We @statnews published this story on the first randomized trial evaluating #colonoscopy #screening for colorectal #cancer. tl;dr - results disappointed docs, but many nuances to consider.🧵continues on nuances, impt details, and health news you can use 1/8 statnews.com/2022/10/09/in-…
At first glance, intent to screen colonoscopy did not reduce colon cancer deaths in this trial. It did reduce cancer incidence by 18% which is great. Biggest caveat is that only 42% of the ppl in the screening group actually got a colonoscopy 2/8
When you compare just the people who got colonoscopy to those who didn't get it, colonoscopy looks like it has a 50% reduction in cancer mortality and 30% reduction in incidence. That was a secondary analysis called the per protocol analysis 3/8
But as a coworker said, things r supposed to work in the ITT or intention to treat analysis. What does this mean? Prob that in a real-world scenario where not everyone will actually do colonoscopy, the population effect is that colonoscopy helps! just not as much as we want 4/8
Other screens, like fecal testing, can have much higher adherence - which is key. In a world where ppl are not forced to screening, adherence is a variable in efficacy. So maybe the more popular test ends up being the more effective one - like the easier, at-home fecal tests 5/8
Another caveat - we do a lot more colonoscopy in the US than Europe as well, and our population is much more primed to do the screen than in many European countries. So maybe the same trial would have played out differently here. 6/8
Here's an interesting note that didn't make it into the article - the trial found in Poland, ppl who actually went for colonoscopy seemed, for some reason, to be higher risk for colon cancer than those who chose not to do screening. That may have affected results further 7/8
Lastly - as oncs like to say, the best test is the one that was done. So get whatever tests make the most sense for you and your lifestyle. Also, if colonoscopy, docs say ask about the polyp or adenoma detection rate. You want someone with ideally over 30% higher is better 8/8
oh yeah - if you have an abnormal fecal test, follow up with colonoscopy. and if you have abnormal colonoscopy, get it again in 5-7 years.
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