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The article linked below is about breast cancer, not colon cancer,  but it is an interesting read with important insights into issues surrounding cancer prevention, screening, and treatment.


Our Feel-Good War on Breast Cancer






I used to believe that a mammogram saved my life. I even wrote that in the pages of this magazine. It was 1996, and I had just turned 35 when my doctor sent me for an initial screening — a relatively common practice at the time — that would serve as a base line when I began annual mammograms at 40. I had no family history of breast cancer, no particular risk factors for the disease.


So when the radiologist found an odd, bicycle-spoke-like pattern on the film — not even a lump — and sent me for a biopsy, I wasn’t worried. After all, who got breast cancer at 35? It turns out I did. Recalling the fear, confusion, anger and grief of that time is still painful. My only solace was that the system worked precisely as it should: the mammogram caught my tumor early, and I was treated with a lumpectomy and six weeks of radiation; I was going to survive.


By coincidence, just a week after my diagnosis, a panel convened by the National Institutes of Health made headlines when it declined to recommend universal screening for women in their 40s; evidence simply didn’t show it significantly decreased breast-cancer deaths in that age group. What’s more, because of their denser breast tissue, younger women were subject to disproportionate false positives — leading to unnecessary biopsies and worry — as well as false negatives, in which cancer was missed entirely.


Those conclusions hit me like a sucker punch. “I am the person whose life is officially not worth saving,” I wrote angrily. When the American Cancer Society as well as the newer Susan G. Komen foundation rejected the panel’s findings, saying mammography was still the best tool to decrease breast-cancer mortality, friends across the country called to congratulate me as if I’d scored a personal victory. I considered myself a loud-and-proud example of the benefits of early detection.


Sixteen years later, my thinking has changed. 
Edited by Sibiriak
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At this point the mortality rates do not appear to be lower for those receiving colonoscopy even though it clearly lowers colon cancer mortality. Could this link be one more peice to the puzzle as to why? It does, if nothing else, strongly suggest serious body disruption from the procedure

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Quoted from the article cited:


>Don't skip scope


>Despite the paper's significant findings, Basson urged patients not to draw the wrong conclusions: "To be clear, this is not to say that colonoscopy isn't safe or that people should be afraid to have the procedure. Colonoscopy is valuable and the appendicitis rate is still very, very low -- so low that we wouldn't even have been able to define this increased risk without this huge dataset


Wise advice, IMO.


Also, whenever contemplating any procedure, one should carefully track the reputation of the person performing the procedure -- something not discussed in the quoted artticle.


-- Saul

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  • 2 months later...

Chiming in here with personal experience. As I wrote in another thread, at the suggestion of my PCP, I underwent a colonoscopy. I did not opt for full anesthesia, instead went with partial/local. I found it a rather interesting experience.


The prep was absolutely vile, and I'm now on a desperate journey to recover the health of my gut biome. I'm gradually introducing various fibers and fermented foods, raw veg and fruit etc., in other words, doing a careful prebiotic intervention. I'm also taking in live yoghurt and home-made kefir as well as tablets with gut bacteria from Trade Joe's (of uncertain effectiveness). I'm also fantatically avoiding any food that might introduce deleterious bacteria, such as animal protein, sugar etc.. I will have to keep up this regimen for many weeks, until I can go back to my regular diet of massive fiber etc.


Here's what I wanted to add to this discussion. IT'S NOT ALL ABOUT COLORECTAL CANCER! Although no CRC was found, my gastroenterologist diagnosed me with diverticulosis. When I asked him to characterize it, he said it was just a SINGLE and SMALL diverticulae, and in his opinion nothing to worry about. Now, I don't know what to do about it exactly, as I'm already doing what I can to make BMs as easy as possible (and have for many years), but the point is rather different:


A colonoscopy might find OTHER conditions than CRC related - therefore even if you are not worried about CRC, you might want to get a "gut check" to identify conditions such as inflammation etc.

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Adding to my report - I have a blood relative who died of CRC, an uncle (my mother's older brother), who died very young (early 30's). In view of this, my gastro suggested that while every 10 years is indicated, I might think about every 5 years. So, even if you are a CRONie, genetics might - and frequently do - trump lifestyle. If you have very close blood relatives, sibling, parent etc., you might take that into account in making a risk/benefit decision wrt. colonoscopies. The other thing is that there are quite a few SNPs that have been identified that are associated with higher CRC risk - if you have access to your genome, you might want to check that out, and that too may factor into your risk/benefit calculus.


