Start colon cancer screening at 45, not 50, American Cancer Society urges | Hacker News Reader

Start colon cancer screening at 45, not 50, American Cancer Society urges

usatoday.com

93 pointsmudil67 comments

Annual home stool tests (FIT) mentioned in this article can be as effective as colonoscopies. My provider, Kaiser-Permanente mails a kit once a year and I mail it back so no appointment is necessary and it's a lot less invasive.

538 wrote a good piece about the advantages of FIT vs. colonoscopy: "You Could Skip Your Colonoscopy If You’re Willing To Collect Your Poop" https://fivethirtyeight.com/features/you-could-skip-your-col...

I agree FIT kits are great especially to ease your mind if you're worried about colon cancer.

But the FIT kit can be difficult to use with two main problems. It's like bobbing for apples only much less fun. You can't urinate or it ruins the sample. I don't know about you guys but I find it almost impossible to avoid urinating when defecating.

And with that happy mental image have a nice day everyone! And remember to eat lots of fibre.

> I find it almost impossible to avoid urinating when defecating

Can't you just urinate first, flush, and then defecate?

Fishing out poop from the toilet? No. Buy latex gloves and poop in your hand like every self-respecting primate.

...then fling it right into that envelope!

The sample is not allowed to get wet at all.

OK, so urinate first into a toilet, then defecate into the container. The point is, it's pretty hard to urinate with an empty bladder.

Still seems better than a colonoscopy experience if it's as effective a screen.

The FIT kits I've received have tissue that you use to keep the stool out of the toilet and you can urinate around the tissue. Here's a somewhat graphic video that explains how to use it (this may be NSFW): https://www.youtube.com/watch?v=NOhjxfkf4tw

What privacy agreements are in effect to protect your DNA from being sold? Asking because I know of a few labs that do something similar to this to research gut health, but the nurse friend said to use a fake name and throw away email address.

Update:

Here [1] is an example of why DNA should be shared with care, given that you can not easily change your DNA and it says a LOT about you and your family members.

[1] - https://motherboard.vice.com/en_us/article/vbqyvx/myheritage...

Thank you for sharing. I tried to get something going at just under 30 years old and insurance wouldn't even consider it.

Datapoint: At 36 I noticed small amounts of blood in my stool intermittently over the course of a year and told my GP. He said it was probably nothing (hemorrhoids) but that I could get a sigmoidoscopy if I was really concerned. I did, and right around-the-corner was a big old polyp. The Gastroenterologist was surprised. Had 3 more removed in the following colonoscopy. None cancerous, thankfully, but who knows how much longer that would have lasted. I should also note that bleeding is not a very common symptom. Usually there are none, so I got lucky.

He said that my bowels were pretty bad looking, like a 70 year old. This surprised me since I thought I had a pretty good diet for most of my adult life, and very good in my 30s. I had a garbage diet as a child and teenager though.

I really can't guess what's driving the trend of bowel disease in younger and younger patients, but I am following news on it with great interest.

You can’t guess?

> I had a garbage diet as a child and teenager though.

Always check the online reviews before going to any doctor. A bad doctor with zero ethics might be tempted to do a "rush" job on you. If you want to know what that experience would be like, click the link below:

https://www.youtube.com/watch?v=SmW9Pl7R1dc&t=238s

Online reviews by patients are almost always useless and have near zero correlation with actual evidence-based medicine care quality. Studies have shown that patient satisfaction is most impacted by whether the doctor writes a prescription, regardless of whether the patient really needs one. Apparently patients like to feel they're getting something for their money.

Did you even watch the video?? When the patient says his doctor rushed his colonoscopy which only lasted 5 minutes and that he was in extreme agony through the procedure, i'm going to believe the patient. That's a terrible service.

Would you mind citing your sources?

Here you go: https://www.bmj.com/content/315/7117/1211.short

Bowel disease is becoming a widespread problem in the United States, and is a big factor behind the increasing popularity of specialized diets such as The Whole 30 Diet, Keto, Paleo, gluten free, etc.

Many people's bowels are not happy, and they're looking for answers by modifying their diets.

The increase is colon cancer among younger people is likely a result of the increased bowel disease among younger people.

The medical establishment is not really equipped for handle this rise in disease; much of the focus is on the development of expensive drugs that are basically cash-cows for pharmaceutical companies. For example, Remicade costs up to $20,000 a month -- and the market of potential users of it is many millions of people.

The financial math for researching non-drug treatments simply pales in comparison to the potential payoff for successfully developing a drug, even if the results are far-inferior to alternative approaches.

> For example, Remicade costs up to $20,000 a month -- and the market of potential users of it is many millions of people.

That is the annual cost: https://en.m.wikipedia.org/wiki/Infliximab

Those numbers are from 2007.

