3 ms·

The risk of serious complications like major bleeding or perforation is closer to 40-80 per 10,000, significantly higher than the roughly 3-5 per 10,000 annual

by panarky 5mo ago

The risk of serious complications like major bleeding or perforation is closer to 40-80 per 10,000, significantly higher than the roughly 3-5 per 10,000 annual chance of actually having colorectal cancer for low-risk groups. My doctor says that since Cologuard catches a large percentage of those 3-5 per 10,000 without any of the colonoscopy risk, the marginal benefits from colonoscopy really aren't justified since FIT+DNA testing is almost as good, at least for low-risk cohorts. Very few things in medicine are zero risk. I wish more doctors would help balance the risk of doing A vs. the risk of doing B vs. the risk of doing nothing. It's all Bayesian conditional probabilities, considering your own individual risk factors, and considering the false positive rate and false negative rate of each test.

bonsai_spool 5mo ago
> The risk of serious complications like major bleeding or perforation is closer to 40-80 per 10,000 What's your reference for this? That's incredibly (read, unbelievable) high for a routine procedure.
- genewitch 5mo ago
  not who you asked but the perforation is 3-5 per 10,000; cardiovascular issues is 52 per 10,000, polyp removal carries risks of bleeding or perforation, and underlying patient physiology. RESULTS Among the 30,818 records identified, 82 population-based studies from 24 countries were included, involving a total of 38.5 million colonoscopies. The estimated incidence per 10,000 colonoscopies was as follows: gastrointestinal AEs, including perforation (5.15; 95% confidence interval [CI] 4.19-6.34, I2 = 99%), bleeding (18.39; 95% CI 13.53-24.99, I2 = 100%), and splenic injury (0.61; 95% CI 0.43-0.85, I2 = 93%); nongastrointestinal AEs, including cardiovascular events (52.11; 95% CI 18.67-144.59, I2 = 100%), respiratory events (4.26; 95% CI 0.73-24.99, I2 = 100%), and deaths related to colonoscopy (0.18; 95% CI 0.10-0.34, I2 = 74%). Subgroup analyses yielded partially divergent findings. The majority of the included studies exhibited a low to moderate risk of bias. just ask any AI, i don't got time to play tic-tac-toe with the NIH.gov website gating me behind click bus images for 10 minutes
  - bonsai_spool 5mo ago
    You are hardly describing "serious complications" ('bleeding', and 'respiratory events' are very non specific, and the fact that this is an uncited meta-analysis across nations makes the whole enterprise suspect), even less so since your source averages 24 countries while we are speaking about US colonoscopy recommendations. My source is not seeing one perforation each week at work. > just ask any AI These do not give reliable answers, as I am sure you know
    - genewitch 5mo ago
      they give citations which i was going through and literally copied and pasted the CITE to you, not the AI. i only answered the specific question of where the number "48" or the range 40-80 came from. my cite even shows perforations are 3-5 per 10000 so i don't know what you're on me about
      - bonsai_spool 5mo ago
        > they give citations which i was going through Yes, I am sure. Do send the actual citations. > my cite even shows perforations are 3-5 per 10000 An implausible number for humans who have actual, non-LLM experience in this area
        genewitch 5mo ago
        my EXPLICIT SOURCE was 10.14309/ajg.0000000000003429 do you require other ones, or do you wanna keep harping on the fact i used LLM as a fucking search engine? https://jamanetwork.com/journals/jama/fullarticle/2779987 https://jamanetwork.com/journals/jama/fullarticle/2779987 3.5 per 10,000 take it up with JAMA and the AJG. do you do SCREENING or DIAGNOSTIC/POLYP REMOVAL? because there's a difference. And it has nothing to do whether i use google.com or chat.whatever.com to find that out.
        bonsai_spool 5mo ago
        > do you wanna keep harping on the fact i used LLM as a fucking search engine? You didn't give me a source before now, so I unfortunately had no other source to challenge except the LLM! > https://jamanetwork.com/journals/jama/fullarticle/2779987 https://jamanetwork.com/journals/jama/fullarticle/2779987 3.5 per 10,000 Different source, friend. Please note that they say 3.1, not 3.5. That is at about 25% less than 4 (and even less than 5, let alone your previous assertions). And if either you or your LLM troubled yourself to read the article, even this is a confounded number in that we cannot determine whether low-volume, 'community' operators are worse than high-volume settings. > do you do SCREENING or DIAGNOSTIC/POLYP REMOVAL? We are talking about screening—once you have a target to remove, you are looking at a high-likelihood-of-cancer population. I am fully aware of this, so I don't understand why you are bringing up this difference which has not yet figured into our discussion. Is this something your LLM suggested to you? --- I think the thing to take away is that LLMs do not yet replace human understanding and discretion.
BobbyTables2 5mo ago
The real risk is getting a doctor that is more interested in money than medical care. These seem to be more like 3000-5000 per 10000.

