10 ms·

Several posters have criticized the title of the news article "In gold-standard trial, colonoscopy fails to reduce rate of cancer deaths". The actual study is

by em500 4y ago

Several posters have criticized the title of the news article "In gold-standard trial, colonoscopy fails to reduce rate of cancer deaths". The actual study is titled "Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death" [1] The authors conclude that "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. " 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're not written for domain experts only. As we see in the discussions here, it's questionable whether the rephrasing from journalists really adds anything. [1] https://www.nejm.org/doi/full/10.1056/NEJMoa2208375 https://www.nejm.org/doi/full/10.1056/NEJMoa2208375

hef19898 4y ago
That makes so much more sense and would lead to a much better discussion. Any chance the title and linked site can be changed? It does show quite nicely how one can lie through scientific studies and confuse people.
ricardobeat 4y ago
There is nothing wrong with the title. The study failed to find a reduction in death rate despite lowering the incidence of cancer, and that is the center of the piece. It goes into detail of why this is surprising. The study authors were interviewed and agreed. The reporting actually adds a lot of context that you would never get from a link to a random study. Like, for example, how it is called the “gold standard” because it’s a 10-year large scale randomized trial, and the doctors running the study are the ones who promoted colonoscopy as a tool to reduce cancer mortality in the first place.
- em500 4y ago
  The problem with the title is that it might lead individuals to believe they shouldn't bother with getting a colonoscopy. You can't conclude that from this study at all. If your doctor recommends you to get one, you probably should. The study answers a question pertaining public health policy (should we invite everyone in some age group for a colonoscopy?). It does not answer any individual health/treatment/screening question. The article's headline and content is problematic because it's easy to confuse the two, and the vast majority of readers will never get involved in public health policy (but will certainly have to make lots of individual health decisions).
  - ldoughty 4y ago
    > The problem with the title is that it might lead individuals to believe they shouldn't bother with getting a colonoscopy. That is exactly what I thought it was saying at a glance. If I skimmed the headline and moved on, instead of digging in, it might have contributed to an unconscious bias against the procedure.
    - jrochkind1 4y ago
      Uh... I think it is what it's saying though? I mean, you should probably still get a colonoscopy if recommended by your doctor which it probably will be right now... but the effects of this study may be to change those recommendations down the line, that is what it suggests. (I think it's not the first, but I'm not sure).
      - ldoughty 4y ago
        The summary I read on CNN: > In this study, about 12,000 people in Sweden, Poland and Norway got colonoscopies. They saw a 31% reduction in their risk of colon cancer and a 50% reduction in their risk of dying from colon cancer compared with people who were not invited to get a colonoscopy. https://www.cnn.com/2022/10/10/health/colonoscopy-study-q-and-a-wellness/index.html https://www.cnn.com/2022/10/10/health/colonoscopy-study-q-an...
  - darkerside 4y ago
    You're walking a dangerous path, friend
  - JohnJamesRambo 4y ago
    I’m so confused though, because based on my reading of it, it seems like the prostate screening thing where yes it might find cancer but no it won’t prevent deaths, so it might be better to just not know/do invasive procedures and treatment for it. Is that the wrong conclusion to reach from the data?
    - bitcurious 4y ago
- ChrisMarshallNY 4y ago
  "Death rate" != "Cancer Rate." Cancer is much more treatable, these days. I had a friend that just underwent seven months of chemo for colorectal cancer. Looks like he'll be fine, but it was Stage IV, when it was discovered. Had a couple of surgeries, and radiation. The chemo was the worst, though. He channeled Uncle Fester, and this was a fairly robust, somewhat overweight chap. So he would not go in the "death" column, but I guarantee that he would not be one to dismiss the seriousness of the disease (or its treatment).
  - refurb 4y ago
    Yeah, it's pretty complicated. I'm not that surprised death rates were similar. Colonoscopies will catch pre-cancerous masses like polyps, so I can see the cancer rate being lower. But if diagnosed with cancer, treatments are quite good for colorectal cancer, so you may not see that much of a difference in death rate on a 10 year horizon.
    - eecc 4y ago
      Well then the title is indeed misleading. It's not the colonoscopy that's failing to reduce cancer death rates, treatments are. Indeed the title should have been: with colon cancer deaths unchanged, screening and pre-malignant treatments are ever more important.
      - pessimizer 4y ago
        This is nonsensical. Any number of things are failing to reduce cancer death rates, including professional football and jelly donuts. This study is about colonoscopies also failing to reduce cancer death rates. Changing the title to Don't Worry About Colon Cancer Death Rates, Just Continue To Do What You're Told would not have been better or more accurate.
        eecc 4y ago
        > This is nonsensical. Can you please keep it civil and avoid devolving into insults? I don't spend my time online to get treated like a fool. Now please restrain yourself from trolling even further and say "well, then don't say foolish things" because I'd flag you. If you bothered reading the article, a paragraph reads that this particular form of screening did have an impact. Just not as significant as the community thought. The study is about _one particular form of screening_ that might might have been oversold. Perfectly consistent with the parent observation and my own: screening is significant, curing cancer isn't as easy as avoiding it altogether. Now, if you have something constructive to add please do so. Otherwise, please shut up and move on to some Reddit sub.
