Dr. Michael Kirsch, who claims that “when I’m not writing, I’m performing colonoscopies, has published a blog post, “Is Colonoscopy the Best Colon Cancer Screening Test?”
It’s an excellent piece, which I encourage you to read in its entirety. It touches on medical conflicts of interest, comparative effectiveness research, the medical arms race, medical marketing and more.
But here’s how Kirsch ends the piece:
“To a gastroenterologist, 50 is a milestone year. This is the age that we pounce upon you to scour your colon to remove cancers-in-waiting. While we champion this test, and sincerely believe in its worth, it is not ideal. Here are some drawbacks.
- The pre-colonoscopy cathartic cocktail
- Discomfort (no its not always painless)
- Risk of complications
- High rate of negative results
- Loss of a days wages or personal enjoyment
- Need for a driver
What will gastroenterologists’ reaction be when a better test threatens to retire our colonoscopes? Will we defend colonoscopy against a simple analysis of a person’s stool which is just as effective? Will we claim that the research behind the new development is flawed? Gastroenterologists have successfully prevailed against CAT colonography, a competing test which examines the entire colon for polyps using a CAT scan. We have the edge in this duel since patients who pursue the CAT scan option must still take a vigorous laxative and, if polyps are discovered, they cannot be removed. Colonoscopys unrivaled advantage is that it can remove nearly all polyps discovered. Its one stop shopping. If radiologists perfect the technique of performing a CAT colonography without any required laxatives, then the scales may tip in their favor.
The above vignette is not a futuristic hypothetical creation. I suspect that colonoscopy and CAT colonography will be properly forced out during my own career as colon cancer screening techniques. Colonoscopy will still be performed, but only when some kinder and gentler screening test indicates that an individual has a high probability of harboring polyps. It will no longer be wielded in a buckshot fashion. The number of colonoscopies being performed will be decimated.
When that happens, it will not be good news for the Kirsch family. But, it will be greater good news for everyone elses family.”
Kirsch is worth following on a regular basis. We linked to his piece, “Evidence-based Medicine in Disguise: Beware the Surrogate!” in our Toolkit’s Tips for Understanding Studies.