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I am curious about the NHS guidelines for when this lovely procedure is done. I have a high regard for the NICE guidelines, but I can't find much about this except the suggestion that it isn't used for screening
Over here, in the USA, home of double priced and comparably sketchy medical care (it's good, but the population indicators, heavily skewed by those who cannot afford medical care, are low compared to its peers), it is almost a routine procedure, started when your are 50 and and continued every 7 - 10 years.
I'm not a great fan of "screening" tests for people with no symptoms, so I'm very curious what happens in the NHS (or any other country for that matter). Mrs pneame refers to it as "scoping for dollars".
And, of course, my GP-equivalent wants me to have one....
Looking forward to the workings of UKC's hive mind
Over here, in the USA, home of double priced and comparably sketchy medical care (it's good, but the population indicators, heavily skewed by those who cannot afford medical care, are low compared to its peers), it is almost a routine procedure, started when your are 50 and and continued every 7 - 10 years.
I'm not a great fan of "screening" tests for people with no symptoms, so I'm very curious what happens in the NHS (or any other country for that matter). Mrs pneame refers to it as "scoping for dollars".
And, of course, my GP-equivalent wants me to have one....
Looking forward to the workings of UKC's hive mind
In reply to pneame: Why not? Catch it at stage 0.. no symptoms 100% survival.. stage 1.. 80%.. wait until you get colon cancer symptoms and its very late...
It may not be pleasant but neither is death..
It may not be pleasant but neither is death..
In reply to IainRUK:
True - but the problem with screening in this case is
1) it's not risk free (my B in-law had his gut perforated and had 2 huge surgeries and is still not a happy camper
2) it's prone to false positives (particularly in the US where the litigious society and conflict of interest associated with testing generate a bit of a witches brew)
3) it's bloody expensive (probably around £2000 )
True - but the problem with screening in this case is
1) it's not risk free (my B in-law had his gut perforated and had 2 huge surgeries and is still not a happy camper
2) it's prone to false positives (particularly in the US where the litigious society and conflict of interest associated with testing generate a bit of a witches brew)
3) it's bloody expensive (probably around £2000 )
In reply to pneame: Do you pay? I thought it would be covered by your health insurance?
http://odphp.osophs.dhhs.gov/pubs/guidecps/PDF/CH08.PDF
Thats worth a read. my missus is at US med school, so just doing this now.. we were just discussing this yesterday so quite topical.
Aye false +ves are an issue, it's a tough one. Any family history?
http://odphp.osophs.dhhs.gov/pubs/guidecps/PDF/CH08.PDF
Thats worth a read. my missus is at US med school, so just doing this now.. we were just discussing this yesterday so quite topical.
Aye false +ves are an issue, it's a tough one. Any family history?
In reply to IainRUK:
If its for screening for bowel cancer but with no symptoms, I've heard the risk of death in doing the procedure at the recommended interval in the UK over a number of years is similar to dieing of bowel cancer.
I would have thought the success rates of the procedure varys quite a bit depending which surgeon you get.
If its for screening for bowel cancer but with no symptoms, I've heard the risk of death in doing the procedure at the recommended interval in the UK over a number of years is similar to dieing of bowel cancer.
I would have thought the success rates of the procedure varys quite a bit depending which surgeon you get.
In reply to pneame: http://pathways.nice.org.uk/pathways/colonoscopic-surveillance
Is the NiCE pathway you are looking for.
Is the NiCE pathway you are looking for.
In reply to IainRUK:
Thanks for that - an interesting read. It actually has the lifetime prevalence lower than I thought it was - the risk of serious complications from a colonoscopy seems to be about 0.2%, which gives a risk/reward ratio of about 1/10. Not too inspiring, but as you say, the reward (cancer caught early) is considerable!
The NCI has an informative site - http://www.cancer.gov/cancertopics/pdq/screening/colorectal/HealthProfessio...
and
http://seer.cancer.gov/statfacts/html/colorect.html
Probably covered a bit by insurance, but I have a high deductible, so the major benefit is not being robbed by being charged market prices. Which would likely be about 2 - 3 times what the insurance company allows.
