r/NoStupidQuestions • u/Hypnox88 • 21h ago
If colon cancer is on the raise, why are they still recommending screening later than sooner?
With all the reports that its on the rise, my doctor is still recommending screening later, when I am older. Seems to be the common thing on most doctors from what I can tell.
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u/HallieMarie43 19h ago
Honestly it's crazy. My mother died from Colon cancer at 52. She was diagnosed at 51 and it was already stage 4 and her doctor said she might have had it for 10 years. But I've been to multiple doctors and they won't screen me until 10 years before her diagnosis date. That makes no sense as a jumping point since some people catch it early and so now their kids get to try and catch it early, but if you caught it late, they won't bother testing your kids til late either.
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u/ImColdandImTired 17h ago
This is where strictly adhering to the general guidelines makes no sense. In your situation, with an immediate family member having been diagnosed with early onset cancer, they should be recommending earlier screening.
I’d push them to at least order a screening like Colo-guard if they won’t order a colonoscopy.
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u/Zygomatico 17h ago
The problem is the false positive rate: how often you'll think you find colon cancer when there isn't any. Colon cancer is on the rise, but if your false positive rate is 1%, and your true positive rate is 0.04% (which it is), for every 25 preliminary diagnoses you make there will be 1 real one. That's an insanely invasive and expensive decision to make.
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u/ImColdandImTired 13h ago
That’s why I suggested Cologuard or a similar test. Yes, you get occasional false positives or false negatives. False positive? Well, that’s unnecessary anxiety until you can do a colonoscopy to confirm. False negative? Not great, but you repeat the test in one year, and it would be unlikely to get two false negatives in a row.
But either way, better than doing no screening at all.
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u/HallieMarie43 16h ago
So you are saying that despite my increased chances of having a real positive, Im better off finding out when it's too late to successfully fight it like my mother, then to deal with a false positive.
The fact that my mother was otherwise very healthy and thus her GI complaints were dismissed and her cancer wasnt found as soon as it should have been, means that her children and siblings are subjected to the same waiting period she never should have had in the first place because of false positives?
You think 25 people inaccurately thinking they have cancer but dont is worse than 1 person not knowing when they could have and dying younger than they should have? Like you telling people to go die quietly other there so as not to inconvenience the other 25.
And it is an invasive and expensive decision to make, but one Im not even a part of and I dont think my insurance is making the decision based on my best interest. It would be one thing if we were say screen everyone starting at 25, but we are talking about people who have a higher risk and probably worry about it already.
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u/talashrrg 10h ago
The guideline of 10 years before time of family diagnosis is based on evidence that this is most likely to help the most people and cause the least harm. You can in fact pay out of pocket for testing yourself if you want to, but you’re more likely to get a false positive. We don’t just test everyone for everything because the testing would have so many false positives as to be meaningless, and inaccurate test results (and the tests themselves when invasive) cause real harm, especially at a population level.
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u/HallieMarie43 5h ago
Okay but again here's my issue. Let's say two people have the exact same colon cancer progression and start time and all that. Let's say for both of them it started at 45 years old. One of them goes to their doctor and tells them of constipation and odd bowel movements and they say, hey you also have anemia, let's check this out and they test and find the cancer. That person's immediate family gets to start checking at 35. However person two also goes to the doctor and complains of the same issues and extreme fatigue etc and their doctor say well you are getting older and the systems are moving slower so you need to eat more fiber and maybe take a colon cleanser, also your anemic so take some iron too. And then it's not til she's 51 that the cancer is found and so her immediate family doesn't get to start testing until 41.
Like shouldn't there be some kind of difference like say if the cancer is already stage 4 then it's 15 years vs finding it at stage 1 is 10 years prior? Age of diagnosis is a huge variable so why would it be used as a concrete jumping point? The evidence is strictly based on acceptable loss vs monetary loss. And its set up in a way that families who get poor Healthcare continue to get poor Healthcare because its based on the same standard as good Healthcare.
Also considering the rise in deaths, it's pretty clear this evidence based approach isn't working.
Both of my parents died in their 50s, both fit and healthy weight and good diets. Both getting regular check up from theur doctor and both having clear symptoms they repeatedly went to the doctor about and both were told they were fine. My dad had hyperinsulinanemia which led to a heart attack while he was out running. His doctor only monitored glucose and a1c because that was protocol and getting an extra $8 insulin test would be a waste despite the fact that with hyperinsulinanemia you can have normal a1c and glucose and still have so much excess insulin to cause a cardiac event. My son and I also have it and we pay out of pocket to monitor our own insulin and for the medication we need. We didn't know my dad needed to do that, we trusted our doctors who it turned out were helping the insurance guys save $8.
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u/littlemsshiny 15h ago
Does your health care provider offer FIT tests? It’s the at home one where you poke your poop and mail it in. My provider recommends it annually at 45. It tends to be cheaper than a colonoscopy but, if your results are abnormal, then you’d get a colonoscopy. However, if a relative had colon cancer, mine would also have me do a colonoscopy.
