Plus, how you can help put an end to the dangerous and costly colonoscopy scam
For years, I have been warning you about the hidden dangers of colonoscopies — everything from contaminated testing instruments to perforations of the colon.
And to top it off, there’s little evidence that colonoscopies are any better at saving lives from colon cancer than far less-expensive, safer screening approaches.
When it comes to wide-reaching, critical issues like this, the voice of many is stronger than the voice of one. Which is why I recently launched a new citizen campaign called the Safe Colon Cancer Screenings Initiative. I’ll tell you more about how you can participate in a moment.
But first, I want to share some recent information about colonoscopies that shocked even me.
Mainstream medicine finally admits there’s a major problem with colonoscopies
After nearly a half-century as the dominant approach to colon cancer screening in the U.S., colonoscopies are finally being critically analyzed by the medical gastrointestinal establishment.
The American Journal of Gastroenterology recently published an unprecedented 34-page report, “Quality Indicators for Colonoscopy,” from the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology.1
This report provides a huge amount of data to digest, so to speak, but there is one startling conclusion I want to highlight. Something so surprising, it was news even to me.
The report states that colonoscopy is less effective at preventing colon cancer and cancer deaths due to cancers of the upper colon.
This is truly astonishing when you consider that the U.S. medical establishment’s cornerstone justification for colonoscopies has always been that they are the “only” procedure that allows doctors to examine both the upper and lower colons.
But now, thanks to this report, we know that doesn’t really matter as much. Colonoscopies don’t work well in the upper colon. (And we already know they may often not be any more effective than other screening procedures in the lower colon.)
And that’s not the only bad news the report had about colonoscopies.
Americans are getting way too many colonoscopies
The report also analyzed when and how often “routine” colonoscopies should be performed in order to optimize effectiveness, reduce costs, and minimize risks. And I bet it’s no surprise to you — or anyone else who has been paying attention — that Americans get substantially more colonoscopies than they should.
For people with an average risk of colon cancer (meaning they’re over age 50 and have no more than one close relative who was diagnosed with colon cancer after age 60), the standard recommendation in the U.S. is one colonoscopy every 10 years.
However, the report cited German studies that showed a single colonoscopy can have protective effects for 20 years or more. This makes sense because it takes an intestinal polyp about 15 years to become cancerous (if, in fact, it ever develops into cancer at all).
So, to recap, that data shows that if you do have a colonoscopy, you most likely won’t need another one for at least 20 years. But here’s the kicker: Surveys indicate that Americans frequently have colonoscopies even more often than every 10 years.
The report cited Medicare billings that demonstrate systematic overuse of colonoscopy for screening and surveillance by some physicians. Particularly surgeons, who are more likely to recommend shorter screening intervals compared to GI specialists.
In fact, the report concludes that GI specialists are more effective than primary care physicians or surgeons at finding colon cancer using colonoscopy. Of course, practice makes perfect, and GI specialists have had plenty of practice with this procedure over the years.
Considering this revelation, it’s no surprise that the report reveals important variations in the quality of colonoscopies performed. And that, of course, increases the risk of the deadly side effects associated with these invasive procedures.
Perforated intestines and other fatal side effects
I mentioned earlier that one of the hidden risks of colonoscopies is infections caused by contaminated testing instruments. And, of course, there are always risks associated with any procedure that involves general anesthesia.
But, to cite the popular phrase, “wait, there’s more!” The report notes that perforation of the intestine is considered the most serious adverse event either during or shortly after a colonoscopy. And about 5% of colonoscopic perforations are fatal.
The report points out that it’s not well understood how perforations happen. And even worse, steps that are designed to prevent perforations during colonoscopies have not been shown to be effective. Alarmingly, few studies on colonoscopic perforations have been published in the last five years.
Overall, perforations appear to occur in between one in 500 and one in 1,000 patients. Considering that the report said there were more than 3 million colonoscopies performed in the U.S. in 2010 (and no doubt that number has skyrocketed since then), that translates to thousands of perforations and hundreds of deaths each year.
All from a procedure that’s supposed to help save your life.
And if that weren’t enough, internal bleeding is another common side effect of colonoscopies, especially after removal of polyps.
Studies suggest that about 1% of people who have a colonoscopy have bleeding. In general, about 10% of bleeding caused by colonoscopic procedures requires abdominal surgery — and, of course, that carries its own risks.
Five better, safer options for colon cancer screening
So in light of all of the convincing data regarding the dangers and ineffectiveness of colonoscopies, why are so many doctors still recommending these procedures?
Well, maybe they haven’t taken the time or don’t have the interest in investigating alternative screening methods. Or maybe they’ve swallowed the establishment’s codswallop about colonoscopies being the “gold standard” of colon cancer screening tests.
If these practitioners simply did a little research, they’d discover a number of screening procedures that are as effective or even more effective 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 sigmoidoscopy has been shown to be much safer and less expensive than colonoscopies. In fact, the 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 just found out that colonoscopies aren’t so effective in the upper colon either.
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%. Not bad for a test that is cheap, completely safe, noninvasive, and that you can administer yourself in the privacy of your own bathroom.
3) In the August 2015 issue of Insiders’ Cures, I wrote about CT colonography, which is a simple, 15-minute CT scan that allows a radiologist to see anything that remotely looks like 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 to deal with 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. But unfortunately, the FDA only okayed this pill for secondary use — after an inadequate colonoscopy — instead of as 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.
The camera pill carries few risks. It doesn’t require sedation or anesthesia. And the prep is simple. For the small intestine scan, you only have to fast for 12 hours. (And you can conveniently start this fast after dinner the night before the procedure). For the colon (large intestine) scan, it does require a full 24-hour fast.
The camera pill can take 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 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.
How you can help put an end to the colonoscopy bias
Of course, colonoscopies are not all bad. The report listed 39 appropriate indications for colonoscopy, including GI bleeding of various kinds, abnormalities found after a barium enema, long-standing inflammatory bowel diseases, monitoring of significant family history of intestinal polyps and colon cancer, and removal of foreign bodies in the intestines.
These medical indications for colonoscopy apply to thousands of patients each year. But what pushed colonoscopy into an industry with millions of yearly procedures is the mistaken belief that it’s the only way to “routinely” screen for colon cancer in the entire U.S. population, including asymptomatic, average-risk patients.
Of course, you and I know better. And it’s time to make sure everyone else knows as well.
We need to do a lot more to ensure the safety and effectiveness, and control the costs, of colonoscopies and colon cancer screenings. And we should join the rest of the world in embracing safer, less-expensive, routine colon cancer screening procedures.
That’s why I launched the Safe Colon Cancer Screenings Initiative I told you about above. The goal of this initiative is to urge the U.S. Congress and the FDA to improve oversight, regulation, and patient safety for endoscopes, as well as to increase public awareness of the safe, effective alternatives to colonoscopies.
And the first step is a petition that we intend to send to the U.S. House of Representatives Committee on Oversight and Government Reform.
Please consider supporting this important initiative — and adding your name to the petition. You can read more about the initiative, and take a few seconds to sign the petition, by clicking here.
And please, share it with everyone you know. This is a serious issue that affects every citizen — and it is up to all of us to demand better, safer care.