Thanks for that - an interesting read. It actually has the lifetime prevalence lower than I thought it was - the risk of serious complications from a colonoscopy seems to be about 0.2%, which gives a risk/reward ratio of about 1/10. Not too inspiring, but as you say, the reward (cancer caught early) is considerable!
The NCI has an informative site - http://www.cancer.gov/cancertopics/pdq/screening/colorectal/HealthProfessio...
and
http://seer.cancer.gov/statfacts/html/colorect.html
Probably covered a bit by insurance, but I have a high deductible, so the major benefit is not being robbed by being charged market prices. Which would likely be about 2 - 3 times what the insurance company allows.
In reply to CurlyStevo:
I think that would depend on family history. There's a large genetic component to bowel cancer, it can happen regardless but those with it in their family are much more at risk.
> (In reply to IainRUK)
> If its for screening for bowel cancer but with no symptoms, I've heard the risk of death in doing the procedure at the recommended interval in the UK over a number of years is similar to dieing of bowel cancer.
>
> I would have thought the success rates of the procedure varys quite a bit depending which surgeon you get.
> If its for screening for bowel cancer but with no symptoms, I've heard the risk of death in doing the procedure at the recommended interval in the UK over a number of years is similar to dieing of bowel cancer.
>
> I would have thought the success rates of the procedure varys quite a bit depending which surgeon you get.
I think that would depend on family history. There's a large genetic component to bowel cancer, it can happen regardless but those with it in their family are much more at risk.
In reply to IainRUK: It's not just false positives, false negatives, and problems arising from the procedure that are a problem - it is knowing whether it is effective at all.
E.G. Someone with an asymptomatic disease has it detected in early stages, and they survive another 5 years - great.
But the same person might have survived quite happily for 4 and a half years without screening and therefore not knowing they had the disease, then when they finally present with symptoms 'only' survive another 6 months. So on one measure - life expectancy after disease detected - screening looks great, on another - actual outcomes from onset of disease - it doesn't.
IIRC this was being hotly debated in the UK before breast screening was introduced, and Thatcher pre-empted the outcome of RCTs to make a political point, as a result proper studies in the UK have since been impossible. I'm not sure that some Scandinavian country(s) participating in similar trials actually came to an opposite conclusion.
E.G. Someone with an asymptomatic disease has it detected in early stages, and they survive another 5 years - great.
But the same person might have survived quite happily for 4 and a half years without screening and therefore not knowing they had the disease, then when they finally present with symptoms 'only' survive another 6 months. So on one measure - life expectancy after disease detected - screening looks great, on another - actual outcomes from onset of disease - it doesn't.
IIRC this was being hotly debated in the UK before breast screening was introduced, and Thatcher pre-empted the outcome of RCTs to make a political point, as a result proper studies in the UK have since been impossible. I'm not sure that some Scandinavian country(s) participating in similar trials actually came to an opposite conclusion.
In reply to sleavesley:
Thanks - so not routinely used in asymptomatic / low risk populations, it seems.
Of course, being older is a significant risk in itself, but that takes it from not much risk at all to (IMHO) a fairly low risk.
Thanks - so not routinely used in asymptomatic / low risk populations, it seems.
Of course, being older is a significant risk in itself, but that takes it from not much risk at all to (IMHO) a fairly low risk.
In reply to Rob Exile Ward:
Yes - thank you for reminding me of that inherent bias in survival statistics!
Excellent point.
I worry also that as don't really want the procedure done, I'll tend to favor the negative evidence higher than the positive evidence!
Scoping for dollars, scoping for dollars.... repeat!
Yes - thank you for reminding me of that inherent bias in survival statistics!
Excellent point.
I worry also that as don't really want the procedure done, I'll tend to favor the negative evidence higher than the positive evidence!
Scoping for dollars, scoping for dollars.... repeat!
In reply to pneame:
Is a CT Scan an option? Less risk of perforation. I don't know how the cost compares .
As a result of my having suspicious symptoms, I had an attempted colonoscopy back in the summer but it had to be aborted due to intense pain caused by encountering a difficult sharp angled bend in my intestine, where the operator considered the risk of perforation to be too great to continue.
