Ep. 11 - Should you have regular colonoscopies?
If you were offered a colonoscopy free of charge, would you do it? Would you believe most people said no? More importantly, should you have regular colonoscopies? Find out what the latest research recommends on today’s edition of Straight Talk on Health with Dr. Chet Zelasko
Narr: Straight Talk on Health with Dr. Chet Zelasko was recorded in the studios of WGVU Public Radio in Grand Rapids, Michigan. The views and opinions expressed on straight talk on health are not necessarily those of WGVU, its underwriters, or Grand Valley State University. Episodes are found at wgvunews.org and wherever you get your podcast, please rate and subscribe.
Welcome to Straight Talk on Health, I’m your host Dr. Chet Zelasko. Together with WGVU in Grand Rapids, Michigan. I examined the latest and greatest in the world of health. Whether it's research that makes headlines, another miracle diet, a new supplement, or an exercise trend. I look at the science behind them and then let you know whether it's real or not. You can check out other things that I do on my website, doctor Chet Dot com and please sign up for my free e-mail.
If I were to take a poll, I would wager that most people would skip a colonoscopy if there were an alternative that provided the same information on the health of your colon. I mean, realistically, who really thinks about the health of your colon? Maybe when you got an upset tummy? Maybe when you have diarrhea? That's about it. But notice the words that I used. Same information, not only that, but also provided the same diagnostic outcomes. Will a test tell you whether you have colorectal cancer or not? Will it give information on the health of your colon like diverticulitis or something else? A recent research paper called that into question.
So what we're going to do is take a look at the study that was published in the New England Journal of Medicine in the fall of 2022. Here is how it went down- Researchers from several European countries. Those countries happened to be Poland, Norway, Sweden and the Netherlands, they wanted to examine the difference in outcomes between 2 groups. The first were a group who were invited to have a colonoscopy. Can you imagine getting that invitation in the mail? We welcome you to a free colonoscopy.
The second was a group that received usual care. So what that means is for those that had normal yearly physicals, it was time to schedule colonoscopy. Well, the people have the option to do it or not do it. So that was what they meant by regular care. They recruited over 28,000 people between the ages of 55 and 64 years of age for the invited colonoscopy and compared those people with over 56,000 people, same age group, who received usual care. Here's the biggest outcome. After following subjects for 10 years. And you have to do that with cancer research because there may be people who already have it that you might catch for those that are doing colonoscopies you might miss, it may not show up till years later. So they'll eliminate some of the years. That's why it takes at least 10 years. Sometimes 15 years when you're looking at cancer research.
So what they found is that the risk of colo-rectal cancer diagnosis after 10 years was 0.98% in the invited group versus 1.2% in the typical treatment group. Now was it statistically different? Yes. Was there a lot of difference? Because both round to one percent between the two? Probably not especially. But it still looked good for having regular colonoscopies. But that's not what caused the controversy in the health headlines, because the controversy is what they said next. And what could that possibly be? Remember, the comparative rates of diagnosing colo-rectal cancer were slightly lower in the invited group. The controversy came when they stated that there was no difference in mortality over the course of 10 years. And that suggested that it doesn't matter whether you’re specifically asked to have a colonoscopy or you get one as part of your usual care, your risk of dying from colo-rectal cancer, which happens to be the second leading cause of cancer death in the United States, is no different. If you listen long enough, you'll know that nothing is quite as simple as it appears to be.
But before I get into that, let me say again, there is a difference in diagnosing compared to mortality. And when it comes to what we might consider preventive tests like a colonoscopy, white blood work that you might get to check PSA levels, for men to look at their protein-specific antigen levels. Those are considered preventive tests. But in the case of a colonoscopy it's not a simple blood test, it's fairly expensive to have that done. And so could there be something else that might be better? Well, we'll get into that. But here's something that amazed me: invitations doesn't mean that you will accept. This stunned me when I got into the numbers that are in the study, only 42% of the people that were invited to get the colonoscopy actually did it. This is where going back to the negative results, or what you might expect to be negative results, is important. It's not who got what, it's why didn't they do it to begin with? What was their reasoning? I mean, was it social issues? Was it they just felt it was yucky? I mean, we need to know that. Not having that information so important, but I can't believe that 42% of the people accepted over half did not. So we need to look at what data they didn't collect, which I can't believe they didn't, in order to get something meaningful.
Well, let me give you a little personal experience here. And here's why I think colonoscopy are a good idea. Now I can understand why people don't want to colonoscopy. Paula was visiting her gastroenterologist for an appointment. And I happen be very close to the phone there talking the patient after patient after patient and what she was doing was describing what medications they would have to take before the colonoscopy when they would have to take them when they could and could not eat and what they could and could not eat. Then she went through a list of the cautions. Are you allergic blood thinners? Do you any issues with anesthesia? Will you have someone with you and drive you home and on and on. Now, in reality only took about 5 minutes, a person, but I can understand how getting all that information might be intimidating for some people. And they may just decide to call the whole thing off. But remember, well, ignorance, may be bless, ignoring the fundamentals of preventive health care are not, in fact, they can be downright dangerous. But it doesn't mean I don't understand what you have to go through because I've done it myself a couple of times, including a couple months ago, something had been bugging me after my latest blood test. I wanted to know why I was close to being considered anemic. I didn't feel bad and I didn’t have a lack or anything else we might consider anemic.
First thing that they have to do is try to figure out where you might be bleeding from and where do they start the G I track. So I had a double dose. I had an endoscopy and a colonoscopy at the same time, consecutively, of course, with different equipment. From the colonoscopy they found that I did have three abnormals which will not cancerous may lead to cancer if not removed. The next part was super important. My voice is my money maker to a large degree. I noticed that my voice was hoarse more often than I would like. So what they found in the endoscopy that's looking around inside your stomach is that I have a common condition called Barrett’s esophagitis.
And that is caused by acid reflux. Now used to be a person could eat anything any place any time in mass quantities. But I'm not that age anymore. And the hoarseness of my voice caused by acid reflux that I didn't know I had was impacting my life. And so the solution is reduced the fatty food, don't eat so much in use a proton pump inhibitor. And what most people don't know is that that's not a medication. You have to take all the time. But that's a topic for another day. So where does that leave us? What other preventive test?
The only other thing that we have is something that's called fecal occult blood test. And you've probably done this at a preliminary time before where you take and take some of your a feces, put it on a little thing and then you mail it in for to be analyzed. What they're looking for there is blood that you don't notice in your stool, but it's the occult part of it. But that's important if you're bleeding, by the way, they didn't find anything in my colonoscopy that was bleeding. So the blood in the stool commutes symptom of several conditions, including anemia and colo-rectal cancer.
But here's the thing. What that test can't do is identify people who have [unknown], that precancerous growths that are not bleeding the fecal occult blood test can’t detect them. You know, the other thing that they can do is they can provide genetic material so that if necessary, it can look at your familial risk of whether you have a tendency towards getting colo-rectal cancer. But here's where we stand. Look, I understand the preparation for colonoscopies can be unpleasant and it may be too much for people that are very elderly. We didn't do it for my mother-in-law and it might be that colon cancer is what killed her but the procedure might as well. So the thing is that you have to do what you have to do. Is this research important? Absolutely. Because we know things that we didn't know before.
We also have more questions to ask what the test is to help find out what your past should be. Once you know what followed? Because the last time I checked death is permanent. That's all the time we have for the show until next time. Till next time this is Dr. Chet Zelasko. Health is a choice, choose wisely today and every day.