The ultimate goal of cancer research is to prevent the disease the way vaccination has eradicated polio and smallpox. In the absence of a definitive strategy, medical science’s best efforts have been applied to finding or screening for the disease early enough so that it is curable in virtually all of those in whom the disease is found. There have been unquestioned successes. The pap smear is the best example, as it permits the early detection and cure for cervical cancer. Recently there has been a trend looking at these screening tests to evaluate their benefit. Many guidelines no longer recommend getting a PSA test for prostate cancer and all guidelines have reduced emphasis on getting the test regularly.
The problems with these screens: while they did find more disease, there was little evidence that it changed the number of deaths. Although I appreciate the science and recognize the need to scrutinize the cost and value of all medical interventions, I remain steadfast in my support of early detection with the best-proven means available. My logic is simple. Cancer evolves from a precancerous state to an aggressive life threatening cancer. Catch the disease when it is precancerous and you prevent the cancer.
With this trend of screening tests being put under scrutiny, it was only a matter of time until perhaps the most dreaded screening test of all, the colonoscopy, was looked at. This week, the results of a study examining the effect of colonoscopies 23 years in the making were released. It was performed at institutions around the world and it followed patients who had precancerous lesions removed on colonoscopy for an average of 15.8 years and compared it to the expected number of deaths from colon cancer based on epidemiological data. The results were impressive; there was a 52% reduction in deaths that were expected from colon cancer. While an imperfect study, it is seen as very well done and very strong support for test that is started on your 50th birthday.
With such a powerful tool to combat a dangerous disease, it is amazing how common colon cancer is to this day. Colon cancer is still the second most deadly cancer but far too few people are up to date on their colonoscopy. The huge effect of this study assumes that 100% of people get their colonoscopies done and this is not the case. While many screening tests have been scrutinized and shown to have limited use, it seems that colonoscopy is a good test that deserves doing. While uncomfortable and inconvenient, it certainly is better than colon cancer. Think about it – is a minor inconvenience once every decade worth another decade of life?
You be the judge.
Dr. Bruce Feinberg