I subsequently underwent a CT scan. The downside of the CT scan against the physical colonoscopy is that any polyps encountered during the procedure can't be removed there and then, not can biopsies be taken
Is a CT Scan an option? Less risk of perforation. I don't know how the cost compares .
As a result of my having suspicious symptoms, I had an attempted colonoscopy back in the summer but it had to be aborted due to intense pain caused by encountering a difficult sharp angled bend in my intestine, where the operator considered the risk of perforation to be too great to continue.
I subsequently underwent a CT scan. The downside of the CT scan against the physical colonoscopy is that any polyps encountered during the procedure can't be removed there and then, not can biopsies be taken
In reply to Andrew Mallinson:
Sorry! Hope I haven't put you off?
Apparently I'm rare as a very small percentage of patients have odd shaped guts like me and can't tolerate the procedure, the vast majority are ok, so the chances are that you will be fine.
Good luck!
Sorry! Hope I haven't put you off?
Apparently I'm rare as a very small percentage of patients have odd shaped guts like me and can't tolerate the procedure, the vast majority are ok, so the chances are that you will be fine.
Good luck!
In reply to pneame:
It's not routine screening in the UK in an asymptomatic patient but there is a high index of suspicion and the symptoms needed to prompt colonoscopy are pretty common.
As to the CT alternative this is nowhere near as good at detecting disease, cannot get tissue samples for histology, and theres a decent chance the CT will find something incidental which is almost certainly innocuous but you'll then get into a lot of anxiety and potentially a lot of investigations for something very likely not to be of concern.
[Anyone who wants a laugh should read this thread - it's a classic imho - http://singletrackworld.com/2009/02/the-picolax-thread-returns/ ]
It's not routine screening in the UK in an asymptomatic patient but there is a high index of suspicion and the symptoms needed to prompt colonoscopy are pretty common.
As to the CT alternative this is nowhere near as good at detecting disease, cannot get tissue samples for histology, and theres a decent chance the CT will find something incidental which is almost certainly innocuous but you'll then get into a lot of anxiety and potentially a lot of investigations for something very likely not to be of concern.
[Anyone who wants a laugh should read this thread - it's a classic imho - http://singletrackworld.com/2009/02/the-picolax-thread-returns/ ]
In reply to Trangia: also that a CT scan uses ionising radiation and that if you have no symptoms or red flag signs etc etc the examination is not justified under IRMER in the UK. The USA have a very different approach to radiation protection!! IE it's all about £££££
In reply to pneame: ive not got much to add, other than ive had it done twice, once with and once without sedation, no problems except for being uncomfortable.
In reply to pneame: I have to have one every four years now due to having had acromegaly - can't say it was even uncomfortable. Certainly not bothered about next year's one and as someone mentioned, I'd sooner catch it early.
In reply to pneame:
I had this done last year. Bizarre - as there was a large TV screen in the room which I was watching. Its the first time I've ever been able to look up my own backside.
And of course the guys 'n girls in the room really do go home each day after working with a bunch of ars***les all day.
I had this done last year. Bizarre - as there was a large TV screen in the room which I was watching. Its the first time I've ever been able to look up my own backside.
And of course the guys 'n girls in the room really do go home each day after working with a bunch of ars***les all day.
In reply to pneame: Since I have suffered from colitis for over 30 years, I get probed every 2 or 3 years now. The worst bit is the cleansing prep to ensure a clean bowel. The dynorodding is done with some mild sedation... it is uncomfortable rather than agonising.
In reply to earlsdonwhu: Agreed - the worst bit is the preparation. Abysmal, abysmal few hours that.
In reply to BGG:
O.M.G. I couldn't read because of all the tears! The mental imagery is just ....
.... Mental.
Very well shared.
Thank you.
> (In reply to pneame)
>
> [Anyone who wants a laugh should read this thread - it's a classic imho - http://singletrackworld.com/2009/02/the-picolax-thread-returns/ ]
>
> [Anyone who wants a laugh should read this thread - it's a classic imho - http://singletrackworld.com/2009/02/the-picolax-thread-returns/ ]
O.M.G. I couldn't read because of all the tears! The mental imagery is just ....
