Had my first colonoscopy 4 months ago, after going for a couple of years with every red flag symptom under the sun.
The procedure was a piece of cake. As the standard is where I'm from (Norway), I was only administered some sedatives - but honestly I couldn't feel much difference. I watched the procedure on the screen, which was quite fascinating.
The worst part, by far, was the emptying / prepping. A month prior to the colonoscopy I took a stool sample (negative for blood), but my doc wanted to be safe.
In the end they nothing was found, not even polyps.
EDIT: I had put of going to it for the longest time, but a friend of mine (35 years old) was diagnosed with stage 4 last year, which pushed me to get it checked out. He had experienced prolonged constipation, that's it. When the tumor was found, the cancer had spread to both of his lungs and liver. He's still alive, and fighting it.
My doctor recommended a combination FIT+DNA test instead of colonoscopy (brand name "Cologuard"). She said it's not quite as good as the "gold standard" colonoscopy, but it also doesn't have the risks of colonoscopy.
And the FIT+DNA test is so cheap and easy, you can do it every year or three instead of every 10 years with the colonoscopy.
She still recommends colonoscopies for high-risk patients, but she thinks the risks outweigh the benefits for low-risk patients, so she recommends Cologuard in those situations.
I appreciate this risk-adjusted and probabilistic approach rather than one-size-fits all recommendations.
The main issue with those tests is they have a relatively high false positive rate. If you pop on that one you need to follow up with a colonoscopy to confirm.
The big issue has been that in the US, the followup colonoscopy was often no longer covered by insurance as it was no longer classified as part of the preventative medicine tier, and instead was now a different sort of procedure. My understanding is that this is no longer true though.
Got burned by exactly this when on a high deductible HSA plan.
my PCP thinks i am over 50 twice a year and mentions i should get one, and he knows i won't pay for anything, so that means my insurance covers it.
This is anecdote by induction.
Risks? The risks of a colonoscopy are crazy low though.
The risk is the primary reason the age for first colonoscopy is so high. Even with cologuard it's not typical before 40 unless you have family history.
There's also risks of false positives/negatives for some tests which complicate matters as well.
> The risk is the primary reason the age for first colonoscopy is so high
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.
Those are also factors for sure, but the the risks from complications aren't undefined. Even cheap and non invasive screening carry risk due to false positives inviting unnecessary downstream procedures.
Not an MD but have worked in cancer prevention for a while in a software capacity.
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.
They are until they aren't. My grandmother had a puncture and almost died
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There is still the rush of perferating the colon, but I assume it doesn't happen very often. Cologuard has got to be cheaper though.
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I remember reading somewhere that the highest risk is you falling off the table while you are sedated.
>"Risks? The risks of a colonoscopy are crazy low though."
The risk of serious complications like major bleeding or perforation is closer to 40-80 per 10,000, significantly higher than the roughly 3-5 per 10,000 annual chance of actually having colorectal cancer for low-risk groups.
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.
The real risk is getting a doctor that is more interested in money than medical care. These seem to be more like 3000-5000 per 10000.
> The risk of serious complications like major bleeding or perforation is closer to 40-80 per 10,000
What's your reference for this? That's incredibly (read, unbelievable) high for a routine procedure.
not who you asked but the perforation is 3-5 per 10,000; cardiovascular issues is 52 per 10,000, polyp removal carries risks of bleeding or perforation, and underlying patient physiology.
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
You are hardly describing "serious complications" ('bleeding', and 'respiratory events' are very non specific, and the fact that this is an uncited meta-analysis across nations makes the whole enterprise suspect), even less so since your source averages 24 countries while we are speaking about US colonoscopy recommendations.
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
they give citations which i was going through and literally copied and pasted the CITE to you, not the AI.
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
> they give citations which i was going through
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
>>"Risks? The risks of a colonoscopy are crazy low though."
> 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!
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.
This is funny. I've had an unbelievable string of bad doctors / clinics... almost as though something is wrong with medical care around here.
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%.
What an interesting and obvious approach, wish I'd thought of it. Tell me more about your inquiry for the answers the doctor avoided.
What is your point?
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2 to 3 colonoscopies per ~1k to 2k people cause severe rupture of the intestines that require urgent surgery.
Kinda annoying that the minimum age is 45 and its explicitly not for high risk individuals though. Like you would think having a non-invasive test would be incredibly important for that.
> The worst part, by far, was the emptying / prepping.
This. The procedure itself was a snap (I was completely sedated; I'm in Canada), but it was NOT a fun 2 days of "pooping" pure liquid and being hungry. I don't think I was away from the toilet for more than 20 minutes at a time.
Having had three colonoscopies so far, my system for prep is to change what I eat at least the week before. Jello, ice pops. . . generally light stuff. At some point before I start drinking the beverage from hell, I get butt cream. Smear it on and then drink. Keeping a layer of diaper rash ointment on the tush helps a LOT.
I suggested to the pharmacists at my local pharmacy they should recommend butt cream when someone buys the prep stuff. Not sure if they do it, but all agreed it was a good idea.
+1 on low fiber diet 5-7 days before.
And although I didn’t try the diaper rash cream, Balneol was definitely a life saver.
Why can't you just fast the day before and then get an enema on the day ?
Yeh if you want to improve the screening rate then someone needs to figure out how to make the prep easier.
There are slow-acting laxatives that you have to drink a lot of and tastes wile but is soft on the intestines, and then there is quick-acting laxative that is easier to get down.
The former tends to be prescribed by default, obviously.
If you have no prior intestinal diseases and are in for a routine check, ask for the quick-acting one. You will have to drink the same total amount of liquid, but at least most of it will not be drinks of your choosing.
Also get anal cream, and apply it once before going to the toilet.
> The worst part, by far, was the emptying / prepping.
Protip to those who have it coming up: Ask for the pill prep instead of the "sludge" prep. You end up spending the day on the toilet either way, but at least it doesn't taste as bad with the pills.
It depends, if you want the best possible colonoscopy quality, do the liquid/"sludge" prep, the general consensus is it cleans you out the best and gives the best possible view during the procedure. However that's only true if you actually do it properly and drink all the liquid.
A decent number of patients can't/don't get through all the liquid in which case the pills are far better.
I’m doing it this year. Does the pill work as effectively as the drink?
> Oral sodium sulfate in a single dose has been found to cause increased gastrointestinal (GI) events
> Sodium phosphate is no longer recommended as a bowel preparation regimen due to its serious side effects
Essentially, put in the effort and do the liquid bowel prep.
Consider adding flavour drops to your drink, icing it or turn it into a slushie to make it slightly more interesting to drink. The PEG will make the ice crystals slightly more smoother.
Essentially, put in the effort and do the liquid bowel prep.
It's not just about effort. I must do the liquid prep due to my Crohn's disease. And while I am able to get the liquid down (as you note, it helps to make it as cold as possible; also, suck on an ice cube before drinking to numb the taste buds), I can't keep it down. Within an hour it has me evacuating from both ends.
For my last test, I barely slept at all the night before on account of the vomiting, and even once I got to the hospital I was lying on the wonderfully cold tile of the floor between rolling over to vomit in a trash can.
They know it affects me badly, but still assess that it's necessary due to my risk factors. And because I'm losing much of the drug due to the vomiting, the prep is poor, so I have to start fasting a day early to ensure that I get sufficiently cleaned out. It's torture all around.
What helps for me was using cool/chilled water, and a swimmer's nose clip to help reduce the smell of the ingredients. If you are adding flavor drops - go with lemon and not anything blue or red in color.
One other piece of advice - stay off the internet afterwards until you're sure the anesthesia has worn off. My doctor related that a previous patient had gone on the Carvana website and bought a car while still under the effects. Oops.
> Sodium phosphate is no longer recommended as a bowel preparation regimen due to its serious side effects
Well in my country, it's still wildly used for people without renal issues.
These are best practices guidelines that are ultimately implemented (or rejected) by surgeons who still go by feel, whether following the latest-and-greatest or by what they are used to.
Some doctors will say yes, some no. Best bet is to do what your doctor suggests, but at least ask if the pills are an option.
I can’t compare the two, but fwiw, in my experience, while the drink is mildly unpleasant it’s only the texture of the drink itself that’s bad and the fact that you have to drink quite a bit of it. It doesn’t taste bad per se (and you can add flavored drink mix to help) and the “purging” part is painless, ie no cramps or anything.
I didn't actually mind the prepping too much personally. Just to be safe I started early to go on the long end of what they suggested with the diet and basically just ate baked, unseasoned chicken for 10 days. Then did the bowel prep; a lot of people hate the drink, but idk. I thought it was fine. Maybe better to assume it will suck though, that way you at least can't be disappointed.
> In the end they nothing was found, not even polyps.
Same here, thank god.
> a lot of people hate the drink, but idk. I thought it was fine.
Aren’t there a lot of different drinks, though (at least 3 or 4)?
E.g. I know Miralax can be an option for some which practically is tasteless.
I see. So I escaped the experience of the nasty drink, then. I thought it was just "the standard" because it was also word for word what I saw when I googled it at the time. (Gatorade + Miralax.)
I overshot their requirements as well. I wanted them to have a clear view.
These days, in the USA, they're starting to give you an over-the-counter laxative rather than that nasty drink.
I just had my hole inspected and all the preparation was with over-the-counter supplies. My prep drink was gatorade with some flavorless powder mixed in. It made no change in the taste or texture of this drink. Having the squirts for a day was no fun, but other than that it was a breeze.
Same here. I didn't find the drink especially nasty. I drank it very cold, it had a somewhat chemical taste but very fluid, not disgusting texture. I do remember it was a lot of liquid to drink though. As for the bathroom part, no pain or discomfort whatsoever. It took a couple of hours total if I remember correctly.
No, the worst part is the risk of puncture. Rare, but it happens. Happened to a colleague of mine.
It is likely that your friend could have a genetic disposition for colon cancer. He should get a gene test once he has recovered.
I was the same age. My doctor saw signs in an early blood test, and followed it up so mine got detected relatively early. My test was positive for Lynch syndrome, and I am now a colonoscopy veteran.
I did one two years ago without sedation, I wanted to work afterwards. I didn't feel any pain, so sedation is really not necessary
I woke in the middle of my first one due to inadequate sedation and it felt like someone was pushing their fist into my stomach too hard and/or having cramps. Tolerable but unpleasant. I elected for propofol on my second and was happier (though both midazolam/fentanyl and propofol basically make you kinda useless for the rest of the day).
my guess is that they take more care when they know you are not sedated. I know a guy whose intestines have been perforated during a colonoscopy if he wouldn't have been sedated he would have felt the perforation right away
I ended up paying 15000 usd due tó complications.. that was the worst part for me
Which country are you in? Did you have insurance? What kind of complications? Have you recovered completely?
I’ve also done it, without finding polyps or anything. Obviously it’s normal to run through the entire Bristol Stool Chart in one sitting.
I had a colonoscopy without any sedatives and I agree, the prepping was worse. Not eating for 24 hours was easy, drinking the solution the night before was unpleasant, and drinking the solution the day of was awful.
My pro tip would be to take the day off work. Trying to work while drinking the solution in the morning didn't really work.
Can also confirm that the worst part was the prepping. You have to dring 2 liters of liquid that give you diarrea... The second liter is the worst, since the body learns that it's "poison" and triggers all the reflexes to make you not swallow it.
