5 ms·

How many have you had? My understanding is the risk of a perforated colon is actually quite high, like 1 in 500. Do you worry about that risk? I got referred

How many have you had? My understanding is the risk of a perforated colon is actually quite high, like 1 in 500. Do you worry about that risk? I got referred to a gastroenterologist before I was 45 and he talked me out of it because he didn't think it was going to show anything (my symptoms that I was referred there for were gone by then) and the risk wasn't worth it. Obviously if you're going to get some life-saving results, the risk-reward calculation changes.

actually_a_dog 5y ago
You consider 1 in 500 high? That's only 0.2%. At that rate, assuming the probability of complication for each procedure is independent from all the others, you could undergo the procedure 20 times with only about a 4% chance of complication. Since the American Cancer Society only recommends colonoscopy every 10 years, starting at age 45, most people wouldn't even have 5 procedures done in a lifetime, which would give about a 1% cumulative chance of complication.
- heleninboodler 5y ago
  That is very high if you get one every year.
  - actually_a_dog 5y ago
    So, don't do that, unless you have enough risk factors to justify it. Get it done once every 10 years as per the recommendation.
    - heleninboodler 5y ago
      You realize the context of my question was that I was responding to someone who actually does get one done every year, right? And that I acknowledged that the risk-reward calculation changes quite a bit depending on what risk factors you have? I don't know what point you're trying to make, unless you think I'm just wrong to be asking this person in a special circumstance how he thinks about the risk. For example, perhaps there are extra precautions that I don't know about that can be taken for someone for whom yearly scopes are important.
- saurik 5y ago
  It would be one thing if you were to have done that math to show "the risk of colon cancer is so high that this decision is worth it"--and to be clear: maybe it is!--but the idea that you simply don't find a 1% chance of a complication to be a big deal as the absolute number looks small to you (as opposed to making some relative comparison to the rate of preventable cancer) horrifies me... and, for your sake, I hope you aren't that careless continually with all of the other decisions you make in your life (any number of which might also have a 1% chance of going badly for you). 1 in 500 is absolutely a very very large number.
  - actually_a_dog 5y ago
    You have roughly a 4% chance of developing colorectal cancer in your lifetime: https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html https://www.cancer.org/cancer/colon-rectal-cancer/about/key-... Amazingly, the American Cancer Society had already done that calculation when they made their recommendation to get scoped once every 10 years.
    - heleninboodler 5y ago
      ... which might lead one to ask "do you worry about the risk of complications?" when hearing about someone who gets the scope 10x as often as recommended. The answer may be "well, even if the risk of complications is 10x, my risk of getting a disease the scope will catch still far outweighs it, so it's worth it. Or it may be "yeah, that is a concern, but it's mitigated somewhat by xyz factor." And both of those are interesting answers. Why the hostility to this conversation?
robbiep 5y ago
Commonly quoted figures are 1:2000 in western countries with experienced operators with good operators claiming significantly better than that
Findecanor 5y ago
I've heard such numbers before and asked my doctor about them, but been told that those are overexaggerated. A higher risk apply to patients with intestinal diseases such as Chron's (not me) or when doctors have conducted minor surgery from inside the gut. A normal colon is quite flexible, and should not get hurt just from the endoscope being pushed through the gut. Snipping a "normal" polyp or taking a biopsy would cause a little bleeding, but should heal up quickly. I've been told that I could see blood in my stool after it, but it's been so little that I haven't.

actually_a_dog 5y ago

You consider 1 in 500 high? That's only 0.2%. At that rate, assuming the probability of complication for each procedure is independent from all the others, you could undergo the procedure 20 times with only about a 4% chance of complication. Since the American Cancer Society only recommends colonoscopy every 10 years, starting at age 45, most people wouldn't even have 5 procedures done in a lifetime, which would give about a 1% cumulative chance of complication.

heleninboodler 5y ago
That is very high if you get one every year.
- actually_a_dog 5y ago
  So, don't do that, unless you have enough risk factors to justify it. Get it done once every 10 years as per the recommendation.
  - heleninboodler 5y ago
    You realize the context of my question was that I was responding to someone who actually does get one done every year, right? And that I acknowledged that the risk-reward calculation changes quite a bit depending on what risk factors you have? I don't know what point you're trying to make, unless you think I'm just wrong to be asking this person in a special circumstance how he thinks about the risk. For example, perhaps there are extra precautions that I don't know about that can be taken for someone for whom yearly scopes are important.
saurik 5y ago
It would be one thing if you were to have done that math to show "the risk of colon cancer is so high that this decision is worth it"--and to be clear: maybe it is!--but the idea that you simply don't find a 1% chance of a complication to be a big deal as the absolute number looks small to you (as opposed to making some relative comparison to the rate of preventable cancer) horrifies me... and, for your sake, I hope you aren't that careless continually with all of the other decisions you make in your life (any number of which might also have a 1% chance of going badly for you). 1 in 500 is absolutely a very very large number.
- actually_a_dog 5y ago
  You have roughly a 4% chance of developing colorectal cancer in your lifetime: https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html https://www.cancer.org/cancer/colon-rectal-cancer/about/key-... Amazingly, the American Cancer Society had already done that calculation when they made their recommendation to get scoped once every 10 years.
  - heleninboodler 5y ago
    ... which might lead one to ask "do you worry about the risk of complications?" when hearing about someone who gets the scope 10x as often as recommended. The answer may be "well, even if the risk of complications is 10x, my risk of getting a disease the scope will catch still far outweighs it, so it's worth it. Or it may be "yeah, that is a concern, but it's mitigated somewhat by xyz factor." And both of those are interesting answers. Why the hostility to this conversation?

robbiep 5y ago

Commonly quoted figures are 1:2000 in western countries with experienced operators with good operators claiming significantly better than that

Findecanor 5y ago

I've heard such numbers before and asked my doctor about them, but been told that those are overexaggerated. A higher risk apply to patients with intestinal diseases such as Chron's (not me) or when doctors have conducted minor surgery from inside the gut. A normal colon is quite flexible, and should not get hurt just from the endoscope being pushed through the gut. Snipping a "normal" polyp or taking a biopsy would cause a little bleeding, but should heal up quickly. I've been told that I could see blood in my stool after it, but it's been so little that I haven't.