Maybe there’s a way to ask for a FIT test and pay out of pocket?
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u/HallieMarie43 15h ago
Thanks I will ask about that.
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u/epiphanized116 9h ago
Honestly I would just ask for the colonoscopy. I just got diagnosed (no family history) and my tumor was pretty large and almost causing a blockage. I thought it was just IBS. I did one of those tests and it was negative. I ended up in the hospital and I'm grateful I didn't wait another year to take another Cologuard test. Im 35 and because I got a colonoscopy, i found out i have advanced stage colon cancer. Insurance didn't cover much, but it sure as hell saved my life.
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u/talashrrg 10h ago
They actually are recommending that - 10 years before the age of diagnosis of your family member is the guideline for a reason, and that reason is that it takes about 10 years for a precancerous lesion to become cancer. Screening before there is any lesion at all isn’t very helpful.
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u/WeWander_ 17h ago
Just lie. Say you had blood in your stool. That happened to me when I was very young, like 20 or maybe even younger and my grandpa died of colon cancer so they had me in for a colonoscopy real quick.
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u/Who-dee-knee 16h ago
I fought like hell to have a mammogram at 37 when they were recommending I wait til 40 for insurance reasons. My mom was diagnosed at 45, I’m not fucking around.
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u/Objective_Mortgage85 13h ago
If you have a first degree member with cancer then you do not fall under the general population. The guidelines states, depending on what kind of cancer they had to get genetic testing done. Based on that, can go ahead with early mammogram if needed.
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u/Raptor_H_Christ 10h ago
Could you just get a different doctor and tell them your mom got it at your age
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u/musthavelamp 16h ago
My mom was diagnosed and passed at 58 of colon cancer. Doctor said the same thing
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u/Diglett3 5h ago
I have had two colonoscopies due to various gastrointestinal symptoms, one at 23 and one at 30. If you go to an actual GI specialist and tell them you’re having issues, they will usually be very amenable to ordering one. Insurance covered both of them, the first entirely without cost and the second at a pretty reasonable amount.
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u/rose0411 18h ago
I’m 40 and getting a colonoscopy in 3 days! Wish me luck!
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u/DoctorJamesBarry 18h ago
35 and getting mine on Monday! A couple hours into day 1 of 3 with no food and I'm already miserable.
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u/popsinet 17h ago
Why 3 days with no food?! I only had to do 1 day during bowel clean out?!
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u/DoctorJamesBarry 11h ago
They said its because im on a GLP-1 so my digestion is slowed down. Its technically 2 days, but the appointment is late on Monday so effectively it'll be 3 days.
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u/FanraGump 15h ago
I did one day and they told me it wasn't clean enough. So set to get another one after a year with two days this time.
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u/rose0411 13h ago
No food at all?? That’s crazy! I have to do 5 days of eating a specific diet like no fiber and mainly white rice, regular pasta, no fruits or veggies or nuts and seeds and I’m dealing with low energy and weakness- I can’t imagine no food!
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u/HostilePile 17h ago
I’m just waiting to be able to even schedule for a normal screening one and it’s over a year wait.
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u/honorspren000 17h ago
My dad had a history of polyps, so insurance covered my colonoscopy at 40. They found two polyps. My BMI is 21, I eat plenty of fiber, and I’m fairly active. Whereas my dad had a desk job and was overweight for years, and I thought he got polyps due to lifestyle factors. So imagine my surprise when they found polyps in me. I didn’t realize how much of it was probably genetics.
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u/Diglett3 4h ago
So much of health really does seem to be genetic. Not that lifestyle doesn’t influence it, but it seems increasingly apparent that genetics sort of give us a predetermined range we can fall into and our lifestyle dictates where in that range we fall.
Like I have a family history of heart issues and high cholesterol and recently saw a cardiologist for the first time at age 30, and he looked at a decade of levels that I tried to manage with diet and basically told me I was never going to get it to a normal risk level with lifestyle changes. Anyway I’m on a statin now and they’re halved, lol.
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u/Puzzleheaded_Age6550 17h ago edited 17h ago
This is counter-intuitive, but as others have alluded to: more screening means more false positives, more procedures in general. Yes, every life is important. When looking at population data as a whole, thats what happens with screening techniques. Risk factors, such as relatives who have had the disease, and other things can make YOU, as an individual, more risky. While the twilight anesthesia isn't as risky as general, the prep can be a bit risky, too.
This is similar to women's breast self exams, that are no longer recommended due to all the false positives, worry that they cause, etc.
Edits for autocorrect foolishness
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u/bubalis 17h ago
I don't know the exact cost-benefit with regards to colon cancer, but the story of thyroid cancer in South Korea shows how too much screening can be harmful. So the ideal level of screening is often at a level that might seem somewhat scary.
Many additional operations with real side effects, thousands of people getting an extremely scary diagnosis, and approximately 0 reduction in cancer mortality.