If you have red flag symptoms you should get checked out. This type of cancer is often not caught until stage 3-4, at which point even if you do survive you may end up with a colostomy bag or other serious issues. You're also looking at tons of grueling chemo. It's often caught late because people ignore minor symptoms, assuming them to be something like hemorrhoids or digestive issues or self-misdiagnosing as having Celiac's disease.
If you catch it at precancerous or stage 1, it can often be removed with minimal side effects.
Sounds like for you the red flag symptoms were something else, but others shouldn't treat it this way.
How old are you? I’m 37 and my doc says you get one at 45
Okay, so another pro-tip for prep. I can promise it's not bad at all if you're already very regular.
So what you do is, schedule it for weeks or months out as you can and use that to develop good eating and fiber habits over that time. You have a deadline and real stakes in the game. You will literally hurt more unless you get that straight before then.
Win-win.
> The worst part, by far, was the emptying / prepping.
As described in one of the great modern tales of legend:
Seeing young adults around me going through this made me change my dietary habits 1 year ago. I went to the extreme by modern food industry standards, but now:
- I take 100g proteins, 30g fibers daily
- Red meat once a week but never fried
- Most of the protein comes from eggs, yoggurt, chicken and various plant based sources
- No white bread
- No added sugars, no deserts except fruits
- Nothing fried
- No added salt
- No canned food
- Saturated fats kept at minimum.
- No spicy food
- No alcohol
The results are incredible. I lost 8 kg, my blood samples are perfect, my pulse dropped with 10, I sleep better, no migraines (I had those for years). Also this year I was the only one in the family that didn't got any cold, and that's quite hard with two kids going to kindergarten.
It's hard in the first two weeks, but afterwards it's becoming your daily routine. I also use an app to track various stats. The gameification of the diet also helped me a little.
I urge you to try this. To make it more manageable start small. For example avoid fast food for 2 weeks. Don't put any mayonnaise in your food for 1month. Stop eating white bread. And then add more and more restrictions. The hardest fight is the urge to eat sugar and drink alcohol, give it time.
Glad you’re feeling better, but you could have just stopped at increase fiber intake and decrease red meat and alcohol consumption. None of the rest is linked to colorectal cancer, certainly not mayonaise, which is just oil and egg.
I've explained why I don't have mayonnaise. Also it was just an example. I avoid it because I can eat more meaningful stuff without bombing my calories and saturated fats stats. The mayonnaise I find in the shops has terrible composition.
There are brands of "mayo" and other products that contain some emulsifying agents that have been observed to deteriorate the mucus membrane in the colon, and that effect is believed to increase the risk of colon cancer.
I haven't heard about any risk with the natural emulsifier in egg yolk though.
"Other products" is quite a long list, though there's more a link between a high intake of refined sugars that promote particular bacteria that can damage the lining. Still often the same products to avoid or minimise.
We've been on the whole food path for a few years now, and while there's a bit of extra time in prepping all the ingredients from scratch and you have to turn over fresh vegetables often (therefore more frequent visits to the market) you at least know what you're eating.
homemade mayo is one of the easiest things to make if you have a hand blender and wayyyyyy tastier, addictingly so actually
you need some real, strong dijon mustard though, like the kind trader joe's sells for ~$3
in a tall glass or container:
1 raw egg
1 soup spoon dijon
1 soup spoon apple cider vinegar
salt/pepper
a bunch of vegetable oil (about 1.5 cups? eyeball - watch some youtube videos)
blend
don't overblend once it seizes or it can de-emulsify
Kenji's stick blender mayo recipe is also really good and really easy.
These are really good changes for your overall health, but what I hear anecdotally is that a lot of the young adults diagnosed with colon cancer don't have traditional colon cancer diet/lifestyle risk factors. There's even a theory that healthy activities like long distance running might be contributing to cancer risk.
Curious, why no canned goods? I recently added smoked canned oysters to my diet due to high zinc, protein and heme iron. I struggle to assume iron because green leaf veggies (which I like) irritate my stomach, so I often end up in the washroom. With the oysters I am finally getting iron.
But of course I don't want to mess up. I roughly eat like you do
Many of them are loaded with preservatives and salt but it shouldn’t be a problem if it’s just sardines in olive oil or whatever.
What about the can lining?
I think the hard part for me about doing something like that is not forgoing those things, it's figuring out what to eat instead. Any tips?
In the morning I have boiled eggs, or yoggurt with cereals that don't have sugar, I also add various type of seeds and maybe I have a fruit or two.
At lunch I usually have chicken breast or fish and some carbs (usually rice, or baked potatoes, rarely some simpla pasta). Salads, carrots, tomatoes, cucumbers, cooked vegetables, home made soups.
Then I have smaller meals with more fruits, or yoggurt with less fat. Or soups.
The simple answer is plants. Lots of fruits and vegetables, and pulses (beans, legumes, etc) for protein.
You have to consume a ridiculous amount of beans to get 100g of protein. That’s something like 7-8 cans of chickpeas per day.
Then don't get 100g of protein. Most people don't need anywhere near that much.
Why no spice? And why no salt assuming you balance properly with potassium and limit intake overall?
If I track the salt, a lot of the salt I need comes already from various types of yoggurts (like ayran, or light cheeses and meat), if you actually track it and scan the barcodes of what you eat, you will find out there's already enough to add more.
I was eating spicy food and it irritated my intestines. I have enough fibers to never get constipated.
How do you make sure you’re getting enough iodine?
Fish and dairy.
I’ve done the same. Lately the increased fiber is making me think I have colorectal cancer with all the abdominal bloating LOL. Hope it settles soon! Been like a month
I've increased the fiber intake from close to nothing to 30g gradually. After a few months into the game the bloating doesn't appear anymore. Also some probiotics can work in the beginning, but usually the best ones are more expensive and the science behind them is disputed.
Why no canned foods? Sodium concerns?
Cans also have linings made of material that can contribute to ingesting microplastics and other uncertainties
Yes. Too much sodium, or oil. Or other nasty substances.
Plenty of canned things that don’t have added sodium or oil though.
In my part of the world this is the norm.
Here too. If I were to pick a can up on the shelf it would likely have 800-1200mg of sodium. But if I look for low sodium beans it has like 100mg.
What’s the no spicy food about. Capsaicin has a lot of benefits especially as an anti inflammatory and (less researched) anti oxidant. Plus, it makes a lot of bland food incredibly palatable. There are almost no downsides.
Nice! Now you see what Gen Z sees in the practically poison stuff we call modern food. The obesogenic system of laws, the corporations, culture, the ads, the home delivery
How do you get enough calories while avoiding fats?
What do you usually eat in a day?
I don't avoid fats, just saturated fats.
Kefir, eggs, chicken breast, potatoes, beans, rice, oats, fruits, vegetables, a little olive oil, low fat cheese and raw seeds (pumpkin) or raw nuts.
To be honest making the calories today is easier than not making your calories. Go to any supermaket you have caloric bombs everywhere and in everything.
Mayonnaise is just oil, egg, and some vinegar, salt, and mustard. All of those things you have in your new diet so you lost me on why you wouldn’t eat it.
As someone mentioned a lot of the store bought ones have emulsifiers that might be contributing to the colon cancer rates.
The one you find in shops has terrible stats. If you make it at home I guess it's manageable, still it can really bomb your fats stats for the day.
Sure but you should be counting your saturated fats if you’re counting your fiber and protein intake as well as everything else. I make my own mayonnaise.
Ok. Maybe it wasn't the best example, but my reason I avoid things like mayonnaise is because they add lots of fats and calories without making me feel full. Most of the commercial mayonnaise, in my part of the world, doesn't have a lot of proteins (even if in theory the eggs should be there), and have lots of saturated fats. So I prefer to fill the calories counter with more meaningful choices. For example I very much prefer having 20g of nuts instead of adding mayonnaise.
All in all. That was an example to make a point. I also don't eat butter.
I agree anything in grocery store labeled as mayonnaise, peanut butter, olive oil, etc should be vetted for the exact things you describe in your posts.
Had my first colonoscopy at 46. Found cancer, stage 2b. Resection and chemo. I was completely asymptomatic. I put a post on FB and I now know about a dozen people who that prompted to get their colonoscopy done. Get it done, the prep isn't bad, get the pills if you can, otherwise make sure you get a Zofran along with the prep. If found early, it's easy to treat. Get It Done.
> Yes, if you are currently young, you face higher CRC risk than previous generations did when they were young. That’s the bad news.
Unlike the usual Bettridge's law, the answer to the headline is only a qualified "No".
It is a "So is all other cancers!", which is pretty bad news for folks who are young and healthy right now.
One thing I can't figure out from the content or the graphs (where I can read the legends with my 1975 eyes) is whether this adjusts for overall mortality rate, which is to say, is any of this effect due to the fact people are more and more likely to wear seat belts, not die of (now-)preventable diseases, etc.?
EDIT: having thought that over a third time, I am not sure it makes any sense.
I think the standard calculation is per person-year, not per person. So a 22-year-old dying of a car crash shouldn't skew the statistics, because they only contribute 2 people-years to the 20-24 age group.
That being said, I can see a few plausible biases (though none of them explain the scale of the increase IMO):
1. CRC risk is correlated with some previously fatal, but now curable disease. The mechanism would be that your high-risk CRC patients would die due to yellow fever or something in 1970, meaning they don't have the chance to get CRC. The important thing is that it would have to "artificially" remove high-risk patients from the age group, but not low risk patients.
2. CRC risk is noticeably higher at 24 than it is at 20, and all-other-cause mortality is significantly lower today. That would lead to a higher proportion of 24-year-old "years" in the calculation.
3. People used to die of CRC before it was caught, which caused it to not be recorded as a cancer incidence.
1 seems unlikely, and even if true shouldn't make a big difference. 2 seems the most possible, but still unlikely to make a huge difference. I don't know enough about how they determine cause of death to know if 3 is a possible outcome.
No, not all cancers - a handful of cherry picked cancers.
The overall age-adjusted cancer rate has been going down, and the death rate even more so.
People should be reminded that colonoscopy is not just a screening, it is also preventative. They often find growths that may develop into cancer, and remove them during the procedure.
Does insurance see it this way? I've had a couple precancerous moles (melanoma in situ) removed, which seems similar, and my health insurance provider billed me more than I was expecting because they didn't categorize it as preventive care.
I did a colonoscopy at 38, because I saw something in the toilet that looked like the lingonberries at Ikea. Everyone was like "Man that seems early" but when I woke up, the doctor expressed some surprise when he told me they removed a couple of polyps.
A week or two later, I got a bill for several thousand dollars, and I just had to roll with it. I believe that in the US, there is a certain age, after which, they're covered.
> I believe that in the US, there is a certain age, after which, they're covered.
There is a lot of confusion over this point, even among support agents for health insurance companies.
i) The Affordable Care Act specifies that all Marketplace health plans must cover colorectal cancer screening for adults 45 to 75 years at zero cost [i]. That means no copay and no coinsurance, even if you haven't met your deductible. You pay $0.
ii) That generally means that colonoscopies will be zero-cost for anyone in that age bracket, but only if it is a "screening". If you have symptoms, the service may be billed as diagnostic rather than preventative, which takes it out of the "zero cost" category
iii) All of the above is separate from whether the procedure is "covered" or not, because "covered" in the context of health insurance means "your plan covers this, subject to your normal deductible, copay and coinsurance, so long as it is medically necessary". If something is truly "not covered" then your insurance pays $0 and the provider will bill you the full, undiscounted cost of the procedure.
