Is there still a controversy in colonoscopy? The American Cancer Society recommends screening and removal of tumor polyps in colon, but the number is increasing in the last fifteen years

A procedure called a colonoscopy is a tool for cancer screening and can look for tumors, called polyps, that are growths in the colon. The procedure serves as both a cancer screening method and an intervention to stop a Tumor from forming in the first place if it were to turn into cancer after a certain amount of time.

“If a patient gets a colonoscopy, it will be effective,” says the president of the American Society for Gastrointestinal Endoscopy, an association of GI doctors. Petersen says it’s important to focus on the outcomes of the people who actually underwent the procedure, which was about 42% of participants who all lived in European countries, including Norway and Poland.

I was shocked that only a small percentage of cancer were detected by screening. We think that all cancers are diagnosed through cancer screening, that is how we imagine it. We talk about mammograms and colonoscopies all the time,” said Caroline Pearson, an author of the report and senior vice president at the organization.

It’s not likely that the controversy created by this study will lead to changes in U.S. screening recommendations. Karen Knudsen, CEO of the American Cancer Society, says that preventive cancer screenings are the best and most trusted way to save lives. The ACS recommends colorectal cancer screening for adults 45 and older. “There’s no reason to change that direction,” says Knudsen.

Some doctors have been quick to point out that the methods used by endoscopists (doctors performing the procedure) have improved, compared to 2009 when the European study began.

The incidence of colorectal cancer has gone up significantly in the last 15 years, according to a research scientist at Kaiser Permanente. He says that the equipment and preparation methods have improved, and that patients are required to fast and drink a specially formulated drink to help clear the GI tract before the procedure. Corley says that the physician’s ability to detect and remove polyps is better. The benefit we would expect to find would be higher if the study were to start now.

If you have a family member who’s had colon cancer, especially if they’re at a young age, then you should have a colonoscopy,” Corley says. If you’re not at high risk, he says, you should pick the test that you’ll be able to complete, whether that’s a colonoscopy or one of the less invasive and more frequent stool-based tests.

Patients at Kaiser Permanente opt for the FIT tests more commonly. At Kaiser, Corley says that the biggest hurdle is remembering to take the test, so they mail stool-based tests to patients and then keep contacting them until tests are sent back.

Corley says the approach has its plus and minuses. If the stool sample test is positive, then a colonoscopy will likely be recommended to get a better look and remove any polyps. There are small risks associated with colonoscopies, including the risk of a tear in the colon, bleeding at the site of a biopsy, and possible side-effects from anesthesia.

The impact of screening on cancers and how screening tests can be improved: The NORC/JUPONS study published by E.A. Pearson

The remaining diagnosed cancers tend to be found when someone has symptoms or seeks imaging or medical care for other reasons, suggests the report, posted online Wednesday by researchers at the nonprofit research organization NORC at the University of Chicago.

There has not been much data in the medical literature on cancers that are detected by screening, she said, adding that she hopes the report draws attention to the importance of cancer screening, the need for more tests and the need for more data on how cancers are diagnosed, including the important role that screening tests play in catching cancers early.

Pearson said that we could better understand how cancer affects different populations and how we can improve equity with more robust data. “For the researchers of the world, I would love for people to dig into some of these estimates and some of the geographic variations that we’re seeing to understand how we can begin to shape the public policy environment to improve treatment across the country and improve screening across the country.”

Dr. Otis Brawley, an oncology professor at Johns Hopkins University, said he was not surprised by the findings in the new report – especially because some cancer screening tests can be improved in their performance.

“We spend so much time pushing screening and pushing screening tests – yes, they do save lives, but we need to be able to save more lives,” he said. “We need better.”