mention. My doctor suggested using Endocuff for our colonoscopies (hubbie and I had them 2 weeks apart)- it’s a device proved to improve visualization of the colon lining and increase detection of adenomas. Insurance doesn’t cover it yet- it takes several years from approval/recommendation to insurance covering it. It’s optional due to the additional cost ($117), but my husband and I opted to use it and paid for it with our FSA and our doctor highly recommended it; said likely that’s what made him detect/see a concerning polyp at the opening of my husband’s appendix which has to be removed.
Study in Taiwan suggests that starting screening at age 40 instead of 50 reduces CRC and deaths from CRC. The screening method used there is FIT every two years.
“According to the propensity score–matched results of the current study, the number of participants needed to screen to prevent 1 additional CRC case was 1548 when screening began at ages 40 to 49 years, which was lower than 2079 when screening began at age 50 years, compared with no screening.”
It is all good and great, but the US is not Taiwan. There are substantial dietary and other differences between the two populations. Did that study say anything about that? Sorry don’t have the time to read the article.
ENDOCUFF VISION® does not appear to be mutually exclusive to the use of AI / CADe assist in colonoscopy.
The vendor of ENDOCUFF VISION® claims that it has been shown to increase ADR (adenoma detection rate) by “up to” 16% on the marketing web page at ENDOCUFF VISION® | Olympus America | Medical
A caution about comparing gastroenterologists’ ADR (adenoma detection rate = number of exams where an adenoma was detected / number of exams): if the examined patients were not demographically similar, ADR can vary for reasons other than the gastroenterologists’ skill.
For example, if a gastroenterologist does mostly colonoscopies on patient who were referred due to having a positive FIT (or other non-colonoscopy primary screening) result, then they are likely to have a higher ADR than one who does mostly primary screening colonoscopies. Another example would be one working in a practice that has mostly Medicare patients, compared to one working in a practice that has few or no Medicare patients.
Hi everyone, I had written before about being nervous about my upcoming colonoscopy. I wanted to report that I had the procedure and it was uneventful and I received a good report. Thank you all so much for your reassurance and for calming my nerves. I was really on the verge of canceling the appointment, but you all made me feel so much less anxious about it, and I kept the appointment and I’m so glad I did (as many of you said I would be!). I really appreciate it!