In other words, there is a difference between "your plan covers this (as it does for any other regular medical care)" and "your plan covers this at zero cost, as it falls into one of the narrowly defined 'preventative care' buckets as defined by the ACA"
It's common for people to confuse these things.
In your case, it sounds like the procedure was not covered at zero cost (as expected, as you are not in the 45-75 age bracket defined by the ACA, and in any case your procedure was diagnostic, not preventative), but it was "covered" by your health insurance in that you paid your regular deductible and copay, rather than the insurance company saying "your plan does not cover this procedure (at all)" and then the hospital billing you the full cost of the procedure, which would be tens of thousands of dollars.
> i) The Affordable Care Act specifies that all Marketplace health plans must cover colorectal cancer screening for adults 45 to 75 years at zero cost [i]. That means no copay and no coinsurance, even if you haven't met your deductible. You pay $0.
At least with my ACA insurance plan, you have to appeal it first because they pretend like it's actually diagnostic even though it was billed as screening.
It's fraud prevention! You see, people love to shit in a bucket multiple times a year to have their shit tested all to defraud insurance companies.
Reading this should make everyone in the US furious about the state of our health system
I achieved what I understand to be maximum furiosity on this subject years ago.
I mean it does. That's why so many people cheered when Brian Thompson was... involved in a shooting and died.
Not ideal but better a couple thousand bucks than cancer... but seriously, especially if they actually found something worrying like polyps, the insurance shouldn't even get a say.
I think so, even with shitty U.S. providers. I've never had a problem.
Most US insurance has very strict guidelines about what is diagnostic vs preventative for a colonoscopy. And its almost certianly diagnostic.
diagnostic does not mean "not covered", it just means it moves out of the "zero cost even if you haven't met your deductible yet" categroy defined by the ACA, and into the regular category where you pay your deductible, copays and coinsurance
In situ should be medically necessary and thus should be widely covered. That's surprising.
I have UC and will get colonoscopies to confirm it is well-controlled for the foreseeable future. It also increases risk of colorectal cancer, something I am actively thinking about. Rates of UC, IBD, and similar digestive issues are up across the board, also for a mixed and seemingly inscrutable set of reasons.
IMO, the fundamental issue for preventative screening is there is basically no amount of money I would not part with (of my money, the insurer's money, or private debt) to not die. I expect this is true for most people, and it makes preventative screening a tricky topic. In recommending screening for those >x age, you will miss some detectable, preventable and treatable cancer risk for those <x age, purely for cost. No one wants to be explicit about that though!
I think the only way out of that uncomfortable conversation is making screening so cheap via automation that you can basically run it for very low incremental cost as often as individual risk tolerance permits. This would be paid for on the back of earlier interventions vs late-stage, expensive interventions.
A colonoscopy is more than screening, if they see a polyp they remove it. Left alone that polyp will very likely eventually become cancer. Routine colonoscopies for someone with IBD is multi purpose, you screen for active disease, fistula, strictures, cancer, while simulatenously treating active disease (polyp removal)
Similar things happen in any general surgery, for example you can get your tubes removed and send up with all your endometriosis that you weren't able to diagnosis removed as well
> Left alone that polyp will very likely eventually become cancer
I don't think so. You have a reference?
You can't tell whether a polyp is cancerous or not before you have removed it, sent it to the lab and got the results back.
Therefore, all polyps should be removed. (Sending them all to the lab might be superfluous though)
Yes. That is the recommendation because "some" polyps are or may become cancerous. Not because all do. Unless you are saying that they do?
Though I regurgitate this information based off conversations with gastroenterologists not one off studies.
You claimed that "polyp will very likely eventually become cancer". I don't think this is true, in general, for polyps even though some might become cancerous. The paper you provided is pretty dense, but it didn't see to me as though it is saying that polyps generally become cancerous.
It's an internet forum, I didn't claim anything. And your doctor isn't going to first biopsy just a little bit of a polyp to determine if it's the "bad" kind, he's going to remove all of it.
It's annoying pedantry, a distinction without a difference.
Oh FFS. The difference between polyps very likely becoming cancer and some polyps maybe becoming cancer is not pedantry. And it probably wouldn't be as annoying to you if you just said that you didn't know instead of attempting to dig deeper by providing a source that you either didn't read or didn't understand.
Nice to have a good data-based take on this question make it to the front of HN!
One of our better microscopes these days is DNA sequencing, especially for cancer, and the particular base mutations and the sequences in which they occur give heavy clues about the types of mutagens that are going on. The DNA damage from UV radiation from the sun and bulky adduct repair from smoking damage are vastly different. Even when cells have a defect in a repair mechanism, you can tell which repair mechanism is broken based on the particular base changes in which context.
A study from 2025 reapplied these Alexandronv signatures to colorectal cancer with a global set of cohorts, and suggests that colibactin, a mutagen produced by some strains of E. coli and related bacteria, could be driving some of the increase in early age colorectal cancer:
Of course we don't know exactly how much of the increase, or the other explanations; causality is multi-causal and I bring this particular cause up because it's one of the stronger leads so far. But when we've lost our keys in the night, even if its easiest to look under the light of the streetlamp, that doesn't mean its the only place we might find them.
> We don’t yet know if colonoscopies are better than other methods of screening
My Gastroentrologist told me just recently that the stool test (Cologuard) is very accurate but must be repeated every 3 years as opposed to getting a Colonoscopy which should be repeated every 7 to 10 years
What is better? If the stool test can find something that isn't in the colon but isn't as good for things that are in the colon which is better?
The important part is both are good, so get one.
What is better? My colonoscopy came with a dose of propofol that made me understand why Michael Jackson went out the way he did. Best sleep I've ever had.
I hope that is forever the only difference. However if you actually have a deadly form of cancer (not all are worth treating, but that is a different discussion) better is whichever one gets you the correct treatment sooner. By contrast if you don't have cancer is whichever doesn't have side effects.
My doctor makes me do one every year
I had bleeding for a over a year and every time there was a good explanation. After all the news about cancer I pushed for a colonoscopy at 41.
36 polyps were found. Some of elevated risk. So now I get yearly screening. But by the sounds of the type of polyps I had, if I had waited until the screening age I would have had high chances of cancer.
Also increased, or we're now aware of, higher rates in long distance runners.
I'd love to know the causation for that correlation
There was some discussion about this on HN recently. Supposedly something to do with less blood going to the bowels during prolonged exercise. Apparently the risk was largest in people who ran 5+ marathons.
No one knows for sure. One hypothesis is chronic inflammation, perhaps linked to diet or mechanical stress.
My understanding is that exercise lowers chronic inflammation. Basically, you trade off acute inflammation during the exercise itself for less inflammation when you're not exercising. But, maybe long distance running is too long or something.
Perhaps higher sugar consumption from fueling techniques?
I've often wondered if colorectal cancer is really on the rise in young people, or are we testing more younger people, which makes it seem like it's on the rise? Hopefully my question makes sense...
That's covered in the article. Deaths are also rising, which suggests it's not just more testing.
No, this isn’t true, and the article makes the same fundamental mistake.
While certainly deaths are a more reliable indicator than diagnoses, you always expect to see an increase in “deaths from X” when you more aggressively screen for X. The intervention of cancer treatment comes with serious risks, and screening sometimes finds cancers that would otherwise never be a problem.
We’re talking about very subtle differences in population-level trends, so these kinds of errors matter.
Bad diet is on the rise.
Some people have turned vegetarian, vegan or gluten-free for health reasons, but substituted foods for other foods with additives that may come with their own health risks.
Methyl cellulose is in gluten-free bread and in most fake meat products.
Some emulsifiers are found in mayo, other sauces and "ice cream". Not just vegan brands, but overall.
Ethic is the leading reason for the vegan lifestyle [0]. It's also well known [1] that a plant-based diet is effective with colorectal cancer (+9%):
> The random-effects model demonstrated a significant inverse association between plant-based dietary patterns and CRC risk (hazard ratio [HR], 0.91 [95% CI, 0.85–0.97])
But as you guessed it varies between healthy and un-heatly diets:
> This protective association was strengthened when the definition of plant based patterns specifically emphasized the inclusion of healthy plant foods
However those un-healty foods are not restricted to plant-based meal (evidence: any supermarket shelf or snack restaurant), and lentils, tofu or seeds are as much -or more- likely to be found in a long term vegan dish than an impossible burger. As you noted it's "Not just vegan brands, but overall". For the mayo I recommend tahini instead (way more tasty) or just olive oil but if you really need it:
- ~2/3 sunflower oil
- ~1/3 soy milk (with no additive ;-) )
- a bit of citrus juice
- a pinch of salt
-> Blend high speed to emulsify
-> For a thicker texture you may use some silken tofu
> “Hey! CRC is going up! You should get screened!”
Try asking a doctor for asymptomatic screening (for anything), they usually say "There's a schedule for such screenings at age X, you're too young for that. There's also proven negative effects of excessive screenings."
Which kinda makes sense, as they supposed to have protocols/schedules for all kinds of healthcare. We're talking here about changing that protocols/schedules. But doctors (and insurances) are generally reluctant.
So my actionable question is "How do I convince my doctor to get the screening?"
Just say you saw blood in your stool. You can also google some of the symptoms and say you have some of the more ambiguous ones.
Yeah, blood in the stool should get it ordered.
This.
In my 40s I asked my doc what I should get screened for and when. He said to wait until 50. Now I wait here on death row with stage 4 colorectal cancer.
> In my 40s I asked my doc what I should get screened for and when. He said to wait until 50.
What did you want your doctor to say, instead?
what do you think? what do you think he's going to say when he has stage 4 cancer?
I just don't understand why the doctor would say anything different than what the national screening guidelines suggest?
I think he's arguing that guidelines are dumb/outdated
I think the guidelines are fine - we can't stop everyone's disease and that's not what the purpose of these screening tests are.
that's because you don't have stage 4 cancer
> that's because you don't have stage 4 cancer
Several friends broke their arms falling off of swings as children. This maybe means that children should no longer be allowed to have access to swings?
> So my actionable question is "How do I convince my doctor to get the screening?"
I guess we have to pay for it ourselves. It's not exactly cheap, but perhaps worth it.
I recommend getting a colonoscopy if you have any symptoms. There is a lot of stigma that prevents people from being proactive about this type of issue.
My anecdote (M, 35) is that I got one after experiencing symptoms that turned out to be unrelated, but they did find pre-cancerous polyps so now I will be getting them more regularly. I received received meaningful early detection and peace of mind. Also aside from the prep, its a very convenient procedure. You get put under anesthesia and do a quick time travel.
> if you have any symptoms
What kinds of symptoms are people actually seeing? Or, without graphic details of your bowel habits, is this a "you'd know it when you see it" type of situation, where it would probably be obvious?
WebMD just says: change in bowel habits, blood in stool (would this be obvious?), anemia (how would you notice this?), unusual gas (uh, what is normal?), unexplained weight loss, fatigue, vomiting?
