Colonoscopy – Just Do It (an almost forgotten post)

I came across this post in my collection of unpublished drafts. I thought I posted this but obviously I didn’t. This article link was intended to be posted before Colorectal Cancer Rates Rising in Ages 50-54. Better late than never, I guess.

More than one quarter of colonoscopies carried out in Americans aged 30 to 49 years reveal some type of neoplasm, and slightly over 6% of these patients have advanced cancer, results of a nationally representative endoscopic registry show.

One Quarter of 30–49-Year-Olds Have Abnormal Colonoscopy Results – Medscape – Jun 07, 2021. — https://www.medscape.com/viewarticle/952536?src=rss#vp_1
APL = Advanced Premalignant Lesions. CRC = Colorectal cancer.

Also see Study Finds Sharp Rise in Colon Cancer and Rectal Cancer Rates Among Young Adults and Diet and Colon Cancer Risk – CBS News.

Colorectal Cancer Rates Rising in Ages 50-54

During the period 1992–2018, there were a total of 101,609 cases of CRC among adults aged 45–59 years. Further analysis showed that the CRC incidence rates rose from 23.4 to 34.0 per 100,000 among people aged 45–49 years and from 46.4 to 63.8 per 100,000 among those aged 50–54 years. Conversely, incidence rates decreased among individuals aged 55–59 years, from 81.7 to 63.7 per 100,000 persons.

Colorectal Cancer Rates Rising in People Aged 50 to 54 Years – Medscape – Nov 11, 2021 – https://www.medscape.com/viewarticle/962769?src=rss#vp_2

I am posting a link to this article as I enjoy the effects of 238 grams of Miralax mixed with a gallon of sports beverage and/or water. It certainly takes your mind off of not eating all day.

New Blood Test Improves Prostate Cancer Screening – the Stockholm3 test

On July 9 2021, results from the STHLM3MRI study were presented in The New England Journal of Medicine, indicating that over-diagnosis could be reduced by substituting traditional prostate biopsies with magnetic resonance imaging (MRI) and targeted biopsies. The new results, now published in The Lancet Oncology, show that the addition of the Stockholm3 test, which was developed by researchers at Karolinska Institutet, can be an important complement. It is a blood test that uses an algorithm to analyze a combination of protein markers, genetic markers and clinical data.

Karolinska Institutet. “New blood test improves prostate cancer screening.” ScienceDaily. http://www.sciencedaily.com/releases/2021/08/210813100313.htm (accessed August 14, 2021).

Dumb and Dumber – Noncompliance with Colonoscopy Post Positive FIT

Results Some 88 013 patients who were FIT positive complied with colonoscopy (males: 56.1%; aged 50–59 years: 49.1%) while 23 410 did not (males: 54.6%; aged 50–59 years: 44.9%).

The 10-year cumulative incidence of CRC was 44.7 per 1000 (95% CI, 43.1 to 46.3) among colonoscopy compliers and 54.3 per 1000 (95% CI, 49.9 to 58.7) in non-compliers, while the cumulative mortality for CRC was 6.8 per 1000 (95% CI, 5.9 to 7.6) and 16.0 per 1000 (95% CI, 13.1 to 18.9), respectively. The risk of dying of CRC among non-compliers was 103% higher than among compliers (adjusted HR, 2.03; 95% CI, 1.68 to 2.44).

Conclusion The excess risk of CRC death among those not completing colonoscopy after a positive faecal occult blood test should prompt screening programmes to adopt effective interventions to increase compliance in this high-risk population.

Non-compliance with colonoscopy after a positive faecal immunochemical test doubles the risk of dying from colorectal cancer — https://gut.bmj.com/content/early/2021/03/30/gutjnl-2020-322192?rss=1

Help me understand human behavior. You get a positive FOBT or Cologuard test and your doctor says you need a colonoscopy but you decide not to follow up and follow through with the scope.

SMH.

Sex Differences in Coronary Artery Calcium and Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in Adults With Diabetes

Sex Differences in Coronary Artery Calcium and Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in Adults With Diabetes: The Coronary Calcium Consortium

RESULTS Among 4,503 adults with diabetes (32.5% women) aged 21–93 years, 61.2% of women and 80.4% of men had CAC >0. Total, CVD, and CHD mortality rates were directly related to CAC; women had higher total and CVD death rates than men when CAC >100. Age- and risk factor–adjusted hazard ratios (HRs) per log unit CAC were higher among women versus men for total mortality (1.28 vs. 1.18) (interaction P = 0.01) and CVD mortality (1.47 vs. 1.27) (interaction P = 0.04) but were similar for CHD mortality (1.48 and 1.48). For CVD mortality, HRs with CAC scores of 101–400 and >400 were 3.67 and 6.27, respectively, for women and 1.63 and 3.48, respectively, for men (interaction P = 0.04). For total mortality, HRs were 2.56 and 4.05 for women, respectively, and 1.88 and 2.66 for men, respectively (interaction P = 0.01).

CONCLUSIONS CAC predicts CHD, CVD, and all-cause mortality in patients with diabetes; however, greater CAC predicts CVD and total mortality more strongly in women.

Sex Differences in Coronary Artery Calcium and Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in Adults With Diabetes: The Coronary Calcium Consortium — Diabetes Care 2020 Oct; 43(10): 2597-2606. https://doi.org/10.2337/dc20-0166

Cardiac Testing Post COVID-19: Of Echos and MRIs — The Skeptical Cardiologist

CVCT CardioBrief published online earlier this week a letter from a group of “clinicians, researchers and imaging specialists” who are concerned about the “presentation, interpretation and media coverage of the role of cardiac magnetic resonance imaging in the management of asymptomatic patients recovered from COVID-19.” It’s short and sweet but makes many excellent points. Let’s…

Cardiac Testing Post COVID-19: Of Echos and MRIs — The Skeptical Cardiologist

Excellent post. Thanks for sharing your expertise Dr. Pearson.

How Accurate Are Pulse Oximeters Labeled Not For Medical Use? — The Skeptical Cardiologist

I mentioned in my post entitled “Should You Utilize A Home Pulse Oximeter During COVID-19?” that I had purchased a home pulse oximeter and had used it to monitor my oxygen saturation (SpO2) levels during the time I had COVIDesque symptoms recently. Personally, I felt the device was returning accurate information and was helpful in…

How Accurate Are Pulse Oximeters Labeled Not For Medical Use? — The Skeptical Cardiologist

And if you decide not to read Dr. Pearson’s entire article here’s your take home message:

During my illness I would measure my SpO2 twice daily and at times when I felt short of breath. When I felt the worst I noted the SpO2 had dropped to 95%. Within 24 hours it rebounded and I recorded >96% thereafter.

If the SpO2 had progressively dropped and consistently showed values <90% I would have contacted my primary care physician and described the constellation of signs (pulse rate, respiratory rate, BP, and SpO2) and symptoms (shortness of breath, cough, headache, fatigue, etc.) that I had and seek his advice on what to do

https://theskepticalcardiologist.com/2020/09/12/how-accurate-are-pulse-oximeters-labeled-not-for-medical-use/

I encourage all to read the entire article, links provided above.

Thanks for the research Dr. Pearson.