- BenoitEssiambre 4y ago
  That is incorrect. The title is completely wrong. "Study failed to find a reduction" _does not equal_ "There wasn't a reduction". From the abstract: "The risk of death from colorectal cancer was 0.28% in the invited group and 0.31% in the usual-care group (risk ratio, 0.90; 95% CI, 0.64 to 1.16)" Look at the confidence interval. This study was both consistent with a 36% reduction in deaths or a 16% increase in deaths. It's just a really wide range. All we can say about this study is that it didn't gather enough data to identify the size of the effect, not that there wasn't an effect. This is likely because there wasn't that many people who died of colon cancer in any of the groups. This study just didn't track enough people to provide an answer.
  - deleted 4y ago
    [deleted]
  - phkahler 4y ago
    I'm also confused about the "invited" group. Not all of them had the procedure and there is a part talking about lower cancer rates among the subset that actually accepted the invite. It sounds like there is still confusion about how to interpret it.
    - timr 4y ago
      There's not confusion. The study did an intention-to-treat analysis, which failed to find a significant result. "Intention to treat" here means that you count everyone in the group that got an invitation to get a colonoscopy, regardless of whether or not they actually did it. Though this sounds counterintuitive, it's the "gold standard" because, if you don't do this, you leave yourself open to bias -- maybe the people who seek out colonoscopy have some symptom, family history or other reason that leads them to seek out treatment. Maybe the people who get a test get more treatment, and that treatment is harmful in the marginal case. Or just as importantly: maybe the people who don't have the time/inclination to do one would be better served by an alternative test. Everyone (including GP) is fixating on the magnitude of the primary outcome and squabbling about whether or not colonoscopies help people. But I think the more interesting aspect of this study is that it shows that the genetic tests probably aren't inferior to the invasive, painful, time-consuming rectal exam. If that's true, it's great news!
- dahart 4y ago
  > The study failed to find a reduction in death rate despite lowering the incidence of cancer This isn’t true. The secondary analysis shows a reduced death rate. The problem with the title is that it says “Effect of Colonoscopy Screening”, not “Effect of telling people to get a colonoscopy screening”, where the primary analysis is making conclusions based on the latter. Maybe this style of title is standard for medical journals, but the argument in this thread is based on the title priming us for what the paper is talking about, and directly leading to confusion.
- readthenotes1 4y ago
  "The study failed to find a reduction in death rate despite lowering the incidence of cancer, and that is the center of the piece" Maybe you didn't read the article all the way through? What it found was it merely inviting people to a colonoscopy did not result in less deaths from colon cancer, although it did result in fewer people being treated for it. However, if you look at the people who actually took a colonoscopy, there was a 50% reduction in deaths from colon cancer. That's not nothing.
jvanderbot 4y ago
Well, to be fair, the overall risk of death did not seem to be lower for the invited group. The risk was 11.04 vs 11.03 for those with invited colonoscopy, with fairly large confidence interval on the control group. But the risk of colon cancer did decrease, with a risk reduction of 18%. Maybe they just didn't track long enough to tease out a bigger risk reduction in overall mortality, or maybe colon cancer is associated with other risk factors for mortality (like age). Why someone would latch onto one result and not the other is probably just "blow the lid off" style reporting.
- hef19898 4y ago
  Invited or not, if you don't show up to a colonoscopy you don't get one. Which means the study's data on invitations alone cannot be used to evaluate the effect of colonoscopies. Seems the study does provide data that allows this so, and shows clear differences in cancer rates and survival rates for those that did get colonoscopies. Argueing about the randomization of these numbers, and the meta-statistical aspects of that, would be funny if the subject wasn't so serious. It is also the same level of discussion you get from people like JBP, meaning it at least misses the point by a mile.
  - thaumasiotes 4y ago
    > Invited or not, if you don't show up to a colonoscopy you don't get one. Which means the study's data on invitations alone cannot be used to evaluate the effect of colonoscopies. Seems the study does provide data that allows this so, and shows clear differences in cancer rates and survival rates for those that did get colonoscopies. This is not an oversight on the part of the study designers. It's called "intention to treat", and studies are done this way to get past the problem that, when you invite a bunch of people to get colonoscopies (or tell them to comply with any medical procedure), the people who go through with it are statistically very different, in all kinds of ways, from the people who don't. This makes the direct comparison of "received treatment" vs "didn't receive treatment" mostly meaningless. You're here advocating for everyone to ignore the study and do a direct comparison of "received treatment" vs "didn't receive treatment". Don't do this.
hk__2 4y ago
> 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're not written for domain experts only. If the second-hand news report is well done, it should give you more context on the matter, and so be more useful than the "raw" abstract.
pithymaxim 4y ago
I think it's more important to look at all-cause mortality, because treatment can also harm you. In this case it's a fairly tight confidence interval: "The risk of death from any cause was 11.03% in the invited group and 11.04% in the usual-care group (risk ratio, 0.99; 95% CI, 0.96 to 1.04)."