Unexplained weight loss and vomiting seem obvious, but the rest I'm not sure I'd even notice.
Blood in stool has a strong effect on the odor, so you'd probably notice it. If your stool smells dramatically worse (or at least different) than usual, in a maybe metallic way, that's how you know.
And "unusual" usually means unusual for you. So if you don't change your diet or habits, but suddenly get a ton of gas, fatigue, need to go to the bathroom way more often or have a different experience going to the bathroom, it's worth mentioning to do your doctor.
Blood in my case, and it would probably be obvious. In general though I think a lot of these questions are answerable by paying attention to the changes in your body, how you're feeling, researching, and raising thoughts/concerns/etc with your primary cary provider when that comes up short. No need to go searching for issues if there isn't some leading indicator that sticks out to you as something to be curious about, or there isn't some related family medical history.
All this talk about different groupings (and overlapping kinds of time) makes me think of Simpson's Paradox [0], where how we slice things can be very important to what trend we see.
Various kinds of cancer are going up in later generations. (Definitely at younger ages, possibly at all ages.)
Reminder
This blog endorses colorectal cancer screening. We don’t yet know if colonoscopies are better than other methods of screening (sigmoidoscopy, stool tests), but we do know that screening is better than not screening. When caught early, CRC is highly treatable, often with only surgery (no chemotherapy or radiation) and a return to normal activities within a couple weeks.
This hit home. My dad was diagnosed with colon cancer last week and had a large portion of his colon removed last Thursday. Polyps, which often become cancerous given time, can take a few years to get there. So you don't have to get screened every year but should definitely get the ball rolling. They'll usually be able to take them out during the procedure.
The guidlines are where i live (Austria)
First Colo at 45, if nothing found -> Every 5 years. Once a poly is found and removed get one every 2-3 years.
This is an excellent article. The author does a great job taking all this data to reach the conclusion.
What I’m wondering about is…why?
As in…why is cancer rising among the later generations? Smoking has substantially fallen and this has led to a sharp decrease in lung cancer rates. So why are cancer rates overall increasing for those born in the later generations?
How does one determine an increase in somthing earlier in life from having better early detection mechanisms?
Presubably if you detect eveything earlier, every one of the detected cases would be younger if all else were equal.
PROTEIN POWDER AND BIOHACKING
"None of the experts seem to agree on which of these is the culprit, so I figured that I (person with blog) should help."
In case you aren't aware of dynomight yet, there is a great backlog of posts to read.
His other blog about colonoscopies is even better (linked in the post). Id read them again on other topics.
Personally I am hesitant to do colonoscopy after a relative had a botched procedure. Just this month two celebrities revealed botched colonoscopies. I hope they figure out ways to make this procedure safer.
Those articles don't really say what the "botch" is. Was it the anesthesia? The actual endoscopic examination? Removal of polyps?
If its the polyp removal, I can certainly see how that could lead to problems. But you're a little stuck: even if you use another technique to do the scan, you still have to remove any polyps you find, don't you?
yes I've had both a colonoscopy and a sigmoidoscopy (less invasive colonoscopy).
I'm not sure what the botches are here. In the sigmoidoscopy they took out a couple of polyps, in the colonoscopy (more recently than the sigmoidoscopy) they just did a cancer check-up given family history.
I wish those articles discusses the "botches", I'd like to know since from my understanding these are pretty safe procedures
Maybe just don’t worry yourself with anecdata.
A good friend's dad got a routine colonoscopy and they accidentally punctured his intestines. This was during the first COVID outbreak in the US, and the wait time for getting it fixed was so long that he had to walk around for months with a colonoscopy bag, as an old man that spends all day on his feet working. It was not a good experience.
I did mine without anesthesia/sedatives. There were moments of discomfort when they pump gas to expand the area - feels like a big fart is stuck in your gut - but otherwise no big deal, especially knowing that the pain is not dangerous. Recommend. It eliminates recovery time afterwards (you can drive yourself home) and increases safety.
Might try that this time. OTOH, I get the greatest nap of my life shaking off the sedative (get the lighter, cheaper option like Versed instead of anesthesiologist-administered propofol) and my spouse makes me a milkshake.
As someone with colon cancer, I'd rather the complications than what I'm going through. 8" of colon removed, 6 weeks of recovery then 7 months of chemo treatments. If I could go back in time and get my colonoscopy at 35 instead of 46 and get only do a night in the hospital, I would in a heartbeat. Colon resection and chemo suuuuuuuuuuuuck.
My mother had it. I saw this kind of thing with her. I hope you get through this.
Healthy skepticism of procedure over-prescription is reasonable and maybe even wise, but I wouldn't really take the celebrities section of USA Today as a data point, maybe not even as a reliable anecdote.
Based on your concern, the question is whether 'botched' procedures are more or less of a risk (both in incidence and consequence) than non-screening.
I had to start getting colonoscopies ahead of schedule because my dad never did, until it was too late. He was scared of doctors after he associated them with family members' unpleasant deaths.
Read the safety statistics and let it override the anecdotes. Colon cancer is easy to prevent and a horrible way to die.
It is one of the most common procedures and is generally very safe. Even a botched procedure probably just means some temp discomfort after the procedure. Much better than the alternative.
My doctor actually doesn't recommend colonoscopy until age 50. But starting at age 40 they have you do the "poop in a box" test instead, and then only have you come in if that shows anything.
The complication rate for colonoscopy is about 3 in 1000, and that is skewed towards people who have polyps, which in and of themselves could be dangerous if not removed.
So it's always a risk tradeoff. You can skip the procedure and risk the effects of the disease it's supposed to detect instead. But if you do the math, you're statistically better off doing the procedure.
You can do a FIT test instead which can be done at home.
Nothing you do is risk free.
Functional equivalent to “YOLO”.
Avoid risk where you can afford.
Where it costs you nothing.
A lot of posts urging people to get colonoscopies. But general anesthesia also carries risks. How should one weigh the risk vs benefit?
A few now opt for twilight sedation - you'll not remember a thing though you're not fully knocked out, which I understand helps mitigate the risks.
I've had multiple surgeries under general anaesthesia. Twilight sedation was pretty much the same experience (at least for me): eyes slowly get heavy, then all of a sudden 'it's too damn bright in here, someone turn the damn lights off!.... Oh, that was quick...'
In Japan it's normal to have it without general.
you can have a colonoscopy without general anesthesia
I think it is, I think it is also linked to diet. Learn to cook, avoid processed food, eat out less.
Really you have no idea...
FYI there are other options besides a full scope for screening now, especially if you are low risk
what is rate per 100.000 tracking? I guess it means among living persons at every datapoint. If so decreasing mortality overall and final diagnosis specifically plays a large role in the numbers
Get it done!
But not at Kaiser.
$17k later…
Why did Kaiser’s insurance not pay out here?
It did, but my contribution for procedure + pathology was still over $5k. My out of pocket max is ~$8k.
Oh, OK. But you didn’t pay 17K yourself? (I’m also on Kaiser, but never had any major procedure done.)
I’ve been getting scared of psyllium due to lead risk. Any thoughts?
It's the "sodium benzoate + ascorbic acid = benzene" problem. Watermelon + Dr. Pepper = cancer.
Is "medical term" used "appropriately"?
Yes. Nothing to see here. And stop abusing quotation marks.
Very good visualization repair. I particularly appreciate the TL;DR at the end. In a world of mostly bad popular medical advice this seems competent and at least facially correct.
Am I the only one who is confused by the author’s conclusion? He’s saying it is/is not true?
TLDR
No:
Colorectal cancer is going up in young people.
Yes:
Various kinds of cancer are going up in later generations. (Definitely at younger ages, possibly at all ages.)
Maybe they're all running too many marathons.
"maybe"
I defer to Betteridge so that saves me from wasting time reading the article.
Can someone who's read it confirm?
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The same vaccines that can't be tested against a control group for ethical reasons.
Kind of pointless to inject a bunch of corpses anyway.
^ was a dumb joke about what a control group might be, not me being anti-vax.
Excess deaths occured in the vaccinated rather than the unvaccinated.
Did you miss the BILLIONS in lawsuits against RoundUp and other herbicides?
Did you miss all the deregulation by the first and now second Trump administration allowing crazy levels of pollution and toxicity among all the industries?
They are still using leaded fuel in prop aircraft at hundreds of airports around the country and world, spraying it on unknowning population
Our environment has never been more dangerous yet people never more ignorant or carefree
Less MTTF and more MTTR
There are many things causing cancer unfortunately and I think these are just two of them.
One can always count on Trump being brought up in any discussion. Trump is definitely not the Second Coming as his proponents believe, but the previous admin is not the Saint Incarnate either, on this particular subject.
Biden's EPA filing:
The agency says it is standing by its conclusions that, as registered, glyphosate doesn't pose major risks to human health..."
Any US admin always serves the Big Business, and people's health is just a bump on the road.
Why are the "critical terms" in "that headline" in quotes?
Then some clown downvotes this straightforward question. Brilliant.
Probably because one of the main explorations of the articles is quantifying "young people."
If the headline merely had quotes around "young," that would make sense.
Human biology is such a horror...I've been through it with enough loved ones that I've been left with two obsessions: a) a dignified way to go when my time comes, and b) we should either fix human biology, go post-biological, or simply surrender as a species and be replaced by AI. I know there are many counter-arguments to the above, but I've come to suspect the integrity of our species' rationality under the savage ravaging of Dog.
I’m not sure if this comment is AI generated but I’d like to make a point either way.
Human biology is orders of magnitude more efficient than AI; that’s in regards to intelligence and processing the world around us.
It is not only more efficient but more complex but yet simple. Therefore, the complexity of our biology is a result of efficiency. An efficiency that allows us to process the world and achieve homeostasis in the most simple way. I’d like to see a machine achieve the same without having any type of vulnerability or weakness to corruption.
Nonsense. Human biology is incredible. 80 years average life span for a mammal is amazing to the point that it should be impossible.
The real problem is that as lifespans get longer, silent chronic diseases progress over the span of decades without anyone noticing.
I mean look at human teeth. Horses have extra long teeth that emerge slowly out of the jaw over time as they get worn down. Their teeth are absolutely massive and yet their average dental lifespan is 20 years, up to 25 years if they are lucky and have been fed low abrasive food. Same with cows, after 20 years they have worn their teeth down and are called gummers.
Meanwhile humans who brush their teeth with fluoride and hydroxyapatite, and use interdental brushes of the correct size for each tooth gap, can basically keep their teeth all the way into their 80s. Mammals with a similar life span as humans such as elephants have gone through several sets of teeth after 70 years.
Humans are built for longevity. If we died at 30, nobody would give a crap about any type of cancer.
Had my first colonoscopy 4 months ago, after going for a couple of years with every red flag symptom under the sun.
The procedure was a piece of cake. As the standard is where I'm from (Norway), I was only administered some sedatives - but honestly I couldn't feel much difference. I watched the procedure on the screen, which was quite fascinating.
The worst part, by far, was the emptying / prepping. A month prior to the colonoscopy I took a stool sample (negative for blood), but my doc wanted to be safe.
In the end they nothing was found, not even polyps.
