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Comment by codecamper | Hacker News Reader

Nobody should die from colon cancer.

Get a colonoscopy starting soon and then every 5 years.

Get a DNA poop test every year in between.

TotalBiscuit from beyond the grave reminds you all that if you have blood on your stools you really ought go get checked, yes it will be sort of degrading and suck, but it is not the end of the world and you will be happier and calmer afterwards

Had to look up what you meant by "TotalBiscuit". Apparently he was somebody who died of cancer, was diagnosed at 30 but had a history of cancer in his family.

See: https://en.wikipedia.org/wiki/TotalBiscuit

People who use Twitch will likely at least know him as the face of the LUL emoji

fuck I didnt realize TotalBiscuit died. I kept wondering why I hadn’t heard that fantastic voice in a while. double RIP

That may be true, but I find the preparation totally uncomfortable which deters me from a potentially necessary preventative procedure.

It's not that bad, ask for Suprep which is 2 16 oz bottles rather than the gallon you had to drink with earlier preps.

Ask your doc about Osmoprep, which are pills you take with 8 oz water periodically. No weird concoctions to drink.

No. Iatrogenic harms are real and screening has never been shown to save lives. You will have many more people getting punctured colons and unnecessary treatment, causing physical and psychological harm if you try to get everyone screened.

https://www.bmj.com/content/352/bmj.h6080

It's tempting to think that early detection is the simple solution. It's not, and the experts understand this when they make recommendations.

Dan's disease progression was remarkably quick too. He wrote a blog post about his Stage IV diagnosis in early August:

https://www.dankohn.com/health/2020/8/29/diagnosis

And if you quick the 'Previous' link on the bottom you can see how it went from stents to ablation to an emergent hospital admission in the course of two months. Just so tragic for his wife and young sons.

https://www.dankohn.com/health Though it hadn't been updated. There was a FoRK post on the 26th. http://xent.com/pipermail/fork/Week-of-Mon-20201026/066478.h...

> Get a colonoscopy starting soon and then every 5 years.

New guidance is to start at 45.

http://nccrt.org/wp-content/uploads/2018ACSCRCGuidelineOverv... (warning: PDF)

For what reason should it be limited to 45?

If risk is probability * harm, the lower probability of getting colon cancer under 45 should be offset by the greater harm of getting it young.

A colonoscopy requires sedation (typically, in the US; this practice is not universal) and also has a non-trivial chance of complications like bleeding, from perforation of sensitive tissue. Also if the doctor finds polyps they will remove them (usually by hot wire constriction), which means you now have minor surgery to recover from. So it’s not like a “check-up” where they just look up your nose with a light pen.

Anecdotal, but polyp removal for me and some of the people I know didn’t result in any additional post-surgery recovery time.

It was simply: go home, and don’t drive or operate any machinery today, just like any other procedure with light sedation.

That’s it.

I also hear patients can request the level of sedation. It's ultimately up to the doctor though. https://www.templehealth.org/about/blog/what-are-my-options-...

My 2nd colonoscopy, I requested we skip the normal sedation.

During the procedure, there were a few instances of painful bloating, like perhaps the worst gas you've ever felt, as the doctor uses air pressure to expand the intestines for a clearer view and navigation around corners. But the pain receded in seconds each time, and the whole inspection takes maybe 10 minutes.

It was really interesting to see what the doctor saw, fully alert, and be able to leave immediately afterward without a ride.

For those who are curious, not squeamish, and don't mind a little transitory discomfort during a professional procedure, consider less or no sedation.

Great. It seems like you and your doctor both respected each other. As it should be.

I ask for very light sedation. I still remember what was happening, but didn't feel any discomfort.

I asked for local anesthesia for a major knee surgery. (They normally do full anesthesia for that because an epidural injection is considered a bit riskier.)

That was a lot of fun! The doctor was delighted to have such an interested and captive audience, and ran over time because he spent too much time explaining everything while doing the procedure.

"Now I will cut loose this useless tendon from your thigh and reuse it as a replacement ACL."

Now I wish I’d insisted on local for my ACL-from-thigh autograft! (My surgeon discouraged it.)

I remember being rolled back to my room super excited. It was awesome.

And then the drugs wore off and the pain started...

I had a polyp removed during mine, and there was absolutely no physical indication for me that anything had happened. The only way I knew any cutting or burning had been done is because I was told and shown a picture.

Yes, I've also had it done and it was the same experience. (In fact, waking up after propofol was perhaps the most pleasant two minutes I've had in the last ten years.) Just like the procedure itself, the vast majority of times it's fine. But when it's not, you are looking at life-threatening complications: bleeding, tearing, infection, etc. This is why the recommendation for such screenings is so conservative.

Yes, and there is also some risk of process errors introducing infections, and of course the same resources ($, professional time) might better create more health/longevity if directed elsewhere.

Probability dictates the rationing of finite resources

Health resources are finite and colon cancer is extremely rare among young people who do not have family histories of cancer or some existing bowel problems. Norway starts colorectal testing at 55 for people without specific indicators.

Does a check cost more for young people than old? "finite resource" seems to be an issue of public health funding; private health scales to fit the market (by producing more doctors, say) - hence it's not a zero sum if people start spending more on healthcare overall.

Basic colorectal cancer screenings cost around $100, but like all health care there is considerable variance in what people pay. You are implying that we should test all people for all possible problems which is simply not practical and probably not even possible. Testing is instead based on health condition and history.

The specific details of why this money would be a waste that could be better spent elsewhere are in the report which is a good read: http://sciencenordic.com/should-colon-cancer-screening-start...

Cost of a colonoscopy is roughly $3000 in the US, and many insurance providers won't cover the costs of this procedure prior to 50 if not recommended by a doctor. Your doctor will need a reason to prescribe before 50.

Colonoscopy is an entire "line of business". And my insurance provider, CareFirst, balks at Cologuard as an alternative, even though it is less than 1/3 the cost of a standard colonoscopy.

> If risk is probability * harm, the lower probability of getting colon cancer under 45 should be offset by the greater harm of getting it young.

Only if you assume harm goes up at exactly the same rate as probability goes down, which sounds like an application of the law of averages.

You'd get a check so long as risk is over a threshold, without regard to how far above it is. If harm is "dead at 30" vs "dead at 45", that's an extra 15 years lost, so harm should go up linearly.

Cost/benefit. The procedure is not free, and there are harms associated with the procedure that are unlikely, but push it into negative ROI. In particular pay attention to the risks of the procedure; it’s not common (neither is colon cancer in young people) but people do die of complications from the colonoscopy.

I actually saw some discussion a few years ago saying that the procedure is a net harm in all age groups if there are no symptoms/genetic predisposition, trying to dig up a ref and could only find https://www.cancerdefeated.com/the-tragic-risks-of-a-colonos... so I might be misremembering that detail.

Better start at 35. Rare, but happens.

> Get a colonoscopy starting soon and then every 5 years.

That's nice to say, but a colonoscopy costs $3,000 in the US. If you have good insurance, get one.

Any insurance will cover it, good or bad.

And if you can't afford insurance you can get free insurance.

Even in other countries where it's covered they often wont start screening for it until later in life when you are considered at higher risk (but you can get it much younger).

Suppose a programmer saw blood in their stool. Is there a fairly high likelihood that it's due to hemorrhoids rather than cancer?

Obviously, they should get checked anyway. But I was curious if there is usually a benign explanation for the blood.

Do you still get it at early 30s if your family has no history of colon cancer? Are there any complications? I don't want to be sedated because I heard/read there's bad side effects.

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