by em500 4y ago

hef19898 4y ago

That makes so much more sense and would lead to a much better discussion. Any chance the title and linked site can be changed? It does show quite nicely how one can lie through scientific studies and confuse people.

ricardobeat 4y ago

There is nothing wrong with the title. The study failed to find a reduction in death rate despite lowering the incidence of cancer, and that is the center of the piece. It goes into detail of why this is surprising. The study authors were interviewed and agreed. The reporting actually adds a lot of context that you would never get from a link to a random study. Like, for example, how it is called the “gold standard” because it’s a 10-year large scale randomized trial, and the doctors running the study are the ones who promoted colonoscopy as a tool to reduce cancer mortality in the first place.

em500 4y ago
The problem with the title is that it might lead individuals to believe they shouldn't bother with getting a colonoscopy. You can't conclude that from this study at all. If your doctor recommends you to get one, you probably should. The study answers a question pertaining public health policy (should we invite everyone in some age group for a colonoscopy?). It does not answer any individual health/treatment/screening question. The article's headline and content is problematic because it's easy to confuse the two, and the vast majority of readers will never get involved in public health policy (but will certainly have to make lots of individual health decisions).
- ldoughty 4y ago
  > The problem with the title is that it might lead individuals to believe they shouldn't bother with getting a colonoscopy. That is exactly what I thought it was saying at a glance. If I skimmed the headline and moved on, instead of digging in, it might have contributed to an unconscious bias against the procedure.
  - jrochkind1 4y ago
    Uh... I think it is what it's saying though? I mean, you should probably still get a colonoscopy if recommended by your doctor which it probably will be right now... but the effects of this study may be to change those recommendations down the line, that is what it suggests. (I think it's not the first, but I'm not sure).
    - ldoughty 4y ago
      The summary I read on CNN: > In this study, about 12,000 people in Sweden, Poland and Norway got colonoscopies. They saw a 31% reduction in their risk of colon cancer and a 50% reduction in their risk of dying from colon cancer compared with people who were not invited to get a colonoscopy. https://www.cnn.com/2022/10/10/health/colonoscopy-study-q-and-a-wellness/index.html https://www.cnn.com/2022/10/10/health/colonoscopy-study-q-an...
- darkerside 4y ago
  You're walking a dangerous path, friend
- JohnJamesRambo 4y ago
  I’m so confused though, because based on my reading of it, it seems like the prostate screening thing where yes it might find cancer but no it won’t prevent deaths, so it might be better to just not know/do invasive procedures and treatment for it. Is that the wrong conclusion to reach from the data?
  - bitcurious 4y ago
ChrisMarshallNY 4y ago
"Death rate" != "Cancer Rate." Cancer is much more treatable, these days. I had a friend that just underwent seven months of chemo for colorectal cancer. Looks like he'll be fine, but it was Stage IV, when it was discovered. Had a couple of surgeries, and radiation. The chemo was the worst, though. He channeled Uncle Fester, and this was a fairly robust, somewhat overweight chap. So he would not go in the "death" column, but I guarantee that he would not be one to dismiss the seriousness of the disease (or its treatment).
- refurb 4y ago
  Yeah, it's pretty complicated. I'm not that surprised death rates were similar. Colonoscopies will catch pre-cancerous masses like polyps, so I can see the cancer rate being lower. But if diagnosed with cancer, treatments are quite good for colorectal cancer, so you may not see that much of a difference in death rate on a 10 year horizon.
  - eecc 4y ago
    Well then the title is indeed misleading. It's not the colonoscopy that's failing to reduce cancer death rates, treatments are. Indeed the title should have been: with colon cancer deaths unchanged, screening and pre-malignant treatments are ever more important.
    - pessimizer 4y ago
