Colonoscopies

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Although the Canadian team did not call for a change in the recommended screening interval, the researchers did say that the "findings suggest that screening colonoscopies do not need to be performed at intervals shorter than 10 years." THE SECOND STUDY The second study, conducted at Virginia Mason Medical Center in Seattle, looked at colonoscopies that were performed on 1,244 people in three age groups—50 to 54; 75 to 79; and 80 and older. The big issue is identifying those people in whom the benefit of colonoscopy outweighs the risk. Robert A.

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Other studies have shown that peppermint oil relieved spasms during colonoscopies and has a soothing effect in patients who suffer from irritable bowel syndrome. RESPIRATORY RELIEF: Researchers discovered a nerve ending that responded to cold and to menthol. This may explain the cooling sensation from menthol, as well as its common use as an inhalant to reduce congestion in the nose. Tips on Using Mint SELECTION AND STORAGE: • Leaves should be tender and not wilted. Older leaves tend to be bitter and "woody" tasting.

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Based upon rates in three other reference studies where patients underwent colonoscopy with discovery of polyps but who did not elect to undergo polyp removal, researchers anticipated they would find between 20 and 48 polyps, among the 3,000 colonoscopies performed, compared to the five actually detected. Researchers estimate the reduction in colon cancer risk from repeat follow-up colonoscopy ranges from 76 to 90%.

So, among at least 3,000 colonoscopies performed on 1,134 patients, five (5) non-symptomatic, early-stage colorectal cancers (malignant polyps) were detected by colonoscopy (three at three years, one at six years, and one at seven years). This means even among patients who are believed to be at higher risk (already had a polyp removed), only 4/10th of one-percent, or in less than 1 in 200, was a subsequent malignant polyp found.

Polyps are detected and removed during colonoscopies, but recur in the same location. Patients are prescribed aspirin or COX-2 inhibitor anti-inflammatory drugs after polyp removal, but the COX-2 inhibitors raise the risk for fatal heart attacks and aspirin may cause bleeding ulcers. Survival rates do not include figures for patients who succumbed to other causes, even if they were induced by treatment. As ineffective as treatment is for colon cancer, the practice of modern medicine is driven by insurance billing codes.

The population that is most likely to develop colon cancer is the least likely to benefit from screening colonoscopies. Colorectal Cancer Survival Rates The most encouraging statistics for survival are the most often published - that 90% of colon cancer is curable with early detection. The doctors' definition of a cure is survival for five years. However, cure rates are almost totally dependent upon the stage of development on the day of discovery, rather than treatment. Treatment appears to only offer a slight increase in survival, usually a few months.

Researchers claim "it would be unfortunate if patients were falsely reassured by taking calcium and neglected their surveillance colonoscopies." [American Journal Gastroenterology 100: 395-96, 2005] But this falsely assumes that adenoma reduction will prevent cancer and that early treatment will prolong life. There is no evidence for either. Furthermore, a 4-year diet modification trail failed to reduce adenoma (polyp) recurrence. [New England Journal Medicine 342: 1149-55, 2000] A fiber diet also failed to reduce adenoma recurrence.

In one study, 1,235 colonoscopies were examined and yielded a total of 1,933 small or diminutive cancerous polyps. Cancer was found on the biopsy tissue slides by the pathologists in 10.1% of the small adenomas (5-10 mm in size) and 1.7% of diminutive adenomas (less than 4 mm). [Clinical Gastroenterology Hepatology 4:343-8, 2006] Just what percentage of the polyps/adenomas that are surgically removed annually are non-cancerous is unreported. It appears to be 99%. Findings from the National Polyp Study, however, suggest that periodic colonoscopy could prevent 76% to 90% of colon cancers.