.... Mental.
Very well shared.
Thank you.
In reply to BGG:
That's completely undone any of the reassurance I received from everyone else!
The radiation from CT is certainly a concern.
A CT is actually what got my GP thinking about colonoscopies - she's determined to hit me with some sort of statistically bad screening - we've already ditched a PSA test due to my scathing comments about what a crap test it is in asymptomatic patients
I had a CT as a cardio workup and indeed, it found three new problems, including "segmental thickening, distal ileum".
I'm looking at the pictures as we speak and don't see it myself. Just a lot of gas
That's completely undone any of the reassurance I received from everyone else!
The radiation from CT is certainly a concern.
A CT is actually what got my GP thinking about colonoscopies - she's determined to hit me with some sort of statistically bad screening - we've already ditched a PSA test due to my scathing comments about what a crap test it is in asymptomatic patients
I had a CT as a cardio workup and indeed, it found three new problems, including "segmental thickening, distal ileum".
I'm looking at the pictures as we speak and don't see it myself. Just a lot of gas
In reply to pneame: the colonoscopy will help clear that gas im sure...
In reply to Trangia:
...nah...I'll be fine...or not....
THB...crapping myself...no pun intended...especially when I take my klean prep.....
ANdy
...nah...I'll be fine...or not....
THB...crapping myself...no pun intended...especially when I take my klean prep.....
ANdy
In reply to Andrew Mallinson:
The prep is really not too much of a problem, so long as you stay near a loo It's a chance to give your body a good clean out but you'll feel pretty hungry by the time it's all over. Afterwards my first port of call was the hospital canteen for a bun and a delicious cappuccino.....
The prep is really not too much of a problem, so long as you stay near a loo It's a chance to give your body a good clean out but you'll feel pretty hungry by the time it's all over. Afterwards my first port of call was the hospital canteen for a bun and a delicious cappuccino.....
In reply to Dave Perry:
I had a cystocopy... first of all when he said I needed one I pulled up my shirt and asked 'where do you make the cut'..
He then, whilst I had a camera in my bladder asked did I want a look.. 'I'd rather you just take the camera out of my dick quite frankly'.. agony!
> (In reply to pneame)
>
> I had this done last year. Bizarre - as there was a large TV screen in the room which I was watching. Its the first time I've ever been able to look up my own backside.
>
>
> I had this done last year. Bizarre - as there was a large TV screen in the room which I was watching. Its the first time I've ever been able to look up my own backside.
>
I had a cystocopy... first of all when he said I needed one I pulled up my shirt and asked 'where do you make the cut'..
He then, whilst I had a camera in my bladder asked did I want a look.. 'I'd rather you just take the camera out of my dick quite frankly'.. agony!
In reply to pneame: Been there, got the T shirt and I wouldn't be here now if I hadn't had it done 34 months ago.
No brainer, the alternative is not fun
No brainer, the alternative is not fun
In reply to pneame:
We're all going for a sigmoidoscopy,
We're all hoping for a better view,
We're all going for a sigmoidoscopy,
why don't you come too,
we can do it to you.
We're hoping that the light shines brightly,
we're hoping that the prep has gone through,
the nurse said she did a washout,
so lets see if it's true.
We're all going for a sigmoidoscopy...
We're all going for a sigmoidoscopy,
We're all hoping for a better view,
We're all going for a sigmoidoscopy,
why don't you come too,
we can do it to you.
We're hoping that the light shines brightly,
we're hoping that the prep has gone through,
the nurse said she did a washout,
so lets see if it's true.
We're all going for a sigmoidoscopy...
In reply to pneame:
It hasn't been mentioned yet but they are introducing/lowering ages for screening for occult blood for certain age groups in the U.K. (varies according to country - Scotland, Northern ireland etc). this invovles a stool sample which is tested for hidden blood, which can be from a polyp before it turns cancerous and thus is totaly curable.