EDIT: I had put of going to it for the longest time, but a friend of mine (35 years old) was diagnosed with stage 4 last year, which pushed me to get it checked out. He had experienced prolonged constipation, that's it. When the tumor was found, the cancer had spread to both of his lungs and liver. He's still alive, and fighting it.
My doctor recommended a combination FIT+DNA test instead of colonoscopy (brand name "Cologuard"). She said it's not quite as good as the "gold standard" colonoscopy, but it also doesn't have the risks of colonoscopy.
And the FIT+DNA test is so cheap and easy, you can do it every year or three instead of every 10 years with the colonoscopy.
She still recommends colonoscopies for high-risk patients, but she thinks the risks outweigh the benefits for low-risk patients, so she recommends Cologuard in those situations.
I appreciate this risk-adjusted and probabilistic approach rather than one-size-fits all recommendations.
The main issue with those tests is they have a relatively high false positive rate. If you pop on that one you need to follow up with a colonoscopy to confirm.
The big issue has been that in the US, the followup colonoscopy was often no longer covered by insurance as it was no longer classified as part of the preventative medicine tier, and instead was now a different sort of procedure. My understanding is that this is no longer true though.
Got burned by exactly this when on a high deductible HSA plan.
my PCP thinks i am over 50 twice a year and mentions i should get one, and he knows i won't pay for anything, so that means my insurance covers it.
This is anecdote by induction.
Risks? The risks of a colonoscopy are crazy low though.
The risk is the primary reason the age for first colonoscopy is so high. Even with cologuard it's not typical before 40 unless you have family history.
There's also risks of false positives/negatives for some tests which complicate matters as well.
> The risk is the primary reason the age for first colonoscopy is so high
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.
Those are also factors for sure, but the the risks from complications aren't undefined. Even cheap and non invasive screening carry risk due to false positives inviting unnecessary downstream procedures.
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/
> https://pmc.ncbi.nlm.nih.gov/articles/PMC8409520/figure/F5/
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.
They are until they aren't. My grandmother had a puncture and almost died
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There is still the rush of perferating the colon, but I assume it doesn't happen very often. Cologuard has got to be cheaper though.
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I remember reading somewhere that the highest risk is you falling off the table while you are sedated.
>"Risks? The risks of a colonoscopy are crazy low though."
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-...
The risk of serious complications like major bleeding or perforation is closer to 40-80 per 10,000, significantly higher than the roughly 3-5 per 10,000 annual chance of actually having colorectal cancer for low-risk groups.
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.
The real risk is getting a doctor that is more interested in money than medical care. These seem to be more like 3000-5000 per 10000.
> The risk of serious complications like major bleeding or perforation is closer to 40-80 per 10,000
What's your reference for this? That's incredibly (read, unbelievable) high for a routine procedure.
not who you asked but the perforation is 3-5 per 10,000; cardiovascular issues is 52 per 10,000, polyp removal carries risks of bleeding or perforation, and underlying patient physiology.
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
You are hardly describing "serious complications" ('bleeding', and 'respiratory events' are very non specific, and the fact that this is an uncited meta-analysis across nations makes the whole enterprise suspect), even less so since your source averages 24 countries while we are speaking about US colonoscopy recommendations.
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
they give citations which i was going through and literally copied and pasted the CITE to you, not the AI.
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
> they give citations which i was going through
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
>>"Risks? The risks of a colonoscopy are crazy low though."
> 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.
This is funny. I've had an unbelievable string of bad doctors / clinics... almost as though something is wrong with medical care around here.
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%.
What an interesting and obvious approach, wish I'd thought of it. Tell me more about your inquiry for the answers the doctor avoided.
What is your point?
2 to 3 colonoscopies per ~1k to 2k people cause severe rupture of the intestines that require urgent surgery.
Kinda annoying that the minimum age is 45 and its explicitly not for high risk individuals though. Like you would think having a non-invasive test would be incredibly important for that.
> The worst part, by far, was the emptying / prepping.
This. The procedure itself was a snap (I was completely sedated; I'm in Canada), but it was NOT a fun 2 days of "pooping" pure liquid and being hungry. I don't think I was away from the toilet for more than 20 minutes at a time.
Having had three colonoscopies so far, my system for prep is to change what I eat at least the week before. Jello, ice pops. . . generally light stuff. At some point before I start drinking the beverage from hell, I get butt cream. Smear it on and then drink. Keeping a layer of diaper rash ointment on the tush helps a LOT.
I suggested to the pharmacists at my local pharmacy they should recommend butt cream when someone buys the prep stuff. Not sure if they do it, but all agreed it was a good idea.
+1 on low fiber diet 5-7 days before.
And although I didn’t try the diaper rash cream, Balneol was definitely a life saver.
Why can't you just fast the day before and then get an enema on the day ?
Yeh if you want to improve the screening rate then someone needs to figure out how to make the prep easier.
There are slow-acting laxatives that you have to drink a lot of and tastes wile but is soft on the intestines, and then there is quick-acting laxative that is easier to get down. The former tends to be prescribed by default, obviously.
If you have no prior intestinal diseases and are in for a routine check, ask for the quick-acting one. You will have to drink the same total amount of liquid, but at least most of it will not be drinks of your choosing.
Also get anal cream, and apply it once before going to the toilet.
> The worst part, by far, was the emptying / prepping.
Protip to those who have it coming up: Ask for the pill prep instead of the "sludge" prep. You end up spending the day on the toilet either way, but at least it doesn't taste as bad with the pills.
It depends, if you want the best possible colonoscopy quality, do the liquid/"sludge" prep, the general consensus is it cleans you out the best and gives the best possible view during the procedure. However that's only true if you actually do it properly and drink all the liquid.
A decent number of patients can't/don't get through all the liquid in which case the pills are far better.
I’m doing it this year. Does the pill work as effectively as the drink?
> Oral sodium sulfate in a single dose has been found to cause increased gastrointestinal (GI) events
> Sodium phosphate is no longer recommended as a bowel preparation regimen due to its serious side effects
Essentially, put in the effort and do the liquid bowel prep.
Consider adding flavour drops to your drink, icing it or turn it into a slushie to make it slightly more interesting to drink. The PEG will make the ice crystals slightly more smoother.
https://www.ncbi.nlm.nih.gov/books/NBK535368/
Essentially, put in the effort and do the liquid bowel prep.
It's not just about effort. I must do the liquid prep due to my Crohn's disease. And while I am able to get the liquid down (as you note, it helps to make it as cold as possible; also, suck on an ice cube before drinking to numb the taste buds), I can't keep it down. Within an hour it has me evacuating from both ends.
For my last test, I barely slept at all the night before on account of the vomiting, and even once I got to the hospital I was lying on the wonderfully cold tile of the floor between rolling over to vomit in a trash can.
They know it affects me badly, but still assess that it's necessary due to my risk factors. And because I'm losing much of the drug due to the vomiting, the prep is poor, so I have to start fasting a day early to ensure that I get sufficiently cleaned out. It's torture all around.
What helps for me was using cool/chilled water, and a swimmer's nose clip to help reduce the smell of the ingredients. If you are adding flavor drops - go with lemon and not anything blue or red in color.
One other piece of advice - stay off the internet afterwards until you're sure the anesthesia has worn off. My doctor related that a previous patient had gone on the Carvana website and bought a car while still under the effects. Oops.
> Sodium phosphate is no longer recommended as a bowel preparation regimen due to its serious side effects
Well in my country, it's still wildly used for people without renal issues.
These are best practices guidelines that are ultimately implemented (or rejected) by surgeons who still go by feel, whether following the latest-and-greatest or by what they are used to.
Some doctors will say yes, some no. Best bet is to do what your doctor suggests, but at least ask if the pills are an option.
I can’t compare the two, but fwiw, in my experience, while the drink is mildly unpleasant it’s only the texture of the drink itself that’s bad and the fact that you have to drink quite a bit of it. It doesn’t taste bad per se (and you can add flavored drink mix to help) and the “purging” part is painless, ie no cramps or anything.
I didn't actually mind the prepping too much personally. Just to be safe I started early to go on the long end of what they suggested with the diet and basically just ate baked, unseasoned chicken for 10 days. Then did the bowel prep; a lot of people hate the drink, but idk. I thought it was fine. Maybe better to assume it will suck though, that way you at least can't be disappointed.
> In the end they nothing was found, not even polyps.
Same here, thank god.
> a lot of people hate the drink, but idk. I thought it was fine.
Aren’t there a lot of different drinks, though (at least 3 or 4)?
E.g. I know Miralax can be an option for some which practically is tasteless.
I see. So I escaped the experience of the nasty drink, then. I thought it was just "the standard" because it was also word for word what I saw when I googled it at the time. (Gatorade + Miralax.)
I overshot their requirements as well. I wanted them to have a clear view.
These days, in the USA, they're starting to give you an over-the-counter laxative rather than that nasty drink.
I just had my hole inspected and all the preparation was with over-the-counter supplies. My prep drink was gatorade with some flavorless powder mixed in. It made no change in the taste or texture of this drink. Having the squirts for a day was no fun, but other than that it was a breeze.
Same here. I didn't find the drink especially nasty. I drank it very cold, it had a somewhat chemical taste but very fluid, not disgusting texture. I do remember it was a lot of liquid to drink though. As for the bathroom part, no pain or discomfort whatsoever. It took a couple of hours total if I remember correctly.
No, the worst part is the risk of puncture. Rare, but it happens. Happened to a colleague of mine.
It is likely that your friend could have a genetic disposition for colon cancer. He should get a gene test once he has recovered.
I was the same age. My doctor saw signs in an early blood test, and followed it up so mine got detected relatively early. My test was positive for Lynch syndrome, and I am now a colonoscopy veteran.
I did one two years ago without sedation, I wanted to work afterwards. I didn't feel any pain, so sedation is really not necessary
I woke in the middle of my first one due to inadequate sedation and it felt like someone was pushing their fist into my stomach too hard and/or having cramps. Tolerable but unpleasant. I elected for propofol on my second and was happier (though both midazolam/fentanyl and propofol basically make you kinda useless for the rest of the day).
my guess is that they take more care when they know you are not sedated. I know a guy whose intestines have been perforated during a colonoscopy if he wouldn't have been sedated he would have felt the perforation right away
I ended up paying 15000 usd due tó complications.. that was the worst part for me
Which country are you in? Did you have insurance? What kind of complications? Have you recovered completely?
I’ve also done it, without finding polyps or anything. Obviously it’s normal to run through the entire Bristol Stool Chart in one sitting.
I had a colonoscopy without any sedatives and I agree, the prepping was worse. Not eating for 24 hours was easy, drinking the solution the night before was unpleasant, and drinking the solution the day of was awful.
My pro tip would be to take the day off work. Trying to work while drinking the solution in the morning didn't really work.
Can also confirm that the worst part was the prepping. You have to dring 2 liters of liquid that give you diarrea... The second liter is the worst, since the body learns that it's "poison" and triggers all the reflexes to make you not swallow it.
If you have red flag symptoms you should get checked out. This type of cancer is often not caught until stage 3-4, at which point even if you do survive you may end up with a colostomy bag or other serious issues. You're also looking at tons of grueling chemo. It's often caught late because people ignore minor symptoms, assuming them to be something like hemorrhoids or digestive issues or self-misdiagnosing as having Celiac's disease.
