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Comment by em500 | Hacker News Reader

The problem with the title is that it might lead individuals to believe they shouldn't bother with getting a colonoscopy. You can't conclude that from this study at all. If your doctor recommends you to get one, you probably should.

The study answers a question pertaining public health policy (should we invite everyone in some age group for a colonoscopy?). It does not answer any individual health/treatment/screening question. The article's headline and content is problematic because it's easy to confuse the two, and the vast majority of readers will never get involved in public health policy (but will certainly have to make lots of individual health decisions).

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I’m so confused though, because based on my reading of it, it seems like the prostate screening thing where yes it might find cancer but no it won’t prevent deaths, so it might be better to just not know/do invasive procedures and treatment for it.

Is that the wrong conclusion to reach from the data?

You could think of screening as a bet on anti-cancer drugs getting better over the next N years.

Prostate cancer is different from colon cancer.

In the case of colon cancer detected in a colonoscopy they can snip it out right there without a lot of effort, risk or lost function. Surgery on the prostate is likely to cause all sorts of problems for men.

And not having surgery for it can mean death. Steve Jobs, even it wasn't prostate cancer, should serve as good example of how not to tackle it. Or at least to show what not tackeling it looks like, because feel free to do what you want, but be aware of the consequences.

Jobs had pancreatic cancer. His holistic approach to dealing with it notwithstanding, that diagnosis is usually a death sentence no matter what you do.

Generally speaking, yes. Practically, Jobs cancer was of the rare but kind of treatable kind. Unless, of course, you forgo surgery, chemo and radio therapy.

Again, not blaming Jobs for his decisions, cancer is a scary thing. Just pointing out the benefit of eering on the side of aggressiveness when it comes to treatment.

As far as I know, he had a type of (neuroendocrine?) pancreatic cancer that had a much better prognosis than other types.

Or you could wait for better drugs before getting an invasive screening.

> The problem with the title is that it might lead individuals to believe they shouldn't bother with getting a colonoscopy. You can't conclude that from this study at all. If your doctor recommends you to get one, you probably should.

The problem with your doctor's recommendation is that doctors recommend colonoscopy based on age, not whether you have any factors that might indicate colon cancer. I have no cancer of any kind anywhere in my family tree and they are always on me to get one.

From the article, a doctor who still believes in colonoscopy for everyone: “The first message is that screening saves lives [Ed: against this study's data] and prevents cancer. If we could have a chance to start everyone at age 45, I’d like that."

>The problem with your doctor's recommendation is that doctors recommend colonoscopy based on age, not whether you have any factors that might indicate colon cancer.

This study is meant to inform the public health policy of asymptomatic screening. They tried to see if there was a benefit in offering screenings to random patients, regardless of medical history. The currently recommended screenings for asymptomatic people were adopted because meta-analyses showed they reduced cancer mortality. In the US, the US Preventive Services Task Force keeps up with new studies and revises their recommendations: https://uspreventiveservicestaskforce.org/uspstf/home.

For people with family history or other risk factors, doctors will follow different screening guidelines or just order tests whenever they think it useful.

The study does not say that coloscopies don't help. The study measures a difference in the study's population. The study does indicate they don't affect outcomes as much as expected. However, their affect is positive.

The study's measured affect has wide errors bars indicating a larger sample size is needed. Subsequent studies could show the affect is more inline with expectations but are unlikely to show less affect.

The question as to whether this will be used to reinforce hesitancy for this procedure; we can already see it in the comment. Logic and reason are not naturally occurring traits. I predict this will be used to move more people into the control group. Going against medical advice is anecdotally meaningful.

No one in my family history going back several generations had colo/rectal cancer. Yet I developed it at age 41. Diet is increasingly viewed as a factor.

I had it at 26, go figure. My petvtheory is that in orser to get the average age back to 50, you need someone like me for every 80 year old, statistics are a bitch. That also means my children will have screening coloscopies starting age 16.

Have you got your genes tested? People can have Lynch syndrome and not develop cancer. Colon cancer is also a silent danger in that it can grow for years without any noticeable symptoms.

I got colon cancer at age 35 (despite being a vegetarian, BTW), and it was first then that suspicion was raised that there could be a hereditary component - which was later confirmed by a gene test.

I have never had cancer of any kind in my family tree, and I had a precancerous polyp found at 38yo.

You should get a colonoscopy. If you are at low risk and look totally healthy after, they'll tell you that you don't need another for a good while and you'll get the benefit of not (often) getting something that you don't think you need and, as a bonus, not die of treatable cancer.

You'll die of something else then. That's the part that so many people seem to overlook.

There is a money-making industry around colonoscopies and mamograms. I'm not saying to disregard medical advice in this regard as for any individual there may be good reasons to have these procedures. However you can't completely discount the financial incentives for the providers.

doctors recommend colonoscopy based on age, not whether you have any factors that might indicate colon cancer.

That's not completely true. As a Crohn's Disease sufferer, by doctor has been making me get them since I was a teenager. The indications are high for me. For "normal" people, the general wisdom (apparently based on intuition more than any quantitative analysis) has been that the risks catch up with the general population around 50.

> The problem with your doctor's recommendation is that doctors recommend colonoscopy based on age, not whether you have any factors that might indicate colon cancer. I have no cancer of any kind anywhere in my family tree and they are always on me to get one.

Wrong. They recommend on both. I had no cancer in my family history but then I got colon cancer (no, I hadn't gotten a colonoscopy before--yes, I was an idiot). As a result, all my siblings' (some of whom are still in their 30s) doctors had them get colonoscopies right away. All negative, thank goodness.

Good luck with sticking your head in the sand.

> The problem with the title is that it might lead individuals to believe they shouldn't bother with getting a colonoscopy.

That is exactly what I thought it was saying at a glance. If I skimmed the headline and moved on, instead of digging in, it might have contributed to an unconscious bias against the procedure.

Uh... I think it is what it's saying though? I mean, you should probably still get a colonoscopy if recommended by your doctor which it probably will be right now... but the effects of this study may be to change those recommendations down the line, that is what it suggests. (I think it's not the first, but I'm not sure).

The summary I read on CNN:

> In this study, about 12,000 people in Sweden, Poland and Norway got colonoscopies. They saw a 31% reduction in their risk of colon cancer and a 50% reduction in their risk of dying from colon cancer compared with people who were not invited to get a colonoscopy.

https://www.cnn.com/2022/10/10/health/colonoscopy-study-q-an...

Do people really ignore their doctor's advice because they saw a headline? I'm sure there are some examples, but that can't be the norm. Obviously a colonscopy can still be indicated for an individual even if it doesn't help by doing it en masse for everyone. Specific symptoms could indicate a colonoscopy would provide more information and there are a number of other conditions where it would be used besides colon cancer.

I can't realistically see anyone saying "No thanks, doc, I'm not going to get that colonoscopy you recommended, because I saw a headline"

This trend of saying a thing is bad because you can imagine some unbelievably stupid person misinterpreting it and misusing it is getting out of hand. At some point people are responsible for their own decisions.

>The problem with the title is that it might lead individuals to believe they shouldn't bother with getting a colonoscopy.

Dangerous misinformation!! Censor!! I have reported the author, Angus Chen, to his employer.

Or you could just comment...

You're walking a dangerous path, friend

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