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Most people need only two doses "Current screening guidelines recommend colonoscopies beginning at age 50—earlier if you have inflammatory bowel disease or a family history of colon cancer. Check with your doctor. —approximately 3 ounces. Halflytely and other preparations require drinking approximately a half-gallon of foulish-tasting liquid. Phospho-soda tastes like liquid salt. To make it more tolerable... • Chew ice or very minty gum, such as Dentyne Ice, to numb your mouth. •Mix the solution with a teaspoon of vanilla extract and a glass of ice-cold ginger ale or other clear beverage.

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Among Medicare recipients, colonoscopies went up 40 percent; angioplasties, 34 percent; and cardiovascular stress tests, 45 percent. As physicians (and hospitals) figured out ways to regain lost income, the savings that had been wrung out of the system by managed care in the early nineties evaporated. By 1999, a vast majority of people who were insured by their employers were enrolled in managed care plans, the so-called solution to America's health care crisis, yet health care costs were once again rising at double-digit rates.

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THE FIRST STUDY The first study, conducted by researchers at the University of Manitoba in Winnipeg, Canada, looked at data on nearly 35,000 Canadians whose colonoscopies found no polyps. During the next 10 years, the incidence of colon cancer in these individuals was 72% lower than in the general population, the researchers report. In addition, the decreased risk of colon cancer continued for more than 10 years.

THE SECOND STUDY The second study, conducted at Virginia Mason Medical Center in Seattle, looked at colonoscopies that were performed on 1,244 people in three age groups—50 to 54; 75 to 79; and 80 and older. The big issue is identifying those people in whom the benefit of colonoscopy outweighs the risk. Robert A. Smith, PhD The incidence of colon cancer was much higher in the oldest participants—14% for the 80-and-older group—compared with 3.2% for the 50-to-54-year-old group.

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When it comes to hospital and drug costs, on the other hand, the culprit is higher prices. The average cost per day in a U.S. hospital is $1,666, four times the average in the rest of the developed world. However, while all of these factors—wasteful bureaucratic overhead, malpractice, moral hazard, and high prices—contribute to the high cost of American medicine, throughout the political debate over our health care mess, the most important piece of the puzzle has been consistently overlooked. There's one more factor that contributes to our medical bills, and that's unnecessary care.

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The news media—especially television—churn out daily stories urging their viewers and readers to undergo assorted tests, from colonoscopies to full-body scans, without ever mentioning the cost in dollars or the real savings in lives across the entire population. But the driving force behind these and all other factors is one that politicians refuse to recognize: Washington's blind obsession with market-based health care, the notion that competition is always good and can never have a bad result. To be sure, the market approach is unbeatable in most segments of the economy.

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If bleeding is found in the colon, the physician can pass a laser, heater probe, or electrical probe or inject special medicines through the scope to stop the bleeding. Most colonoscopies are performed on an outpatient basis with minimal inconvenience and discomfort. Bleeding and puncture of the colon are possible complications of colonoscopy. However, such complications are uncommon. Barium Enema The use of the double contrast barium enema has declined in recent years in favor of colonoscopy, despite the lower cost of the barium enema.

Critical Condition: How Health Care in America Became Big Business Donald L. Barlett and James B. Steele See book keywords and concepts

Similar studies could be carried out for a range of other diseases and conditions: Are colonoscopies cost-effective? What about the Pap smear? The PSA test? The bone-density test? Genetic screening? Or could much of the money for these and other tests be more productively spent to prevent disease and add healthy years to the lifespan of the population at large? As for prescription drugs, no other segment of health care better illustrates why profit-based medicine and cost containment are mutually exclusive. Drug companies flourish by selling more pills, never fewer.

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More good news is that colon cancer is easy to detect in its early stages with regular screening tests, such as sigmoidoscopies and colonoscopies and now a new noninvasive test called a virtual colonoscopy (a type of CT scan), and is susceptible to protective measures such as those we list in the table on page 42. Fiber has long held a good reputation as a colon protector. However, two recent interventional studies called into question the long-held belief that fiber protects against colon cancer.

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