by panarky 5mo ago

bonsai_spool 5mo ago

> The risk of serious complications like major bleeding or perforation is closer to 40-80 per 10,000 What's your reference for this? That's incredibly (read, unbelievable) high for a routine procedure.

genewitch 5mo ago
not who you asked but the perforation is 3-5 per 10,000; cardiovascular issues is 52 per 10,000, polyp removal carries risks of bleeding or perforation, and underlying patient physiology. RESULTS Among the 30,818 records identified, 82 population-based studies from 24 countries were included, involving a total of 38.5 million colonoscopies. The estimated incidence per 10,000 colonoscopies was as follows: gastrointestinal AEs, including perforation (5.15; 95% confidence interval [CI] 4.19-6.34, I2 = 99%), bleeding (18.39; 95% CI 13.53-24.99, I2 = 100%), and splenic injury (0.61; 95% CI 0.43-0.85, I2 = 93%); nongastrointestinal AEs, including cardiovascular events (52.11; 95% CI 18.67-144.59, I2 = 100%), respiratory events (4.26; 95% CI 0.73-24.99, I2 = 100%), and deaths related to colonoscopy (0.18; 95% CI 0.10-0.34, I2 = 74%). Subgroup analyses yielded partially divergent findings. The majority of the included studies exhibited a low to moderate risk of bias. just ask any AI, i don't got time to play tic-tac-toe with the NIH.gov website gating me behind click bus images for 10 minutes
- bonsai_spool 5mo ago
  You are hardly describing "serious complications" ('bleeding', and 'respiratory events' are very non specific, and the fact that this is an uncited meta-analysis across nations makes the whole enterprise suspect), even less so since your source averages 24 countries while we are speaking about US colonoscopy recommendations. My source is not seeing one perforation each week at work. > just ask any AI These do not give reliable answers, as I am sure you know
  - genewitch 5mo ago
    they give citations which i was going through and literally copied and pasted the CITE to you, not the AI. i only answered the specific question of where the number "48" or the range 40-80 came from. my cite even shows perforations are 3-5 per 10000 so i don't know what you're on me about
    - bonsai_spool 5mo ago
      > they give citations which i was going through Yes, I am sure. Do send the actual citations. > my cite even shows perforations are 3-5 per 10000 An implausible number for humans who have actual, non-LLM experience in this area
      - genewitch 5mo ago
        my EXPLICIT SOURCE was 10.14309/ajg.0000000000003429 do you require other ones, or do you wanna keep harping on the fact i used LLM as a fucking search engine? https://jamanetwork.com/journals/jama/fullarticle/2779987 https://jamanetwork.com/journals/jama/fullarticle/2779987 3.5 per 10,000 take it up with JAMA and the AJG. do you do SCREENING or DIAGNOSTIC/POLYP REMOVAL? because there's a difference. And it has nothing to do whether i use google.com or chat.whatever.com to find that out.
        bonsai_spool 5mo ago
        > do you wanna keep harping on the fact i used LLM as a fucking search engine? You didn't give me a source before now, so I unfortunately had no other source to challenge except the LLM! > https://jamanetwork.com/journals/jama/fullarticle/2779987 https://jamanetwork.com/journals/jama/fullarticle/2779987 3.5 per 10,000 Different source, friend. Please note that they say 3.1, not 3.5. That is at about 25% less than 4 (and even less than 5, let alone your previous assertions). And if either you or your LLM troubled yourself to read the article, even this is a confounded number in that we cannot determine whether low-volume, 'community' operators are worse than high-volume settings. > do you do SCREENING or DIAGNOSTIC/POLYP REMOVAL? We are talking about screening—once you have a target to remove, you are looking at a high-likelihood-of-cancer population. I am fully aware of this, so I don't understand why you are bringing up this difference which has not yet figured into our discussion. Is this something your LLM suggested to you? --- I think the thing to take away is that LLMs do not yet replace human understanding and discretion.

BobbyTables2 5mo ago

The real risk is getting a doctor that is more interested in money than medical care. These seem to be more like 3000-5000 per 10000.