If you catch it at precancerous or stage 1, it can often be removed with minimal side effects.
Sounds like for you the red flag symptoms were something else, but others shouldn't treat it this way.
How old are you? I’m 37 and my doc says you get one at 45
Okay, so another pro-tip for prep. I can promise it's not bad at all if you're already very regular.
So what you do is, schedule it for weeks or months out as you can and use that to develop good eating and fiber habits over that time. You have a deadline and real stakes in the game. You will literally hurt more unless you get that straight before then.
Win-win.
> The worst part, by far, was the emptying / prepping.
As described in one of the great modern tales of legend:
https://singletrackworld.com/2009/02/the-picolax-thread-retu...
Seeing young adults around me going through this made me change my dietary habits 1 year ago. I went to the extreme by modern food industry standards, but now:
- I take 100g proteins, 30g fibers daily
- Red meat once a week but never fried
- Most of the protein comes from eggs, yoggurt, chicken and various plant based sources
- No white bread
- No added sugars, no deserts except fruits
- Nothing fried
- No added salt
- No canned food
- Saturated fats kept at minimum.
- No spicy food
- No alcohol
The results are incredible. I lost 8 kg, my blood samples are perfect, my pulse dropped with 10, I sleep better, no migraines (I had those for years). Also this year I was the only one in the family that didn't got any cold, and that's quite hard with two kids going to kindergarten.
It's hard in the first two weeks, but afterwards it's becoming your daily routine. I also use an app to track various stats. The gameification of the diet also helped me a little.
I urge you to try this. To make it more manageable start small. For example avoid fast food for 2 weeks. Don't put any mayonnaise in your food for 1month. Stop eating white bread. And then add more and more restrictions. The hardest fight is the urge to eat sugar and drink alcohol, give it time.
Glad you’re feeling better, but you could have just stopped at increase fiber intake and decrease red meat and alcohol consumption. None of the rest is linked to colorectal cancer, certainly not mayonaise, which is just oil and egg.
I've explained why I don't have mayonnaise. Also it was just an example. I avoid it because I can eat more meaningful stuff without bombing my calories and saturated fats stats. The mayonnaise I find in the shops has terrible composition.
There are brands of "mayo" and other products that contain some emulsifying agents that have been observed to deteriorate the mucus membrane in the colon, and that effect is believed to increase the risk of colon cancer.
I haven't heard about any risk with the natural emulsifier in egg yolk though.
"Other products" is quite a long list, though there's more a link between a high intake of refined sugars that promote particular bacteria that can damage the lining. Still often the same products to avoid or minimise.
We've been on the whole food path for a few years now, and while there's a bit of extra time in prepping all the ingredients from scratch and you have to turn over fresh vegetables often (therefore more frequent visits to the market) you at least know what you're eating.
homemade mayo is one of the easiest things to make if you have a hand blender and wayyyyyy tastier, addictingly so actually
you need some real, strong dijon mustard though, like the kind trader joe's sells for ~$3
in a tall glass or container:
1 raw egg
1 soup spoon dijon
1 soup spoon apple cider vinegar
salt/pepper
a bunch of vegetable oil (about 1.5 cups? eyeball - watch some youtube videos)
blend
don't overblend once it seizes or it can de-emulsify
Kenji's stick blender mayo recipe is also really good and really easy.
These are really good changes for your overall health, but what I hear anecdotally is that a lot of the young adults diagnosed with colon cancer don't have traditional colon cancer diet/lifestyle risk factors. There's even a theory that healthy activities like long distance running might be contributing to cancer risk.
Curious, why no canned goods? I recently added smoked canned oysters to my diet due to high zinc, protein and heme iron. I struggle to assume iron because green leaf veggies (which I like) irritate my stomach, so I often end up in the washroom. With the oysters I am finally getting iron.
But of course I don't want to mess up. I roughly eat like you do
Many of them are loaded with preservatives and salt but it shouldn’t be a problem if it’s just sardines in olive oil or whatever.
What about the can lining?
I think the hard part for me about doing something like that is not forgoing those things, it's figuring out what to eat instead. Any tips?
In the morning I have boiled eggs, or yoggurt with cereals that don't have sugar, I also add various type of seeds and maybe I have a fruit or two.
At lunch I usually have chicken breast or fish and some carbs (usually rice, or baked potatoes, rarely some simpla pasta). Salads, carrots, tomatoes, cucumbers, cooked vegetables, home made soups.
Then I have smaller meals with more fruits, or yoggurt with less fat. Or soups.
The simple answer is plants. Lots of fruits and vegetables, and pulses (beans, legumes, etc) for protein.
You have to consume a ridiculous amount of beans to get 100g of protein. That’s something like 7-8 cans of chickpeas per day.
Then don't get 100g of protein. Most people don't need anywhere near that much.
Why no spice? And why no salt assuming you balance properly with potassium and limit intake overall?
If I track the salt, a lot of the salt I need comes already from various types of yoggurts (like ayran, or light cheeses and meat), if you actually track it and scan the barcodes of what you eat, you will find out there's already enough to add more.
I was eating spicy food and it irritated my intestines. I have enough fibers to never get constipated.
How do you make sure you’re getting enough iodine?
Fish and dairy.
I’ve done the same. Lately the increased fiber is making me think I have colorectal cancer with all the abdominal bloating LOL. Hope it settles soon! Been like a month
I've increased the fiber intake from close to nothing to 30g gradually. After a few months into the game the bloating doesn't appear anymore. Also some probiotics can work in the beginning, but usually the best ones are more expensive and the science behind them is disputed.
Why no canned foods? Sodium concerns?
Cans also have linings made of material that can contribute to ingesting microplastics and other uncertainties
Yes. Too much sodium, or oil. Or other nasty substances.
Plenty of canned things that don’t have added sodium or oil though.
In my part of the world this is the norm.
Here too. If I were to pick a can up on the shelf it would likely have 800-1200mg of sodium. But if I look for low sodium beans it has like 100mg.
What’s the no spicy food about. Capsaicin has a lot of benefits especially as an anti inflammatory and (less researched) anti oxidant. Plus, it makes a lot of bland food incredibly palatable. There are almost no downsides.
Nice! Now you see what Gen Z sees in the practically poison stuff we call modern food. The obesogenic system of laws, the corporations, culture, the ads, the home delivery
How do you get enough calories while avoiding fats? What do you usually eat in a day?
I don't avoid fats, just saturated fats.
Kefir, eggs, chicken breast, potatoes, beans, rice, oats, fruits, vegetables, a little olive oil, low fat cheese and raw seeds (pumpkin) or raw nuts.
To be honest making the calories today is easier than not making your calories. Go to any supermaket you have caloric bombs everywhere and in everything.
> No added salt
Is life even worth living anymore?
https://i.redd.it/lbsy5h46bql21.jpg
Mayonnaise is just oil, egg, and some vinegar, salt, and mustard. All of those things you have in your new diet so you lost me on why you wouldn’t eat it.
As someone mentioned a lot of the store bought ones have emulsifiers that might be contributing to the colon cancer rates.
The one you find in shops has terrible stats. If you make it at home I guess it's manageable, still it can really bomb your fats stats for the day.
Sure but you should be counting your saturated fats if you’re counting your fiber and protein intake as well as everything else. I make my own mayonnaise.
Ok. Maybe it wasn't the best example, but my reason I avoid things like mayonnaise is because they add lots of fats and calories without making me feel full. Most of the commercial mayonnaise, in my part of the world, doesn't have a lot of proteins (even if in theory the eggs should be there), and have lots of saturated fats. So I prefer to fill the calories counter with more meaningful choices. For example I very much prefer having 20g of nuts instead of adding mayonnaise.
All in all. That was an example to make a point. I also don't eat butter.
I agree anything in grocery store labeled as mayonnaise, peanut butter, olive oil, etc should be vetted for the exact things you describe in your posts.
Had my first colonoscopy at 46. Found cancer, stage 2b. Resection and chemo. I was completely asymptomatic. I put a post on FB and I now know about a dozen people who that prompted to get their colonoscopy done. Get it done, the prep isn't bad, get the pills if you can, otherwise make sure you get a Zofran along with the prep. If found early, it's easy to treat. Get It Done.
> Yes, if you are currently young, you face higher CRC risk than previous generations did when they were young. That’s the bad news.
Unlike the usual Bettridge's law, the answer to the headline is only a qualified "No".
It is a "So is all other cancers!", which is pretty bad news for folks who are young and healthy right now.
One thing I can't figure out from the content or the graphs (where I can read the legends with my 1975 eyes) is whether this adjusts for overall mortality rate, which is to say, is any of this effect due to the fact people are more and more likely to wear seat belts, not die of (now-)preventable diseases, etc.?
EDIT: having thought that over a third time, I am not sure it makes any sense.
I think the standard calculation is per person-year, not per person. So a 22-year-old dying of a car crash shouldn't skew the statistics, because they only contribute 2 people-years to the 20-24 age group.
That being said, I can see a few plausible biases (though none of them explain the scale of the increase IMO):
1. CRC risk is correlated with some previously fatal, but now curable disease. The mechanism would be that your high-risk CRC patients would die due to yellow fever or something in 1970, meaning they don't have the chance to get CRC. The important thing is that it would have to "artificially" remove high-risk patients from the age group, but not low risk patients.
2. CRC risk is noticeably higher at 24 than it is at 20, and all-other-cause mortality is significantly lower today. That would lead to a higher proportion of 24-year-old "years" in the calculation.
3. People used to die of CRC before it was caught, which caused it to not be recorded as a cancer incidence.
1 seems unlikely, and even if true shouldn't make a big difference. 2 seems the most possible, but still unlikely to make a huge difference. I don't know enough about how they determine cause of death to know if 3 is a possible outcome.
No, not all cancers - a handful of cherry picked cancers.
The overall age-adjusted cancer rate has been going down, and the death rate even more so.
https://seer.cancer.gov/statfacts/html/all.html
Fun fact: "Betteridge's law" does not reflect reality.
https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headline...
Thanks for the PFAS old codgers.
People should be reminded that colonoscopy is not just a screening, it is also preventative. They often find growths that may develop into cancer, and remove them during the procedure.
Does insurance see it this way? I've had a couple precancerous moles (melanoma in situ) removed, which seems similar, and my health insurance provider billed me more than I was expecting because they didn't categorize it as preventive care.
I did a colonoscopy at 38, because I saw something in the toilet that looked like the lingonberries at Ikea. Everyone was like "Man that seems early" but when I woke up, the doctor expressed some surprise when he told me they removed a couple of polyps.
A week or two later, I got a bill for several thousand dollars, and I just had to roll with it. I believe that in the US, there is a certain age, after which, they're covered.
> I believe that in the US, there is a certain age, after which, they're covered.
There is a lot of confusion over this point, even among support agents for health insurance companies.
i) The Affordable Care Act specifies that all Marketplace health plans must cover colorectal cancer screening for adults 45 to 75 years at zero cost [i]. That means no copay and no coinsurance, even if you haven't met your deductible. You pay $0.
ii) That generally means that colonoscopies will be zero-cost for anyone in that age bracket, but only if it is a "screening". If you have symptoms, the service may be billed as diagnostic rather than preventative, which takes it out of the "zero cost" category
iii) All of the above is separate from whether the procedure is "covered" or not, because "covered" in the context of health insurance means "your plan covers this, subject to your normal deductible, copay and coinsurance, so long as it is medically necessary". If something is truly "not covered" then your insurance pays $0 and the provider will bill you the full, undiscounted cost of the procedure.
