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Comment by prirun | 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 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."

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>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.

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