The prices have increased dramatically. (Because, why not? They can get away with it.) Of course, it varies, depending on "a number of factors"

> Drug cost was $19,727.34. Total for 1 infusion is $22,278.02.

https://www.howmuchisit.org/remicade-infusion-cost/

That is a self-respect that I am highly suspicious of. Per the dosing guidelines[1] one vial should be enough for one infusion for just about anyone. Per GoodRX linked from the page you linked[2], the inflated cash price is $3500/vial. This, I don't see how $19,000 for one infusion is remotely accurate.

Regardless, since the treatment course is one vial per 8 weeks even if it were it is still not $19,000/month, it would be half that.

Edit: I fail at math. One vial per infusion was based on 1mg per kg. The usage is 5, so a typical infusion would need 4 - 5 vials. Still less than $19,000/month using the cash price, and far less using the GoodRX discount.

[1] https://www.drugs.com/dosage/remicade.html

[2] https://m.goodrx.com/remicade

I have a friend that requires this shot. He has to stay unemployed so that the government will pay for it.

Well, teach/guide him to do open source development? That way he can even do good, and, possibly there might be a charity of some sort that loans the necessary equipment for him to do the work, and as long as he doesn't own it/can't use it for his own good (might be considered as taxable income then), he could probably get away with it. Don't feel bad. UBI is there, just with a shitload of bureaucracy around it.

He rebuilds cars. He has no interest in learning how to code. That said, he does really good work rebuilding and restoring old cars for people. I have seen him contribute to society in other ways, including standing up for a small business owner that was being bullied by a local thug that is the son of a Sheriff.

There is an incentive that people often forget when it comes to drugs vs. lifestyle interventions, which is patient compliance. If a drug is < $50/mo out of pocket, patient compliance is very high. However, prescribed lifestyle and diet changes have very low compliance. If a doctor wants their patients to get better or at least feel better, they'll end up prescribing drugs to a lot of them because most of them aren't going to stick to a dietary change.

I know that more than most, from very personal experience.

However, think about it this way:

Imagine investing $20,000 a month in supporting compliance, instead of Remicade. For dietary interventions, this could mean a nutritionist with weekly meetings, occasional meal-prep provided by a personal chef, and even weekly therapy sessions. This would still likely be cheaper than $20,00 a month.

We're willing to make this kind of investment with drugs, often without batting an eye.

Why not with other interventions?

> This would still likely be cheaper than $20,00 a month.

I'm not sure about that. Non drug interventions that are effective, and not generally cheap. Consider that providers of those services are incentivized to capture as much profit as possible. If the alternative to there service is set to let's say arbitrarily $20k, they can probably charge in that neighborhood as well, or higher if the insurance companies can be convinced to pay more.

This. Someone just needs to know how to wrap it in a package that still makes some central big business a ton of money and it will take right off by itself !). Some large health club chain needs to work on getting certified as a medical care provider and developing package products. Would probably need to partner with a supplement manufacturer with deep pockets to have any chance of success.

It's not just wrapping it in a package. There should be a level of investment in research proving the effectiveness of such alternative treatments, including large studies similar to the types of studies that drugs are required to have. However, this is yet another huge barrier, and our cost incentives simply do not align.

Plenty of gyms offer PT and have registered dietitians, you have to convince insurance companies to pay for it.

Yes, that was my point. You need a behemoth of a special interest to convince anyone with power to make it happen.

Removal of polyps during a colonoscopy dramatically lowers the chances of developing cancer. That's part of why they increase the frequency of screening when they find some.

Of course it is an existing procedure and doesn't especially need to be researched (but it also costs a fair amount).

> but it also costs a fair amount

It doesn't cost anything more than the colonoscopy. It's required by the ACA to be included in a colonoscopy.

Yes, and paying $4,000 for people to get screenings is an actual cost that shows up in premiums.

(I was talking about colonscopies themselves costing a fair bit; of course all told they are preferable to catching and treating cancer later).

Link to the research paper: https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21457 and press release: http://pressroom.cancer.org/releases?item=770

With enough money, I'm sure a whitepaper can be written to support getting Cancer screenings at 20. If you make most of your money off removing polyps then the way to increase revenue is to get more people screenings.

Not everything is a conspiracy.

Colon and rectal cancers have increased 51% among adults under age 50 since 1994, the cancer society said.

That isn't a white paper.

> If you make most of your money off removing polyps

Preventative medicine is cheap. In accordance with the ACA, polyp removal is guaranteed to be covered if discovered during a colonoscopy. Don't want it removed? Maybe it becomes cancerous. Now you've moved on to curative care. Cancer medications can cost over $100k. Surgery to remove the colon is $35k+. These are just small pieces of a larger puzzle including other treatments, readmission risks for related illnesses, etc. Now you're done all your treatment and you've moved on to palliative care. If treatment succeeded, you have costs associated with the constant infections related to a colostomy bag. If the treatment fails, now you have the costs associated with end-of-life care.