In other words, there is a difference between "your plan covers this (as it does for any other regular medical care)" and "your plan covers this at zero cost, as it falls into one of the narrowly defined 'preventative care' buckets as defined by the ACA"
It's common for people to confuse these things.
In your case, it sounds like the procedure was not covered at zero cost (as expected, as you are not in the 45-75 age bracket defined by the ACA, and in any case your procedure was diagnostic, not preventative), but it was "covered" by your health insurance in that you paid your regular deductible and copay, rather than the insurance company saying "your plan does not cover this procedure (at all)" and then the hospital billing you the full cost of the procedure, which would be tens of thousands of dollars.
[i] https://www.healthcare.gov/preventive-care-adults/
> i) The Affordable Care Act specifies that all Marketplace health plans must cover colorectal cancer screening for adults 45 to 75 years at zero cost [i]. That means no copay and no coinsurance, even if you haven't met your deductible. You pay $0.
At least with my ACA insurance plan, you have to appeal it first because they pretend like it's actually diagnostic even though it was billed as screening.
It's fraud prevention! You see, people love to shit in a bucket multiple times a year to have their shit tested all to defraud insurance companies.
Reading this should make everyone in the US furious about the state of our health system
I achieved what I understand to be maximum furiosity on this subject years ago.
I mean it does. That's why so many people cheered when Brian Thompson was... involved in a shooting and died.
Not ideal but better a couple thousand bucks than cancer... but seriously, especially if they actually found something worrying like polyps, the insurance shouldn't even get a say.
I think so, even with shitty U.S. providers. I've never had a problem.
Most US insurance has very strict guidelines about what is diagnostic vs preventative for a colonoscopy. And its almost certianly diagnostic.
diagnostic does not mean "not covered", it just means it moves out of the "zero cost even if you haven't met your deductible yet" categroy defined by the ACA, and into the regular category where you pay your deductible, copays and coinsurance
In situ should be medically necessary and thus should be widely covered. That's surprising.
I have UC and will get colonoscopies to confirm it is well-controlled for the foreseeable future. It also increases risk of colorectal cancer, something I am actively thinking about. Rates of UC, IBD, and similar digestive issues are up across the board, also for a mixed and seemingly inscrutable set of reasons.
IMO, the fundamental issue for preventative screening is there is basically no amount of money I would not part with (of my money, the insurer's money, or private debt) to not die. I expect this is true for most people, and it makes preventative screening a tricky topic. In recommending screening for those >x age, you will miss some detectable, preventable and treatable cancer risk for those <x age, purely for cost. No one wants to be explicit about that though!
I think the only way out of that uncomfortable conversation is making screening so cheap via automation that you can basically run it for very low incremental cost as often as individual risk tolerance permits. This would be paid for on the back of earlier interventions vs late-stage, expensive interventions.
A colonoscopy is more than screening, if they see a polyp they remove it. Left alone that polyp will very likely eventually become cancer. Routine colonoscopies for someone with IBD is multi purpose, you screen for active disease, fistula, strictures, cancer, while simulatenously treating active disease (polyp removal)
Similar things happen in any general surgery, for example you can get your tubes removed and send up with all your endometriosis that you weren't able to diagnosis removed as well
> Left alone that polyp will very likely eventually become cancer
I don't think so. You have a reference?
You can't tell whether a polyp is cancerous or not before you have removed it, sent it to the lab and got the results back.
Therefore, all polyps should be removed. (Sending them all to the lab might be superfluous though)
Yes. That is the recommendation because "some" polyps are or may become cancerous. Not because all do. Unless you are saying that they do?
https://pmc.ncbi.nlm.nih.gov/articles/PMC9924026/
Though I regurgitate this information based off conversations with gastroenterologists not one off studies.
You claimed that "polyp will very likely eventually become cancer". I don't think this is true, in general, for polyps even though some might become cancerous. The paper you provided is pretty dense, but it didn't see to me as though it is saying that polyps generally become cancerous.
It's an internet forum, I didn't claim anything. And your doctor isn't going to first biopsy just a little bit of a polyp to determine if it's the "bad" kind, he's going to remove all of it.
It's annoying pedantry, a distinction without a difference.
Oh FFS. The difference between polyps very likely becoming cancer and some polyps maybe becoming cancer is not pedantry. And it probably wouldn't be as annoying to you if you just said that you didn't know instead of attempting to dig deeper by providing a source that you either didn't read or didn't understand.
Nice to have a good data-based take on this question make it to the front of HN!
One of our better microscopes these days is DNA sequencing, especially for cancer, and the particular base mutations and the sequences in which they occur give heavy clues about the types of mutagens that are going on. The DNA damage from UV radiation from the sun and bulky adduct repair from smoking damage are vastly different. Even when cells have a defect in a repair mechanism, you can tell which repair mechanism is broken based on the particular base changes in which context.
A study from 2025 reapplied these Alexandronv signatures to colorectal cancer with a global set of cohorts, and suggests that colibactin, a mutagen produced by some strains of E. coli and related bacteria, could be driving some of the increase in early age colorectal cancer:
https://www.nature.com/articles/s41586-025-09025-8
Of course we don't know exactly how much of the increase, or the other explanations; causality is multi-causal and I bring this particular cause up because it's one of the stronger leads so far. But when we've lost our keys in the night, even if its easiest to look under the light of the streetlamp, that doesn't mean its the only place we might find them.
> We don’t yet know if colonoscopies are better than other methods of screening
My Gastroentrologist told me just recently that the stool test (Cologuard) is very accurate but must be repeated every 3 years as opposed to getting a Colonoscopy which should be repeated every 7 to 10 years
What is better? If the stool test can find something that isn't in the colon but isn't as good for things that are in the colon which is better?
The important part is both are good, so get one.
What is better? My colonoscopy came with a dose of propofol that made me understand why Michael Jackson went out the way he did. Best sleep I've ever had.
I hope that is forever the only difference. However if you actually have a deadly form of cancer (not all are worth treating, but that is a different discussion) better is whichever one gets you the correct treatment sooner. By contrast if you don't have cancer is whichever doesn't have side effects.
My doctor makes me do one every year
I had bleeding for a over a year and every time there was a good explanation. After all the news about cancer I pushed for a colonoscopy at 41.
36 polyps were found. Some of elevated risk. So now I get yearly screening. But by the sounds of the type of polyps I had, if I had waited until the screening age I would have had high chances of cancer.
Also increased, or we're now aware of, higher rates in long distance runners.
I'd love to know the causation for that correlation
There was some discussion about this on HN recently. Supposedly something to do with less blood going to the bowels during prolonged exercise. Apparently the risk was largest in people who ran 5+ marathons.
No one knows for sure. One hypothesis is chronic inflammation, perhaps linked to diet or mechanical stress.
My understanding is that exercise lowers chronic inflammation. Basically, you trade off acute inflammation during the exercise itself for less inflammation when you're not exercising. But, maybe long distance running is too long or something.
Perhaps higher sugar consumption from fueling techniques?
I've often wondered if colorectal cancer is really on the rise in young people, or are we testing more younger people, which makes it seem like it's on the rise? Hopefully my question makes sense...
That's covered in the article. Deaths are also rising, which suggests it's not just more testing.
No, this isn’t true, and the article makes the same fundamental mistake.
While certainly deaths are a more reliable indicator than diagnoses, you always expect to see an increase in “deaths from X” when you more aggressively screen for X. The intervention of cancer treatment comes with serious risks, and screening sometimes finds cancers that would otherwise never be a problem.
We’re talking about very subtle differences in population-level trends, so these kinds of errors matter.
Bad diet is on the rise.
Some people have turned vegetarian, vegan or gluten-free for health reasons, but substituted foods for other foods with additives that may come with their own health risks.
Methyl cellulose is in gluten-free bread and in most fake meat products.
Some emulsifiers are found in mayo, other sauces and "ice cream". Not just vegan brands, but overall.
Ethic is the leading reason for the vegan lifestyle [0]. It's also well known [1] that a plant-based diet is effective with colorectal cancer (+9%):
> The random-effects model demonstrated a significant inverse association between plant-based dietary patterns and CRC risk (hazard ratio [HR], 0.91 [95% CI, 0.85–0.97])
But as you guessed it varies between healthy and un-heatly diets:
> This protective association was strengthened when the definition of plant based patterns specifically emphasized the inclusion of healthy plant foods
However those un-healty foods are not restricted to plant-based meal (evidence: any supermarket shelf or snack restaurant), and lentils, tofu or seeds are as much -or more- likely to be found in a long term vegan dish than an impossible burger. As you noted it's "Not just vegan brands, but overall". For the mayo I recommend tahini instead (way more tasty) or just olive oil but if you really need it:
0 https://www.statista.com/statistics/1264382/top-motivations-...1 https://www.sciencedirect.com/science/article/pii/S1091255X2...
Bad food is also on the rise
> “Hey! CRC is going up! You should get screened!”
Try asking a doctor for asymptomatic screening (for anything), they usually say "There's a schedule for such screenings at age X, you're too young for that. There's also proven negative effects of excessive screenings."
Which kinda makes sense, as they supposed to have protocols/schedules for all kinds of healthcare. We're talking here about changing that protocols/schedules. But doctors (and insurances) are generally reluctant.
So my actionable question is "How do I convince my doctor to get the screening?"
Just say you saw blood in your stool. You can also google some of the symptoms and say you have some of the more ambiguous ones.
Yeah, blood in the stool should get it ordered.
This.
In my 40s I asked my doc what I should get screened for and when. He said to wait until 50. Now I wait here on death row with stage 4 colorectal cancer.
> In my 40s I asked my doc what I should get screened for and when. He said to wait until 50.
What did you want your doctor to say, instead?
what do you think? what do you think he's going to say when he has stage 4 cancer?
I just don't understand why the doctor would say anything different than what the national screening guidelines suggest?
I think he's arguing that guidelines are dumb/outdated
I think the guidelines are fine - we can't stop everyone's disease and that's not what the purpose of these screening tests are.
that's because you don't have stage 4 cancer
> that's because you don't have stage 4 cancer
Several friends broke their arms falling off of swings as children. This maybe means that children should no longer be allowed to have access to swings?
> So my actionable question is "How do I convince my doctor to get the screening?"
I guess we have to pay for it ourselves. It's not exactly cheap, but perhaps worth it.
I recommend getting a colonoscopy if you have any symptoms. There is a lot of stigma that prevents people from being proactive about this type of issue.
My anecdote (M, 35) is that I got one after experiencing symptoms that turned out to be unrelated, but they did find pre-cancerous polyps so now I will be getting them more regularly. I received received meaningful early detection and peace of mind. Also aside from the prep, its a very convenient procedure. You get put under anesthesia and do a quick time travel.
> if you have any symptoms
What kinds of symptoms are people actually seeing? Or, without graphic details of your bowel habits, is this a "you'd know it when you see it" type of situation, where it would probably be obvious?