      This is nonsensical. Any number of things are failing to reduce cancer death rates, including professional football and jelly donuts. This study is about colonoscopies also failing to reduce cancer death rates. Changing the title to Don't Worry About Colon Cancer Death Rates, Just Continue To Do What You're Told would not have been better or more accurate.
      - eecc 4y ago
        > This is nonsensical. Can you please keep it civil and avoid devolving into insults? I don't spend my time online to get treated like a fool. Now please restrain yourself from trolling even further and say "well, then don't say foolish things" because I'd flag you. If you bothered reading the article, a paragraph reads that this particular form of screening did have an impact. Just not as significant as the community thought. The study is about _one particular form of screening_ that might might have been oversold. Perfectly consistent with the parent observation and my own: screening is significant, curing cancer isn't as easy as avoiding it altogether. Now, if you have something constructive to add please do so. Otherwise, please shut up and move on to some Reddit sub.
BenoitEssiambre 4y ago
That is incorrect. The title is completely wrong. "Study failed to find a reduction" _does not equal_ "There wasn't a reduction". From the abstract: "The risk of death from colorectal cancer was 0.28% in the invited group and 0.31% in the usual-care group (risk ratio, 0.90; 95% CI, 0.64 to 1.16)" Look at the confidence interval. This study was both consistent with a 36% reduction in deaths or a 16% increase in deaths. It's just a really wide range. All we can say about this study is that it didn't gather enough data to identify the size of the effect, not that there wasn't an effect. This is likely because there wasn't that many people who died of colon cancer in any of the groups. This study just didn't track enough people to provide an answer.
- deleted 4y ago
  [deleted]
- phkahler 4y ago
  I'm also confused about the "invited" group. Not all of them had the procedure and there is a part talking about lower cancer rates among the subset that actually accepted the invite. It sounds like there is still confusion about how to interpret it.
  - timr 4y ago
    There's not confusion. The study did an intention-to-treat analysis, which failed to find a significant result. "Intention to treat" here means that you count everyone in the group that got an invitation to get a colonoscopy, regardless of whether or not they actually did it. Though this sounds counterintuitive, it's the "gold standard" because, if you don't do this, you leave yourself open to bias -- maybe the people who seek out colonoscopy have some symptom, family history or other reason that leads them to seek out treatment. Maybe the people who get a test get more treatment, and that treatment is harmful in the marginal case. Or just as importantly: maybe the people who don't have the time/inclination to do one would be better served by an alternative test. Everyone (including GP) is fixating on the magnitude of the primary outcome and squabbling about whether or not colonoscopies help people. But I think the more interesting aspect of this study is that it shows that the genetic tests probably aren't inferior to the invasive, painful, time-consuming rectal exam. If that's true, it's great news!
dahart 4y ago
> The study failed to find a reduction in death rate despite lowering the incidence of cancer This isn’t true. The secondary analysis shows a reduced death rate. The problem with the title is that it says “Effect of Colonoscopy Screening”, not “Effect of telling people to get a colonoscopy screening”, where the primary analysis is making conclusions based on the latter. Maybe this style of title is standard for medical journals, but the argument in this thread is based on the title priming us for what the paper is talking about, and directly leading to confusion.
readthenotes1 4y ago
"The study failed to find a reduction in death rate despite lowering the incidence of cancer, and that is the center of the piece" Maybe you didn't read the article all the way through? What it found was it merely inviting people to a colonoscopy did not result in less deaths from colon cancer, although it did result in fewer people being treated for it. However, if you look at the people who actually took a colonoscopy, there was a 50% reduction in deaths from colon cancer. That's not nothing.