I myself detected blood and had a large polyp removed which proved to be pre-cancer - lucky - i highly recommend screening
It hasn't been mentioned yet but they are introducing/lowering ages for screening for occult blood for certain age groups in the U.K. (varies according to country - Scotland, Northern ireland etc). this invovles a stool sample which is tested for hidden blood, which can be from a polyp before it turns cancerous and thus is totaly curable.
I myself detected blood and had a large polyp removed which proved to be pre-cancer - lucky - i highly recommend screening
In reply to IainRUK:
Yes my reply was badly worded what I was trying to compare was the risk of dieing from colonoscopy over many years over recommended age in the UK at the recommended interval and the risk in the general population (in the same age group) of dieing from bowel cancer in that time period. I've heard/read the two are very similar risk.
Yes my reply was badly worded what I was trying to compare was the risk of dieing from colonoscopy over many years over recommended age in the UK at the recommended interval and the risk in the general population (in the same age group) of dieing from bowel cancer in that time period. I've heard/read the two are very similar risk.
In reply to pneame: Aaagh, US healthcare. What in the name of all we hold dear are they doing seeing your distal ileum on a cardiac CT? FFS. Let me guess, was there also a 3mm nodule in a lung and a small mixed renal cyst? Cardiac studies should image the heart...
Your position does seem tricky - as it isn't 'screening' because of the CT findings, it's viewed as adventitious / opportunistic. But if it's some segmental mucosal thickening then the differential is less cancer (plus it's ileum not colorectal) (although lymphoma can do this IIRC - sorry!) and more a question of an inflammatory process like Crohn's or one of the weirdo infections. Which would be more likely to give rise to symptoms than a small early malignancy.
I'd ask for a faecal calprotectin - that will throw em off sent and pooling in a pot less demanding than a colonoscopy
Good luck (and COI:I am not a gastroenterologist - but some of my best friends etc)
b
Your position does seem tricky - as it isn't 'screening' because of the CT findings, it's viewed as adventitious / opportunistic. But if it's some segmental mucosal thickening then the differential is less cancer (plus it's ileum not colorectal) (although lymphoma can do this IIRC - sorry!) and more a question of an inflammatory process like Crohn's or one of the weirdo infections. Which would be more likely to give rise to symptoms than a small early malignancy.
I'd ask for a faecal calprotectin - that will throw em off sent and pooling in a pot less demanding than a colonoscopy
Good luck (and COI:I am not a gastroenterologist - but some of my best friends etc)
b
In reply to pneame: I think with a family history I was advised to have these from 40. My mum barely survived it being caught late but the procedure as you say is not without risk.
Cheers
Toby
Cheers
Toby
In reply to CurlyStevo:
I didn't know that.. I was just looking at the table of stage of detection versus survival, and basically without screening to detect it at the asymptomatic stage survival rates are low..
However a lot of these cancers, like prostate, whilst hugely prevalent, you often die with not from..
For me the big one would be family history, then there would be no choice to make.
> (In reply to IainRUK)
> Yes my reply was badly worded what I was trying to compare was the risk of dieing from colonoscopy over many years over recommended age in the UK at the recommended interval and the risk in the general population (in the same age group) of dieing from bowel cancer in that time period. I've heard/read the two are very similar risk.
> Yes my reply was badly worded what I was trying to compare was the risk of dieing from colonoscopy over many years over recommended age in the UK at the recommended interval and the risk in the general population (in the same age group) of dieing from bowel cancer in that time period. I've heard/read the two are very similar risk.
I didn't know that.. I was just looking at the table of stage of detection versus survival, and basically without screening to detect it at the asymptomatic stage survival rates are low..
However a lot of these cancers, like prostate, whilst hugely prevalent, you often die with not from..
For me the big one would be family history, then there would be no choice to make.
In reply to ben b:
Thanks Ben - I don't fault them for the CT - non-specific symptoms (acute fatigue) - the cardio workup was due to me passing out when they stuck an IV in! Actually, it wasn't so much "stick" as it was poke around in one arm, miss horribly, try the other arm. That's my excuse, anyway.
As you say, however - I went in with one vague symptom and came out with a kidney stone, atherosclerosis, disk disease and GI weirdness.