If you want your conspiracy to hold some weight, they would be pushing the age in the other direction.

> Colon and rectal cancers have increased 51% among adults under age 50 since 1994, the cancer society said.

Percentages can be deceiving. 51% off what base? Was it 100 people in 1994 and now it is 151?

> Preventative medicine is cheap.

Sure, if the odds of you getting it is high enough. If the odds of getting it is low, does it make sense for tens of millions of adults to get invasive and potentially dangerous check ups?

Not everything is a conspiracy, but we do know that "institutions" love to fear monger to get more money, funding and exposure.

> If you want your conspiracy to hold some weight, they would be pushing the age in the other direction.

Not necessarily. Collecting $200 from 10 million people each for an annual checkup vs the cost of a few thousands with colon cancer. There is a reason why businesses ( like nflx and amzn ) love the subscription model.

> Percentages can be deceiving. 51% off what base? Was it 100 people in 1994 and now it is 151?

Maybe I'm just too close to the source (my father is an oncologist), but I thought it was well known that colon cancer is one of the most prevalent. It ranks 4th behind breast, lung, and prostate, of which only lung is deadlier. There are 140k cases per year and 50k deaths.

> we do know that "institutions" love to fear monger

I don't know what institutions you're referring to, but I don't think cancer needs any boost from fear mongering, it's already a serious-enough disease.

Sure it's well known. But that's not what he was asking. He was specifically asking about the number of cancers in people below 40. 140k is for all ages.

Sample of one, but a relative of mine died less than two weeks ago from colon cancer. It's no joke. I recommend you get your screenings.

One of my best friends just got diagnosed with colon cancer at 38. Surgery last week, hasn’t even gotten the pathology report yet. Anecdotal I admit but when it hits close to home you see things a little differently.

Also, can we pass a law that if the person doing a screening colonoscopy finds "1 polyp" that turns the diagnostic into a far more profitable "treatment" they lose their medical license? And can we make that law retroactive?

> can we make that law retroactive

No, we can't make laws retroactive, at least not in the US, and why would you want that anyway?

*edit for formatting

Only criminal laws are prohibited from being retroactive, because the Supreme Court works in mysterious ways.

I assumed the parent meant a criminal penalty. But, I still don't understand why anyone would want the government to have such a capricious legislative power.

So you want a second, diagnostic colonoscopy to remove the polyp rather than converting the screening into a diagnostic at time of service?

This would require another bowel prep, another round of anesthesia, and even more operative time, and yes, another colonoscopy charge.

The point is, there sometimes isn’t a polyp, they take a chunk out of your bowel and say the did a polyp removal.

If one has some way to prove this there is plenty of legal recourse already available.

Agreed. That would be an easy fraud case to prove. As an extra check, all these polyps get inspected under a microscope by a pathologist to make sure they aren't cancer. They would also be committing fraud to say the "not a polyp" was a polyp.

This is already a law. Polyp removal is included in the cost of a screening colonoscopy as per the ACA. It's only not included if the patient decides they want to do it at a different time.

The article doesn't mention the percentage of colonscopies among 50-year-olds that find something bad. If say it was 30%, that sounds like a great reason to start sooner. 5 - 10% maybe not so much.

"Eat food. Not too much. Mostly plants."

Or start including fermented foods like Sauerkraut at least a day in the meals and keep away from junk food. Prevention is always better than cure.

tl; dr: experts disagree.

"Stop eating so much red meat" - What the American Cancer Society should be urging.

https://www.health.harvard.edu/newsletter_article/red-meat-a...

The Western dietary pattern in general is correlated with increased colon cancer risk.

According to that article this will decrease your risk by... 25%. Which is nice, but not massive on an individual level.

Quitting smoking only drops your risk of lung cancer by 21%: https://www.webmd.com/smoking-cessation/news/20080506/quit-s...

As someone who loves red meat, I find 25% extremely significant on a personal level.

The lifetime risk of developing colon or rectal cancer is about 4.5%. Assuming research cited above is correct (a big assumption, considering the history of medical research) and red meat consumption increases that 25%, your risk is now about 5.5%.

Edit: I misread; the claim is in the other direction, that cutting red meat reduces your risk. So 4.5% becomes 3.4%

Wait what? 25% cut is massive! Especially since it's a relatively small ask. You can still eat red meat, just don't have steak every day. Considering reducing red meat intake has whole bunch of other benefits (reduces pollution, better cardio-vascular health), it's just win-win-win all around.

This actually makes me concerned, I eat pork a lot. Pork chops are a high protein, relatively cheap, quick to make, and tasty meal. I'm also African American so there is a greater risk...

I think lack of fiber could be a factor, too. White bread has almost no fiber.

Neither do meat, dairy, and other animal products.

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