6 ms·

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 th

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
    You could think of screening as a bet on anti-cancer drugs getting better over the next N years.
    - lupire 4y ago
      Or you could wait for better drugs before getting an invasive screening.
    - PaulHoule 4y ago
      Prostate cancer is different from colon cancer. In the case of colon cancer detected in a colonoscopy they can snip it out right there without a lot of effort, risk or lost function. Surgery on the prostate is likely to cause all sorts of problems for men.
      - hef19898 4y ago
        And not having surgery for it can mean death. Steve Jobs, even it wasn't prostate cancer, should serve as good example of how not to tackle it. Or at least to show what not tackeling it looks like, because feel free to do what you want, but be aware of the consequences.
        SoftTalker 4y ago
        Jobs had pancreatic cancer. His holistic approach to dealing with it notwithstanding, that diagnosis is usually a death sentence no matter what you do.
        4y ago
- prirun 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 problem with your doctor's recommendation is that doctors recommend colonoscopy based on age, not whether you have any factors that might indicate colon cancer. I have no cancer of any kind anywhere in my family tree and they are always on me to get one. From the article, a doctor who still believes in colonoscopy for everyone: “The first message is that screening saves lives [Ed: against this study's data] and prevents cancer. If we could have a chance to start everyone at age 45, I’d like that."
  - greedo 4y ago
    No one in my family history going back several generations had colo/rectal cancer. Yet I developed it at age 41. Diet is increasingly viewed as a factor.
    - hef19898 4y ago
      I had it at 26, go figure. My petvtheory is that in orser to get the average age back to 50, you need someone like me for every 80 year old, statistics are a bitch. That also means my children will have screening coloscopies starting age 16.
    - Findecanor 4y ago
      Have you got your genes tested? People can have Lynch syndrome and not develop cancer. Colon cancer is also a silent danger in that it can grow for years without any noticeable symptoms. I got colon cancer at age 35 (despite being a vegetarian, BTW), and it was first then that suspicion was raised that there could be a hereditary component - which was later confirmed by a gene test.
  - Clent 4y ago
    The study does not say that coloscopies don't help. The study measures a difference in the study's population. The study does indicate they don't affect outcomes as much as expected. However, their affect is positive. The study's measured affect has wide errors bars indicating a larger sample size is needed. Subsequent studies could show the affect is more inline with expectations but are unlikely to show less affect. The question as to whether this will be used to reinforce hesitancy for this procedure; we can already see it in the comment. Logic and reason are not naturally occurring traits. I predict this will be used to move more people into the control group. Going against medical advice is anecdotally meaningful.
- hammock 4y ago
  >The problem with the title is that it might lead individuals to believe they shouldn't bother with getting a colonoscopy. Dangerous misinformation!! Censor!! I have reported the author, Angus Chen, to his employer. Or you could just comment...
- imgabe 4y ago
  Do people really ignore their doctor's advice because they saw a headline? I'm sure there are some examples, but that can't be the norm. Obviously a colonscopy can still be indicated for an individual even if it doesn't help by doing it en masse for everyone. Specific symptoms could indicate a colonoscopy would provide more information and there are a number of other conditions where it would be used besides colon cancer. I can't realistically see anyone saying "No thanks, doc, I'm not going to get that colonoscopy you recommended, because I saw a headline" This trend of saying a thing is bad because you can imagine some unbelievably stupid person misinterpreting it and misusing it is getting out of hand. At some point people are responsible for their own decisions.
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.

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
  You could think of screening as a bet on anti-cancer drugs getting better over the next N years.
  - lupire 4y ago
    Or you could wait for better drugs before getting an invasive screening.
  - PaulHoule 4y ago
    Prostate cancer is different from colon cancer. In the case of colon cancer detected in a colonoscopy they can snip it out right there without a lot of effort, risk or lost function. Surgery on the prostate is likely to cause all sorts of problems for men.
    - hef19898 4y ago
      And not having surgery for it can mean death. Steve Jobs, even it wasn't prostate cancer, should serve as good example of how not to tackle it. Or at least to show what not tackeling it looks like, because feel free to do what you want, but be aware of the consequences.
      - SoftTalker 4y ago
        Jobs had pancreatic cancer. His holistic approach to dealing with it notwithstanding, that diagnosis is usually a death sentence no matter what you do.
        4y ago
prirun 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 problem with your doctor's recommendation is that doctors recommend colonoscopy based on age, not whether you have any factors that might indicate colon cancer. I have no cancer of any kind anywhere in my family tree and they are always on me to get one. From the article, a doctor who still believes in colonoscopy for everyone: “The first message is that screening saves lives [Ed: against this study's data] and prevents cancer. If we could have a chance to start everyone at age 45, I’d like that."
- greedo 4y ago
  No one in my family history going back several generations had colo/rectal cancer. Yet I developed it at age 41. Diet is increasingly viewed as a factor.
  - hef19898 4y ago
    I had it at 26, go figure. My petvtheory is that in orser to get the average age back to 50, you need someone like me for every 80 year old, statistics are a bitch. That also means my children will have screening coloscopies starting age 16.
  - Findecanor 4y ago
    Have you got your genes tested? People can have Lynch syndrome and not develop cancer. Colon cancer is also a silent danger in that it can grow for years without any noticeable symptoms. I got colon cancer at age 35 (despite being a vegetarian, BTW), and it was first then that suspicion was raised that there could be a hereditary component - which was later confirmed by a gene test.
- Clent 4y ago
  The study does not say that coloscopies don't help. The study measures a difference in the study's population. The study does indicate they don't affect outcomes as much as expected. However, their affect is positive. The study's measured affect has wide errors bars indicating a larger sample size is needed. Subsequent studies could show the affect is more inline with expectations but are unlikely to show less affect. The question as to whether this will be used to reinforce hesitancy for this procedure; we can already see it in the comment. Logic and reason are not naturally occurring traits. I predict this will be used to move more people into the control group. Going against medical advice is anecdotally meaningful.
hammock 4y ago
>The problem with the title is that it might lead individuals to believe they shouldn't bother with getting a colonoscopy. Dangerous misinformation!! Censor!! I have reported the author, Angus Chen, to his employer. Or you could just comment...
imgabe 4y ago
Do people really ignore their doctor's advice because they saw a headline? I'm sure there are some examples, but that can't be the norm. Obviously a colonscopy can still be indicated for an individual even if it doesn't help by doing it en masse for everyone. Specific symptoms could indicate a colonoscopy would provide more information and there are a number of other conditions where it would be used besides colon cancer. I can't realistically see anyone saying "No thanks, doc, I'm not going to get that colonoscopy you recommended, because I saw a headline" This trend of saying a thing is bad because you can imagine some unbelievably stupid person misinterpreting it and misusing it is getting out of hand. At some point people are responsible for their own decisions.

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.