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Excellent job by FiveThirtyEight on why at-home colon cancer tests are a good screening option

Rating

5 Star

You Could Skip Your Colonoscopy If You’re Willing To Collect Your Poop

Our Review Summary

"Close-up of the controls of a colonoscope. This instrument is used for performing colonoscopies, or polyp removal. Progress monitored by surgeon and assistant on computer screen, the patient is under general anesthesia. Selective focus, shallow depth of field."

This story points out that, based on available data, two at-home screening tests appear to be equally effective compared to the more traditional, and more invasive, sigmoidoscopy and colonoscopy.

We have only minor quibbles with the story–overall, it provided an excellent assessment of the at-home test options, particularly the fecal immunochemical test. However, for any story about screening methods, particularly blood tests, we think it’s important to include the risks of false-positive and false-negative results, which carry harm. The story didn’t go there.

 

Why This Matters

Given that the public has reservations about aspects of the invasive screening methods, information suggesting that they might be adequately replaced by non-invasive approaches is important to the public’s health. All too often, colonoscopy is promoted as the “gold standard” and no mention is made of effective alternatives. This news story does a good job explaining options, and also explores the reasons why so many Americans think that screening with colonoscopy is the best way to be screened for colon cancer and why that attitude is not supported by the evidence and may (in rare cases) be much worse than non-invasive screening methods.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

We’ll give this story a Satisfactory rating in this category since it does mention the $1,000 cost of a colonoscopy and that one of the two at-home screening tests costs about $25.  But readers would benefit more by knowing the average costs of the two alternatives, rather than just the cost of one.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

This story focuses on the available methods of colorectal screening, comparing them based on available data, and points out that the two at-home screening kits are comparably effective to the two invasive procedures: sigmoidoscopy and colonoscopy.  One of the at-home tests — the FIT, or fecal immunochemical test — when used, is estimated to prevent 20-23 deaths per thousand people screened, while estimates among those using colonoscopy suggest 22-24 deaths are prevented per thousand people screened.  The story is clear in saying that there has been no head-to-head comparative study pitting the techniques against each other.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story gets a Satisfactory rating here since it does mention that with colonoscopy, there’s “a small but real risk of harm, such as a perforation” from the screening test.

But, as with all screening methods, there is the possibility of false positives or false negatives with the at-home tests which could produce either false confidence or needless worry, not insignificant issues.  We would have liked the story even better had it mentioned these factors.   

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story is quite open with the fact that comparative data assessing the various screening methods against each other are not available, but it strengthens its offerings by citing recommendations from both the US Preventive Services Task Force and the Canadian Task Force on Preventive Health Care.  The recommendations of these independent groups are based on a rigorous evaluation of the highest-quality evidence available.

Does the story commit disease-mongering?

Satisfactory

Colon cancer is the second-leading form of cancer-related death in the country; the story does not disease monger.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story quotes three independent sources for information and the recommendations of agencies from two different governments.  There is no suggestion that in a story offering a selection of screening techniques, with no one preferred above another, that there is any issue with conflicts of interest.

Does the story compare the new approach with existing alternatives?

Satisfactory

Since this story is totally about the available alternatives for colorectal cancer screening, it easily gets a Satisfactory rating.   

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

Both colonoscopy and sigmoidoscopy have been available for years and the at-home screening tests mentioned in the story are said to be available through a patient’s doctor’s office. These details establish the methods’ availability.  It also quotes one source as recommending against the use of over-the-counter home screening tests for this disease.

Does the story establish the true novelty of the approach?

Satisfactory

The story notes that what’s novel here is that the U.S. Preventive Task Force recently finalized their guidelines on colon cancer screening.

Does the story appear to rely solely or largely on a news release?

Satisfactory

There is no indication that this story relied on a news release.

Total Score: 10 of 10 Satisfactory

Comments (1)

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Marie Koch

January 15, 2017 at 2:43 pm

After being disabled by a colonoscopy [see gutsense.org] I feel that the adverse effects of this procedure is grossly underreported. [I’ve been homebound for eight years, no one knows why]…Maybe the anesthesia [likely], or an infection (you know the scope is reused, right?) or damage by the junk you drink to clean you out that’s synthetic and similar to antifreeze or maybe the adverse effects of washing out a lifetime of probiotics/flora that took a lifetime to balance. I seriously recommend running from this test. This test is not like opening up your mouth and saying, “ah”. It’s dangerous…

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