My hypothesis- that once you get to a certain age you want to steer clear of Drs as they WILL find something wrong - is proven as far as I am concerned.
Interestingly, they don't seem to go for occult faecal blood over here - far too low tech. I don't think I've seen a result for one once in 13 years of direct involvement in the healthcare industry. And before that I only seem to recall one or two being worked up when I was in a pediatric hospital as a researcher. The clinical lab (wonderfully old school) was just down the aisle.
Thanks Ben - I don't fault them for the CT - non-specific symptoms (acute fatigue) - the cardio workup was due to me passing out when they stuck an IV in! Actually, it wasn't so much "stick" as it was poke around in one arm, miss horribly, try the other arm. That's my excuse, anyway.
As you say, however - I went in with one vague symptom and came out with a kidney stone, atherosclerosis, disk disease and GI weirdness.
My hypothesis- that once you get to a certain age you want to steer clear of Drs as they WILL find something wrong - is proven as far as I am concerned.
Interestingly, they don't seem to go for occult faecal blood over here - far too low tech. I don't think I've seen a result for one once in 13 years of direct involvement in the healthcare industry. And before that I only seem to recall one or two being worked up when I was in a pediatric hospital as a researcher. The clinical lab (wonderfully old school) was just down the aisle.
In reply to IainRUK:
Yes, those are my thoughts too - particularly for prostate. Although a friend of mine had his caught just in time at about 65....
No family history, but I'm beginning to think "Oh, stop being a baby!"
I know if I actually go and see a GI doc to discuss things he's going to say something like that! In the US, medics make money from procedures, not from keeping people healthy and happy. Apart from GPs/Primary Care docs - they have a totally different business model. Which, I confess, I don't really understand.
Yes, those are my thoughts too - particularly for prostate. Although a friend of mine had his caught just in time at about 65....
No family history, but I'm beginning to think "Oh, stop being a baby!"
I know if I actually go and see a GI doc to discuss things he's going to say something like that! In the US, medics make money from procedures, not from keeping people healthy and happy. Apart from GPs/Primary Care docs - they have a totally different business model. Which, I confess, I don't really understand.
In reply to pneame:
I think this thread demonstrates why investigations can be harmful.
For example, if you've got an otherwise normal, young healthy patient with for example, either a headache or back pain with no abnormal examination findings and no red flags, if the former is done properly 99 times out of a 100, a 'scan' is unlikely to reveal anything useful and may result in harm.
But they haven't done anything....
And probably for good reason. About 90% of diagnosis is made from good old fashioned history and examination, with tests used as an adjunct.
I think this thread demonstrates why investigations can be harmful.
For example, if you've got an otherwise normal, young healthy patient with for example, either a headache or back pain with no abnormal examination findings and no red flags, if the former is done properly 99 times out of a 100, a 'scan' is unlikely to reveal anything useful and may result in harm.
But they haven't done anything....
And probably for good reason. About 90% of diagnosis is made from good old fashioned history and examination, with tests used as an adjunct.
In reply to Cardi:
Agreed - and further to my comment above, a colleague of mine, when we were both quite young (he was hematologist/oncologist, but doing research) always used to maintain that if you were male, below 40 and in reasonable health, you didn't want to go to a dr as anything that was wrong would get better, but if it wasn't going to, you didn't want to know about it. A bit extreme, perhaps, but not too far off.
Medicine is a bit more advanced than it was then, but a bit of thought and realism is important!
We have folks who come into our office that seem to spend their whole lives going from one specialist to another and managing the 40 or so medications that they are on. I always listen carefully to see if they rattle when they walk!
Agreed - and further to my comment above, a colleague of mine, when we were both quite young (he was hematologist/oncologist, but doing research) always used to maintain that if you were male, below 40 and in reasonable health, you didn't want to go to a dr as anything that was wrong would get better, but if it wasn't going to, you didn't want to know about it. A bit extreme, perhaps, but not too far off.
Medicine is a bit more advanced than it was then, but a bit of thought and realism is important!
We have folks who come into our office that seem to spend their whole lives going from one specialist to another and managing the 40 or so medications that they are on. I always listen carefully to see if they rattle when they walk!
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