A new study showed people are more likely to get screened for colon cancer when their doctor lets them choose the test. For this interesting study, researchers focused on two widely used screenings: the fecal occult blood testing (FOBT), which detects blood in stool, and colonoscopy.
Patients must get the FOBT screening every year. And they must get the colonoscopy every 10 years. (Of course, if the FOBT detects bleeding and two repeat tests again show bleeding over the following two months, then the patient must get a colonoscopy to determine the location and cause of the bleeding.)
For the study, the researchers randomly divided 1,000 patients into three groups. They assigned the FOBT to the first group. They assigned colonoscopy to the second group. And the third group was given a choice between the two tests.
Over three years, 42 percent of those given a choice had gone ahead with a screening test. But just 38 percent of those assigned to get colonoscopies actually went through with the procedure. And just 14 percent of the patients assigned to FOBT got the test done every year. The problem with the FOBT group was that patients got the test the first year, but there was a steep drop off thereafter.
Safety and convenience outweigh frequency
It’s a shame the researchers didn’t find better compliance with the FOBT test. It’s a safer, easier test with virtually zero complications. Colonoscopies, by comparison, have significant complication rates. But, of course, the study didn’t look at the complication rates of the two different tests.
It makes me wonder, given the results of this study and others, why not simply assign everyone to get a FOBT once per year, every year?
Then — only perform a more expensive, potentially dangerous colonoscopy if and when repeated FOBT tests show bleeding. Then they would never subject patients to the risks and costs of an unnecessary, potentially dangerous, even deadly procedure.
But that approach would require doctors make an educated choice — instead of leaving it up to patients — to choose the less expensive, safe screening test option for routine screening. Leave colonoscopies only for those who really need them.
Why any doctor would prescribe a colonoscopy instead of a FOBT to healthy patient is beyond me. Especially now that we know more about the contaminations risks.
Even proper cleaning is no guarantee with colonoscopy endoscopes
Last year, I reported on the problems hospitals face by using contaminated endoscopes such as duodenoscopes and colonoscopes. Even when the hospitals followed proper sterilization procedures, bacteria remained in the reusable scopes. Now it seems the problem of infection-spreading medical instruments extends to physician offices and outpatient clinics.
The CDC and the FDA recently issued a health advisory to all clinical facilities urging improvements in cleaning, disinfecting, and sterilizing reusable medical devices. They cited a rash of infections that forced healthcare institutions to test patients for pathogens such as hepatitis and HIV.
The FDA also ordered a recall of the endoscope-washing machines, due to the risk of infection. The washing machines used to clean the contaminated devices are themselves causing infections. The machines should kill bacteria and microbes found on flexible endoscopes after hospital procedures, but the FDA uncovered ongoing problems with them in April, and finally issued the recall in mid-November 2015.
Custom Ultrasonics — based in Pennsylvania — makes the washing machines reportedly used at more than 1,000 hospitals and clinics.
For several years, the CDC and FDA focused their concerns on hospital endoscopes linked to outbreaks of multi-drug resistant superbug infections across the country. But clearly, the current concerns go beyond hospitals to doctors’ offices and outpatient clinics.
It appears the key is to allow adequate time to carry out all the steps involved in adequate cleaning. Of course, third party insurers and payers constantly cut back on the time available to carry out such routine procedures. So taking adequate time is more and more of a challenge in today’s health care setting.
The risk of contamination isn’t the only problem with colonoscopies. As I often report, colonoscopies carry many other significant but under-recognized risks.
In the New Year, demand choices from your health care provider. Often you have safe, natural options that work better than the traditional, short-sighted, mainstream approaches.
1. “Adherence to Competing Strategies for Colorectal Cancer Screening Over 3 Years,” American Journal of Gastroenterology (www.nature.com) 11/3/2015
2. “Dirty Reusable instruments also plague outpatient settings, CDC warns,” Medscape (www.medscape.com) 9/11/2015