jvanderbot 4y ago

Well, to be fair, the overall risk of death did not seem to be lower for the invited group. The risk was 11.04 vs 11.03 for those with invited colonoscopy, with fairly large confidence interval on the control group. But the risk of colon cancer did decrease, with a risk reduction of 18%. Maybe they just didn't track long enough to tease out a bigger risk reduction in overall mortality, or maybe colon cancer is associated with other risk factors for mortality (like age). Why someone would latch onto one result and not the other is probably just "blow the lid off" style reporting.

hef19898 4y ago
Invited or not, if you don't show up to a colonoscopy you don't get one. Which means the study's data on invitations alone cannot be used to evaluate the effect of colonoscopies. Seems the study does provide data that allows this so, and shows clear differences in cancer rates and survival rates for those that did get colonoscopies. Argueing about the randomization of these numbers, and the meta-statistical aspects of that, would be funny if the subject wasn't so serious. It is also the same level of discussion you get from people like JBP, meaning it at least misses the point by a mile.
- thaumasiotes 4y ago
  > Invited or not, if you don't show up to a colonoscopy you don't get one. Which means the study's data on invitations alone cannot be used to evaluate the effect of colonoscopies. Seems the study does provide data that allows this so, and shows clear differences in cancer rates and survival rates for those that did get colonoscopies. This is not an oversight on the part of the study designers. It's called "intention to treat", and studies are done this way to get past the problem that, when you invite a bunch of people to get colonoscopies (or tell them to comply with any medical procedure), the people who go through with it are statistically very different, in all kinds of ways, from the people who don't. This makes the direct comparison of "received treatment" vs "didn't receive treatment" mostly meaningless. You're here advocating for everyone to ignore the study and do a direct comparison of "received treatment" vs "didn't receive treatment". Don't do this.

hk__2 4y ago

> 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're not written for domain experts only. If the second-hand news report is well done, it should give you more context on the matter, and so be more useful than the "raw" abstract.

pithymaxim 4y ago

I think it's more important to look at all-cause mortality, because treatment can also harm you. In this case it's a fairly tight confidence interval: "The risk of death from any cause was 11.03% in the invited group and 11.04% in the usual-care group (risk ratio, 0.99; 95% CI, 0.96 to 1.04)."