Like I mentioned, I was on partial anaestesia during the procedure, awake, but somewhat in la la land, I had a couple of uncomfortable moments, which I reported and they boosted the painkillers. However, my procedure was very long - 1 hour 20 minutes. Afterwards, my gastro suggested to me that next time I should go in for complete anesthesia, because as he reported, my colon is unusually long and large and it takes a long time to do a thorough exam, so it would be best for all concerned if I go under. I'm not sure how to feel about this, as I am afraid of negative consequences (dementia, mental impairment etc.).

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Tom I also have a very long colon and had Two colonoscopies and requested minimal sedation wherin I would be fully awake. The long colon means I have to fast for two days. The colonoscopy both times was nothing at all pain wise. Felt like gas pain so big deal. It only lasts 20 minutes. I dont get why doctors want you to have general anesthesia. Thats like a freaking concussion to your brain. Not good, not good at all. I had one at 50 and one at 60 and im 65 and no more of those things unless I see definitive evidence that they reduce OVERALL mortality.The only time in my life I had general anesthesia was last year 2/24/2017 for open heart surgery to replace aortic valve damaged by rheumatic fever at age 3. I can tell you it messes up your brain. My memory has not been the same since. I wont say a dramatic change but a negative for sure.

Edited by mikeccolella
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Yes, Mike, it's reports like this that scare the bejeezus out of me. I mean, to me, there is literally zero point to life extension if my brain is gone. What's the point? Living longer is pointless if you are in a coma, a vegetable or mentally incapacitated. Yeah, I think I'll keep insisting on local only... even that makes me uneasy. 

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I'll chime in here as well.   I had a colonoscopy some years ago.    The prep was sublime.  I fasted for three days (small amounts of diluted vegetable juice) and included enemas (as always.)   I had partial anesthesia and remember only  mild discomfort.  It all went very smoothly.  I don't recall having any gut biome problems at all.

Edited by Sibiriak
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  • 8 months later...

Regarding the issue of colorectal cancer prevention vs diagnosis discussed above, this  recent study posted  in "Al's papers' citations..." (October 30)  caught my attention:

Preventing colorectal cancer or early diagnosis: Which is best? A re-analysis of the U.S. Preventive Services Task Force Evidence Report.

Prev Med. 2018 Oct 24;118:104-112. doi: 10.1016/j.ypmed.2018.10.014. [Epub ahead of print]


Flexible sigmoidoscopy (FS) is the only cancer screening test to lower the risk of death compared to usual care in randomized controlled trials (RCTs). We hypothesize that this unique death reduction is more attributable to prevention of colorectal cancer (CRC) than to early diagnosis. The systematic review of the 2016 US Preventive Services Task Force Evidence Report for CRC Screening was used for selection of RCT studies. A random-effects meta-analysis of five FS trials (N = 458,002) and four fecal occult blood test (FOBT) trials (N = 328,767) was performed using intention-to-screen outcomes for death, CRC incidence, and death attributed to CRC; correlation and linear regression analyses explored the relationships between these outcomes. At 10.5-11.9 years of follow-up FS reduces death (relative risk [RR], 0.975; 95% CI, 0.958-0.992 and reduces CRC incidence (RR, 0.79; 95% CI, 0.74-0.84). Within the FS trials death reduction shows a strong linear correlation with CRC incidence reduction (r, 0.95; 95% CI 0.42-0.99). At 15.6-30.0 years of follow-up FOBT does not reduce death (RR, 1.001; 95% CI, 0.992-1.010) or CRC incidence (RR, 0.96; 95% CI, 0.89-1.02) but does reduce deaths attributed to CRC (RR, 0.84; 95% CI, 0.78-0.91).

Clinical trials of screening FS display a dose-response relationship between the magnitude of CRC prevention and the magnitude of death reduction. Prevention of CRC appears to be the major (or sole) mechanism of action for death reduction by FS in clinical trials. Conversely, early diagnosis of CRC does not appear to reduce death.


Edited by Sibiriak
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Hi Sibiriac!

The study suggests that FS is the best way to prevent premature death due to colon cancer -- something that I think was obvious.

And the study mentions that 

13 hours ago, Sibiriak said:

(FS) is the only cancer screening test to lower the risk of death compared to usual care in randomized controlled trials (RCTs)

That is independently interesting.

There have been many posts by members reluctant to have an FS -- I've seen posts where some suggested the possibility of death, or possibly damage, by the operation.  The quoted claim -- if true -- (I believe it) implies that those interested in a longer lifespan and healthspan, would be best off having an FS .

  --  Saul

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