Several posters have criticized the title of the news article &quot;In gold-standard trial, colonoscopy fails to reduce rate of cancer deaths&quot;.<p>The actual study is titled &quot;Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death&quot; [1]<p>The authors conclude that &quot;In this randomized trial, the risk of colorectal cancer at 10 years was lower among participants who were invited to undergo screening colonoscopy than among those who were assigned to no screening. &quot;<p>I find it generally more useful link to the (abstract) of the original article, rather than second hand news reports. The abstracts are usually pretty accessible for a somewhat technical audience, they&#x27;re not written for domain experts only. As we see in the discussions here, it&#x27;s questionable whether the rephrasing from journalists really adds anything.<p>[1] <a href="https:&#x2F;&#x2F;www.nejm.org&#x2F;doi&#x2F;full&#x2F;10.1056&#x2F;NEJMoa2208375" rel="nofollow">https:&#x2F;&#x2F;www.nejm.org&#x2F;doi&#x2F;full&#x2F;10.1056&#x2F;NEJMoa2208375</a>

A lot of the comments here seem to come from the perspective that a colonoscopy is the only way to screen for colorectal cancer. There are also fecal sample tests such as FIT and FIT-DNA. Both involve home collection of fecal samples for testing. In the case of FIT yearly and FIT-DNA every 3 years. In the case of both if there is a positive result a colonoscopy is then performed. Outside the US annual FIT testing seems to be the standard of care versus a screening colonoscopy. A similar study with yearly FIT tests would be interesting to see. I suspect you might have a better compliance rate than the 42% seen in this study.

&gt; When the investigators compared just the 42% of participants in the invited group who actually showed up for a colonoscopy to the control group, they saw about a 30% reduction in colon cancer risk and a 50% reduction in colon cancer death.<p>I’m really confused by this data. First of all, are they testing the efficacy of colonoscopy or the efficacy of inviting people to colonoscopy?<p>And then how is the former group’s reduction in deaths 50% and the latter group’s is about 0%?

Sensationalist title to a good news story: there was no intent-to-treat effect, but a low conversion rate. The ETT is a pretty impressive 50% mortality reduction. Also study is limited by a short 10 year follow-up period but there will be a 15 year follow up.<p>So I&#x27;ll still get my colonoscopy, thanks

Years ago I learned that this is the reason why they don&#x27;t do colonoscopies without good reason in Finland. I asked from a doctor who is a friend why you have regular colonoscopies in the US but not in the Finland and he said &quot;no evidence and colonoscopy has a small risk factor&quot;.<p>If you do medicine for profit and are allowed to advertise and market, doing more is always better.

Vinay Prasad, MD (Heme&#x2F;Onc) gives a very good rundown on why this trial is so important. He also points out why having accurate data for screening recommendations is so crucial. USPTF has been making recommendations recently without data to back up them up and get appropriately taken to task for that.<p>[1] <a href="https:&#x2F;&#x2F;m.youtube.com&#x2F;watch?v=SMRS4-ng8T0" rel="nofollow">https:&#x2F;&#x2F;m.youtube.com&#x2F;watch?v=SMRS4-ng8T0</a>

This is about colonoscopy <i>screening</i>. If you give a fecal sample and it comes up as suspicious, the next step will be a colonoscopy anyway.<p>A colonoscopy is quite unpleasant; you starve for a day, and take an enema. They may sedate you before the procedure. If they don&#x27;t, then the procedure is quite uncomfortable; not exactly painful, but unpleasant.<p>Incidentally, if they find and remove a polyp, they will plant a tattoo inside your gut to mark the spot, for the benefit of future spelunking visitors.

I personally advise everyone to get a colonoscopy.<p>I personally know 4 people who had the procedure and cancer was detected. Some further along than others. All still living.<p>Colonoscopy is one of the few procedures that as they screen they can also take action.

This is a very complex subject because the sensitivity of tests for colorectal cancer has improved over time and more testing is being done. This makes it appear as if there is a great increase in colorectal cancer when there really isn&#x27;t.<p>A very interesting related study has become known as &quot;The Norwegian Colorectal Study&quot; found that early testing was a waste of money since only those with a family history of colorectal cancer or IBS symptoms or both actually got colorectal cancer before 55. For most people the polyps which are precursors to colorectal cancer do not appear before age 55. That means that the current push for aggressive testing starting at 50 is a distracting waste of time, money, and effort that should be eased back.

&gt; The risk of death from any cause was 11.03% in the invited group and 11.04% in the usual-care group<p>IIUC, there was still a reduction in colon cancer deaths, but the populations still experienced the same % of deaths from all causes.<p><a href="https:&#x2F;&#x2F;www.nejm.org&#x2F;doi&#x2F;full&#x2F;10.1056&#x2F;NEJMoa2208375" rel="nofollow">https:&#x2F;&#x2F;www.nejm.org&#x2F;doi&#x2F;full&#x2F;10.1056&#x2F;NEJMoa2208375</a>