Risks? The risks of a colonoscopy are crazy low though.
There's also risks of false positives/negatives for some tests which complicate matters as well.
What? I have a hard time understanding this, what is your primary reference.
Colonoscopies take a lot of resources and GI docs are in high demand—these seem much more plausible limiting factors than undefined 'risks' inherent to the procedure.
Not an MD but have worked in cancer prevention for a while in a software capacity.
See figure 5 https://pubmed.ncbi.nlm.nih.gov/34003219/
You can link to the figures directly for PMC articles.
My point is that the risks aren't the limit for how we think about testing (though they exist), but instead the low marginal improvement in diagnostic yield and life expectancy.
Not at the statistical level. Death rate from complications is about 1 in 10,000: https://www.endoscopy-campus.com/ec-news/risk-of-death-from-...
My doctor says that since Cologuard catches a large percentage of those 3-5 per 10,000 without any of the colonoscopy risk, the marginal benefits from colonoscopy really aren't justified since FIT+DNA testing is almost as good, at least for low-risk cohorts.
Very few things in medicine are zero risk. I wish more doctors would help balance the risk of doing A vs. the risk of doing B vs. the risk of doing nothing.
It's all Bayesian conditional probabilities, considering your own individual risk factors, and considering the false positive rate and false negative rate of each test.
What's your reference for this? That's incredibly (read, unbelievable) high for a routine procedure.
RESULTS Among the 30,818 records identified, 82 population-based studies from 24 countries were included, involving a total of 38.5 million colonoscopies. The estimated incidence per 10,000 colonoscopies was as follows: gastrointestinal AEs, including perforation (5.15; 95% confidence interval [CI] 4.19-6.34, I2 = 99%), bleeding (18.39; 95% CI 13.53-24.99, I2 = 100%), and splenic injury (0.61; 95% CI 0.43-0.85, I2 = 93%); nongastrointestinal AEs, including cardiovascular events (52.11; 95% CI 18.67-144.59, I2 = 100%), respiratory events (4.26; 95% CI 0.73-24.99, I2 = 100%), and deaths related to colonoscopy (0.18; 95% CI 0.10-0.34, I2 = 74%). Subgroup analyses yielded partially divergent findings. The majority of the included studies exhibited a low to moderate risk of bias.
just ask any AI, i don't got time to play tic-tac-toe with the NIH.gov website gating me behind click bus images for 10 minutes
My source is not seeing one perforation each week at work.
> just ask any AI
These do not give reliable answers, as I am sure you know
i only answered the specific question of where the number "48" or the range 40-80 came from.
my cite even shows perforations are 3-5 per 10000 so i don't know what you're on me about
Yes, I am sure. Do send the actual citations.
> my cite even shows perforations are 3-5 per 10000
An implausible number for humans who have actual, non-LLM experience in this area
https://jamanetwork.com/journals/jama/fullarticle/2779987 3.5 per 10,000
take it up with JAMA and the AJG.
do you do SCREENING or DIAGNOSTIC/POLYP REMOVAL?
because there's a difference. And it has nothing to do whether i use google.com or chat.whatever.com to find that out.
You didn't give me a source before now, so I unfortunately had no other source to challenge except the LLM!
> https://jamanetwork.com/journals/jama/fullarticle/2779987 3.5 per 10,000
Different source, friend. Please note that they say 3.1, not 3.5.
That is at about 25% less than 4 (and even less than 5, let alone your previous assertions). And if either you or your LLM troubled yourself to read the article, even this is a confounded number in that we cannot determine whether low-volume, 'community' operators are worse than high-volume settings.
> do you do SCREENING or DIAGNOSTIC/POLYP REMOVAL?
We are talking about screening—once you have a target to remove, you are looking at a high-likelihood-of-cancer population. I am fully aware of this, so I don't understand why you are bringing up this difference which has not yet figured into our discussion. Is this something your LLM suggested to you?
---
I think the thing to take away is that LLMs do not yet replace human understanding and discretion.
those two numbers fall within the range of "3 - 5 per 10,000"
the thing in the first sentence of my reply is called a DOI, it's a document identifier, that you can type into google or bing and it will pull up the correct journal citation i was citing.
I understand that the JAMA paper said 3.1, but it also said a number almost 5 times higher near there for "major complication", separate from perforation.
My original reply, where i did the > block quote, is from the AJG source; 10.14309/ajg.0000000000003429
And, for all we know someone is using a roto-rooter to perform colonoscopies and throwing the statistics off
> Not at the statistical level. Death rate from complications is about 1 in 10,000:
THAT IS NOT what this paper says. Please avoid commenting about things that you do not understand!
Here is the actual article: https://www.cghjournal.org/article/S1542-3565(20)31076-4/ful...
First, the study looks at people who had a positive screening Cologuard/FIT test. These are not normal people!
Second, the test looks at DEATHS WITHIN THIRTY DAYS of the procedure. In fact, the article goes on to say that there are ZERO deaths related to the actual procedure. ZERO.
Couple of years ago the latest doctor who I fired started talking colonoscopies. I asked some basic questions like how do they get paid? How much do they get paid? Who inspects their facilities?
He took great umbrage at the notion that the doctors were getting "bounties" for nipping pieces of tissue for lab review, refused to discuss that. (Tell me you know something without telling me you know something.) He also took umbrage at the notion that his clinic wasn't "clean" and that it was inspected regularly... didn't say by whom.
So here's the deal. Here in Washington State, USA his clinic gets a "wet work" inspection, just like a slaughterhouse or restaurant, as part of the occupancy / doing business license. But there is no ongoing inspection, and fuck no there is no "safe to eat here" poster in the window of his clinic.
It gets more interesting when you start looking at the datasets an inquiry like that turns up. Like: how many deaths / hospitalizations are there per 1K procedures? Actuarily we have a number. Now clinics, at least the ones doing things on a regular basis, have to report adverse events leading to hospitalization: the reporting rate is impossibly lower than the actuarial rate, complications leading to hospitalization are not being reported. But.. there's more! The State collects "foreign contamination" stats from pathologists; you can look at this by pathologist, if they do enough of them. The majority of pathologists scoring colonoscopy samples report ZERO foreign contamination; among the pathologists actually reporting, the rate for presence of foreign contamination is around 25%.
In this case I called public health and building inspection agencies and asked them what sort of ongoing inspections there were for clinics and other medical facilities. That turned up databases online, and keywords which turned up other databases.
What was the germ (pun intended) of this inquiry? Several years earlier, sitting in the waiting room of a different clinic, and the linen supply company pushes a cart through (gets buzzed through to the back) to collect the dirty linen, wearing gloves. Like they did this every day. Many years ago, the memo taped to the doors to a lab wing at a biotech: "gloves must be removed when greeting visitors". Various reports over the years concerning improperly sterilized dental instruments.