WebMD just says: change in bowel habits, blood in stool (would this be obvious?), anemia (how would you notice this?), unusual gas (uh, what is normal?), unexplained weight loss, fatigue, vomiting?
Unexplained weight loss and vomiting seem obvious, but the rest I'm not sure I'd even notice.
Blood in stool has a strong effect on the odor, so you'd probably notice it. If your stool smells dramatically worse (or at least different) than usual, in a maybe metallic way, that's how you know.
And "unusual" usually means unusual for you. So if you don't change your diet or habits, but suddenly get a ton of gas, fatigue, need to go to the bathroom way more often or have a different experience going to the bathroom, it's worth mentioning to do your doctor.
Blood in my case, and it would probably be obvious. In general though I think a lot of these questions are answerable by paying attention to the changes in your body, how you're feeling, researching, and raising thoughts/concerns/etc with your primary cary provider when that comes up short. No need to go searching for issues if there isn't some leading indicator that sticks out to you as something to be curious about, or there isn't some related family medical history.
All this talk about different groupings (and overlapping kinds of time) makes me think of Simpson's Paradox [0], where how we slice things can be very important to what trend we see.
[0] https://en.wikipedia.org/wiki/Simpson%27s_paradox
TLDR from the post itself.
No:
Colorectal cancer is going up in young people.
Yes:
Various kinds of cancer are going up in later generations. (Definitely at younger ages, possibly at all ages.)
Reminder
This blog endorses colorectal cancer screening. We don’t yet know if colonoscopies are better than other methods of screening (sigmoidoscopy, stool tests), but we do know that screening is better than not screening. When caught early, CRC is highly treatable, often with only surgery (no chemotherapy or radiation) and a return to normal activities within a couple weeks.
This hit home. My dad was diagnosed with colon cancer last week and had a large portion of his colon removed last Thursday. Polyps, which often become cancerous given time, can take a few years to get there. So you don't have to get screened every year but should definitely get the ball rolling. They'll usually be able to take them out during the procedure.
The guidlines are where i live (Austria) First Colo at 45, if nothing found -> Every 5 years. Once a poly is found and removed get one every 2-3 years.
This is an excellent article. The author does a great job taking all this data to reach the conclusion.
What I’m wondering about is…why?
As in…why is cancer rising among the later generations? Smoking has substantially fallen and this has led to a sharp decrease in lung cancer rates. So why are cancer rates overall increasing for those born in the later generations?
How does one determine an increase in somthing earlier in life from having better early detection mechanisms?
Presubably if you detect eveything earlier, every one of the detected cases would be younger if all else were equal.
PROTEIN POWDER AND BIOHACKING
"None of the experts seem to agree on which of these is the culprit, so I figured that I (person with blog) should help."
In case you aren't aware of dynomight yet, there is a great backlog of posts to read.
His other blog about colonoscopies is even better (linked in the post). Id read them again on other topics.
Personally I am hesitant to do colonoscopy after a relative had a botched procedure. Just this month two celebrities revealed botched colonoscopies. I hope they figure out ways to make this procedure safer.
https://www.yahoo.com/entertainment/celebrity/articles/kathy...
https://www.usatoday.com/story/entertainment/celebrities/202...
Those articles don't really say what the "botch" is. Was it the anesthesia? The actual endoscopic examination? Removal of polyps?
If its the polyp removal, I can certainly see how that could lead to problems. But you're a little stuck: even if you use another technique to do the scan, you still have to remove any polyps you find, don't you?
yes I've had both a colonoscopy and a sigmoidoscopy (less invasive colonoscopy).
I'm not sure what the botches are here. In the sigmoidoscopy they took out a couple of polyps, in the colonoscopy (more recently than the sigmoidoscopy) they just did a cancer check-up given family history.
I wish those articles discusses the "botches", I'd like to know since from my understanding these are pretty safe procedures
Maybe just don’t worry yourself with anecdata.
A good friend's dad got a routine colonoscopy and they accidentally punctured his intestines. This was during the first COVID outbreak in the US, and the wait time for getting it fixed was so long that he had to walk around for months with a colonoscopy bag, as an old man that spends all day on his feet working. It was not a good experience.
I did mine without anesthesia/sedatives. There were moments of discomfort when they pump gas to expand the area - feels like a big fart is stuck in your gut - but otherwise no big deal, especially knowing that the pain is not dangerous. Recommend. It eliminates recovery time afterwards (you can drive yourself home) and increases safety.
Might try that this time. OTOH, I get the greatest nap of my life shaking off the sedative (get the lighter, cheaper option like Versed instead of anesthesiologist-administered propofol) and my spouse makes me a milkshake.
As someone with colon cancer, I'd rather the complications than what I'm going through. 8" of colon removed, 6 weeks of recovery then 7 months of chemo treatments. If I could go back in time and get my colonoscopy at 35 instead of 46 and get only do a night in the hospital, I would in a heartbeat. Colon resection and chemo suuuuuuuuuuuuck.
My mother had it. I saw this kind of thing with her. I hope you get through this.
Healthy skepticism of procedure over-prescription is reasonable and maybe even wise, but I wouldn't really take the celebrities section of USA Today as a data point, maybe not even as a reliable anecdote.
Based on your concern, the question is whether 'botched' procedures are more or less of a risk (both in incidence and consequence) than non-screening.
I had to start getting colonoscopies ahead of schedule because my dad never did, until it was too late. He was scared of doctors after he associated them with family members' unpleasant deaths.
Read the safety statistics and let it override the anecdotes. Colon cancer is easy to prevent and a horrible way to die.
It is one of the most common procedures and is generally very safe. Even a botched procedure probably just means some temp discomfort after the procedure. Much better than the alternative.
My doctor actually doesn't recommend colonoscopy until age 50. But starting at age 40 they have you do the "poop in a box" test instead, and then only have you come in if that shows anything.
The complication rate for colonoscopy is about 3 in 1000, and that is skewed towards people who have polyps, which in and of themselves could be dangerous if not removed.
So it's always a risk tradeoff. You can skip the procedure and risk the effects of the disease it's supposed to detect instead. But if you do the math, you're statistically better off doing the procedure.
You can do a FIT test instead which can be done at home.
Nothing you do is risk free.
Functional equivalent to “YOLO”.
Avoid risk where you can afford.
Where it costs you nothing.
A lot of posts urging people to get colonoscopies. But general anesthesia also carries risks. How should one weigh the risk vs benefit?
A few now opt for twilight sedation - you'll not remember a thing though you're not fully knocked out, which I understand helps mitigate the risks.
I've had multiple surgeries under general anaesthesia. Twilight sedation was pretty much the same experience (at least for me): eyes slowly get heavy, then all of a sudden 'it's too damn bright in here, someone turn the damn lights off!.... Oh, that was quick...'
In Japan it's normal to have it without general.
you can have a colonoscopy without general anesthesia
I think it is, I think it is also linked to diet. Learn to cook, avoid processed food, eat out less.
Really you have no idea...
FYI there are other options besides a full scope for screening now, especially if you are low risk
what is rate per 100.000 tracking? I guess it means among living persons at every datapoint. If so decreasing mortality overall and final diagnosis specifically plays a large role in the numbers
Get it done!
But not at Kaiser.
$17k later…
Why did Kaiser’s insurance not pay out here?
It did, but my contribution for procedure + pathology was still over $5k. My out of pocket max is ~$8k.
Oh, OK. But you didn’t pay 17K yourself? (I’m also on Kaiser, but never had any major procedure done.)
Free tip: take not too little, not too much... of
(1) Vitamin-D (drops)
(2) Magnesium (as Magnesium aspartate hydrochloride trihydrate)
(3) Psyllium shells (you won't take too much)
(4) Move your body!
I’ve been getting scared of psyllium due to lead risk. Any thoughts?
It's the "sodium benzoate + ascorbic acid = benzene" problem. Watermelon + Dr. Pepper = cancer.
Is "medical term" used "appropriately"?
Yes. Nothing to see here. And stop abusing quotation marks.
Very good visualization repair. I particularly appreciate the TL;DR at the end. In a world of mostly bad popular medical advice this seems competent and at least facially correct.
Am I the only one who is confused by the author’s conclusion? He’s saying it is/is not true?
Maybe they're all running too many marathons.
"maybe"
I defer to Betteridge so that saves me from wasting time reading the article.
Can someone who's read it confirm?
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The same vaccines that can't be tested against a control group for ethical reasons.
Kind of pointless to inject a bunch of corpses anyway.
^ was a dumb joke about what a control group might be, not me being anti-vax.
Excess deaths occured in the vaccinated rather than the unvaccinated.
N =20 million using single payer data:
https://pmc.ncbi.nlm.nih.gov/articles/PMC12095670/
I guess cancer is the new climate denial
Did you miss the BILLIONS in lawsuits against RoundUp and other herbicides?
Did you miss all the deregulation by the first and now second Trump administration allowing crazy levels of pollution and toxicity among all the industries?
They are still using leaded fuel in prop aircraft at hundreds of airports around the country and world, spraying it on unknowning population
Our environment has never been more dangerous yet people never more ignorant or carefree
Less MTTF and more MTTR
There are many things causing cancer unfortunately and I think these are just two of them.
One can always count on Trump being brought up in any discussion. Trump is definitely not the Second Coming as his proponents believe, but the previous admin is not the Saint Incarnate either, on this particular subject.
Biden's EPA filing:
The agency says it is standing by its conclusions that, as registered, glyphosate doesn't pose major risks to human health..."
Any US admin always serves the Big Business, and people's health is just a bump on the road.
Why are the "critical terms" in "that headline" in quotes?
Then some clown downvotes this straightforward question. Brilliant.
Probably because one of the main explorations of the articles is quantifying "young people."
If the headline merely had quotes around "young," that would make sense.
Human biology is such a horror...I've been through it with enough loved ones that I've been left with two obsessions: a) a dignified way to go when my time comes, and b) we should either fix human biology, go post-biological, or simply surrender as a species and be replaced by AI. I know there are many counter-arguments to the above, but I've come to suspect the integrity of our species' rationality under the savage ravaging of Dog.
I’m not sure if this comment is AI generated but I’d like to make a point either way.
Human biology is orders of magnitude more efficient than AI; that’s in regards to intelligence and processing the world around us.
It is not only more efficient but more complex but yet simple. Therefore, the complexity of our biology is a result of efficiency. An efficiency that allows us to process the world and achieve homeostasis in the most simple way. I’d like to see a machine achieve the same without having any type of vulnerability or weakness to corruption.
Nonsense. Human biology is incredible. 80 years average life span for a mammal is amazing to the point that it should be impossible.
The real problem is that as lifespans get longer, silent chronic diseases progress over the span of decades without anyone noticing.
I mean look at human teeth. Horses have extra long teeth that emerge slowly out of the jaw over time as they get worn down. Their teeth are absolutely massive and yet their average dental lifespan is 20 years, up to 25 years if they are lucky and have been fed low abrasive food. Same with cows, after 20 years they have worn their teeth down and are called gummers.
Meanwhile humans who brush their teeth with fluoride and hydroxyapatite, and use interdental brushes of the correct size for each tooth gap, can basically keep their teeth all the way into their 80s. Mammals with a similar life span as humans such as elephants have gone through several sets of teeth after 70 years.
Humans are built for longevity. If we died at 30, nobody would give a crap about any type of cancer.