Lowering screening age for colonoscopy would be a huge mistake

For years, I’ve been warning you about the hidden dangers of colonoscopies — from the exposure to contaminated testing instruments, to the risk of perforations of the colon.

Still, some gastroenterologists just aren’t busy enough, apparently. They want you to get your first colonoscopy at age 45 ¾ five years earlier than current guidelines recommend.

But that’s terrible advice.

As I always report, colonoscopy may be the single-most expensive, dangerous and deadly of all the medicalized procedures promoted in the name of “disease prevention.” And to top it off, there’s little evidence that colonoscopies save more lives than far less-expensive, safer screening approaches for colon cancer, as I’ll explain in a moment.

But then again, when has lack of evidence stopped a group of crony capitalist, quasi-medical organizations with an agenda?

Gastroenterologists want to shatter 50-year-old barrier

Up until this point, the main reason why a doctor would recommend a colonoscopy to someone younger than 50 would be if the patient had a strong family history of colon cancer.

But Dr. David Karsenti recently made his case for lowering the threshold to 45 years for everyone, including those with “average risk,” to a group of gastroenterologists in Europe. (Of course, nobody is a “low risk” in their book, according to these calculations.) He presented findings from his new study as justification.

For this new study, Dr. Karsenti and his team analyzed colonoscopy data on 6,027 men and women whose average age was 57 years. They found small benign polyps in 34 percent of the participants and benign adenoma growths in 32 percent. They found large polyps (1 cm or larger), which are considered more dangerous, in 8 percent of participants, and cancer in 3.6 percent.

In looking at these findings by age, rates of detection in people younger than 30 were very low, and remained low until they reached 45 years of age. Researchers observed a significant increase in “findings” around this age.

Mind you, these were not findings of cancer.

In fact, over 96 percent were non-cancerous findings and most likely would never lead to cancer itself.

Still, Dr. Karsenti, said screening starting at age 45, “will help us to increase the early detection of colorectal cancer in young adults and also enable the identification and safe removal of polyps that may become cancerous at a later date.”

So, screening earlier will find smaller, non-cancerous polyps at a younger age.

Notice how there was no mention that earlier screenings would help to lower mortality rates for colon cancer…

Why didn’t he say that? I can only guess because he knows it won’t.

Screening earlier with colonoscopy certainly will, however, expose more patients to more unnecessary risks and certainly more hassles.

Plus, even if we would decide to screen for colon cancer earlier, what about the safe, inexpensive, alternatives to colonoscopy?

Always consider alternatives to colonoscopy first

 If these practitioners simply did a little research, they’d discover a number of alternative screening procedures, which are just as effective or even more so than colonoscopies for screening for colon cancer. Unfortunately, you aren’t likely to hear about these alternatives from your own physician anytime soon. So here they are:

  1. Flexible sigmoidoscopyhas been shown to be much safer and less expensive than colonoscopies. In fact, a recent report cites studies showing that flexible sigmoidoscopy screening benefits can extend 16 years or longer.

Like a colonoscopy, flexible sigmoidoscopy involves insertion of a tube with a camera. But unlike a colonoscopy, it doesn’t require anesthesia and only takes about 20 minutes. And it’s so effective that in Europe, doctors use sigmoidoscopy for colon cancer screening almost exclusively — instead of colonoscopies.

Granted, sigmoidoscopy doesn’t reach the upper colon, but we recently found out that colonoscopies aren’t so effective in the upper colon either. (I covered this in my August 2016 newsletter. To access my archives, simply go to the Subscribers section of DrMicozzi.com and log in using your username and password.)

2) The long-established hemoccult test detects blood in the stool. When there is bleeding in the lower intestinal tract it can be seen as bright red blood in the stool. But when the bleeding is higher up, the blood breaks down and becomes invisible, or “occult.”

Research shows that fecal occult blood testing (FOBT) can decrease the risk of death from colorectal cancer by 33 percent. Not bad for a cheap, completely safe, noninvasive test that you can administer yourself in the privacy of your own bathroom. (These are available online via sites such as www.ezdetect.com or www.quidel.com. They can even be found on Amazon.com for approximately $25 – $35.)

3) In the August 2015 issue of Insiders’ Cures, I wrote about CT colonography. It’s a simple, 15-minute CT scan that allows a radiologist to see anything that remotely resembles cancer, both in and around your colon.

In general, CT colonography is done every five years, but radiologists have worked out several more specific guidelines for individual cases — including instances of positive fecal occult blood tests and the frequent problem of an “incomplete colonoscopy.”

4) In 2014, the FDA approved the use of an easy, ingestible camera pill for colon cancer screening. Unfortunately, the FDA approved it only for secondary use (after a colonoscopy) — instead of a safer, easier substitute for any type of colonoscopy. This may be the only example in modern medical history in which mainstream doctors don’t want their patients to simply swallow a pill!

The camera is about the size of a dietary supplement capsule. You simply swallow the pill, and it takes multiple photos over an eight-hour period as it passes through your GI tract.

It takes pictures of different parts of the intestines, including the colon. In fact, the camera pill can see and take clear images of 25 feet of the duodenum and small intestine. By contrast, endoscopes (the type of device used to perform colonoscopies) can only show the doctor about two to three feet of the upper intestines.

The camera pill can also identify polyps, cancers and even any sources of GI bleeding. It can also find inflammation and conditions such as inflammatory bowel disease (Crohn’s disease), celiac disease, diverticulitis, and ulcers.

5) DNA stool testing is beginning to gain wider acceptance as a colon cancer screening alternative, particularly with the FDA approval (and Medicare coverage) of one specific testing kit, called Cologuard®, in September 2014.

The idea and procedure itself are simple. You send a stool sample to the lab, and the Cologuard test detects any blood in your stool. The presence of blood could indicate the presence of a tumor. Plus, Cologuard can detect mutated DNA, which could signal cancer or a precancerous polyp.

If the test is positive for cancer, then you may have another procedure, such as a colonoscopy or sigmoidoscopy, to remove the growth or polyp.

So, the next time a doctor suggests you have a colonoscopy, I recommend you ask about these five alternatives and whether they’re appropriate for you.

Share what you’ve learned

 We spread the word about the many safe and effective colon cancer screening alternatives. And we should join the rest of the world in embracing safer, less-expensive, routine procedures.

So, last year, I launched the Safe Colon Cancer Screenings Initiative with the goals of urging the U.S. Congress and the FDA to increase public awareness of the safe, effective alternatives to colonoscopies.

The first step of the initiative was a petition that we intend to send to the U.S. House of Representatives Committee on Oversight and Government Reform. We plan to send the signed petition to Congress in the New Year.

For now, just remember you have many safe, effective options to colonoscopy to explore in the New Year.



“Start Colon Cancer Screening at Age 45, Evidence Suggests,” Medscape, (www.medscape.com) 10/31/2017