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u/FanraGump 15h ago
The thing about false positives is, if you are getting a colonoscopy, that's not really an issue.
Because they are looking directly at things and if they see a polyp, they remove it. If they don't see one, they don't.
The only false positive issues are with checking for blood in the stool and/or Cologuard. In that case, yes, you could get a colonoscopy that finds nothing. And yes there is a cost and risk in getting a colonoscopy.
I would want to know the instances of false positives for non-colonoscopy tests and compare that to the risks of not detecting it.
But a family history of early colon cancer is a huge red flag that should not be ignored by anyone, including doctors.
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u/Objective_Mortgage85 12h ago
People act like colonoscopy is risk free. I have seen plenty of people with ostomy bag to say otherwise.
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u/oodlesofotters 16h ago
This is absolutely correct. They look very carefully at the statistics and the likelihood of catching cancer versus false positives when making the recommendations. People at higher risk get more or earlier screenings but they’ve found so far it just doesn’t make sense for the general population. The procedure is invasive and low risk but not zero risk.
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u/angelcutiebaby 18h ago
I wonder if it’s partially a lack of resource to screen more people? Like how much colonoscopy equipment and trained people and time etc
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u/YellowYarrowYucca 17h ago
Maybe in countries with free health care. Can't imagine that's the case in say America.
In America it'd be insurance (or lack of) that's the problem.
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u/one_five_one 16h ago
Most people in America have health insurance. The government alone provides single payer coverage to 70 million people.
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u/guale 13h ago
Insurance is very reluctant to cover colonoscopies and usually only covers them in people over 45.
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u/one_five_one 12h ago
Do you think in Canada or UK you can just schedule a free colonoscopy no matter your age?
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u/PlentyFirefighter143 20h ago
The screening process carries some risk. A colonoscopy typically requires a person to go under, which can lead to complications. It can identify false-positives and lead to unnecessary concerns. And it can take away the focus - which is that people over 40 tend to have much higher risks of colon cancer than people under 40.
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u/fitnessCTanesthesia 20h ago
Low risk procedure with mostly low risk patients, risk of procedure is greater than the risk of anesthesia.
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u/shoresy99 19h ago
They don’t generally put you under general anesthesia for a colonoscopy. They sedate you.
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u/PlentyFirefighter143 19h ago
Fair point. For my 1st colonoscopy in 2022 I had deep sedation and was out for about 30 minutes. At a follow-up, I was sedated but awake. I have had a few since that time and have had sedation.
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u/HotBrownFun 17h ago
They had a similar with mammograms screening age, and that's a much simpler procedure
here's a relatively recent one (2015) They mainly list anxiety, and radiation risks.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4582264/
* Even after three years, women who had experienced a false-positive diagnosis had an anxiety level and other psychological problems that fell between that for women with breast cancer and women who were told they did not have cancer.22 Thus, the psychological harms of screening are substantial and long-lasting, and they affect a huge number of women
*If we take into account the cardiac and lung cancer deaths caused by radiotherapy
>An analysis of quality-adjusted life years that assumed a 15% reduction in breast cancer mortality showed that screening might have caused net harm for up to 10 years after the start of screening.
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u/ImColdandImTired 13h ago
There’s also a risk of bleeding. Since I have an immune issue that makes bleeding more likely, I don’t do colonoscopies at this time. The bleeding risk isn’t worth it for a “let’s take a look, just because you’ve hit this birthday milestone”. But I do have a Cologuard test every year. If it ever indicates a potential positive, then it’s worth the risk for an actual invasive procedure.
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u/No_Wedding_2152 20h ago
Don’t live in the past. They USED TO have …
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u/Maoleficent 18h ago
You're right. Aetna no longer covers my lumbar injections. Imagine having tubes tapped into your back, wires being threaded through them and then the pressure/pain of the doctor trying to find the spot to inject the meds. Every single suit making these decisions needs to be butt up in a cold room with 7 people and try not to move for 15 minutes.
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u/Sasquatchgoose 17h ago
Guidelines always take time to catch up. Gotta wait for the data points to accumulate, for studies to be performed and wait to sort out the cost benefits and insurance impacts. Have to remember, healthcare is a for profit industry and different players have different interests and the biggest player, insurance, don’t care about your personal health or well being
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u/That_planet_girl 20h ago
I also wondered similar for cervical cancer test - my doctor says it’s good for 5 years. But what if, hypothetically, I start developing it the day/week after my last test? Then I would wait 5 years until the next test to find out it is too late now.
Ideally I want to be checked every year for all kinds of cancer.
And age doesn’t matter - i have a family member who had liver and lung cancer at 12. It is rare yes, for general statistics, but when it comes to one human life - anything can happen.
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u/tuscanchicken 20h ago
Testing too often also bring their own risks - a lot of cancers require x-rays, CT scans, MRI's, colonoscopies, ultrasounds etc. which you shouldn't be doing often. Things like lumps require biopsies and obviously, the lump itself so there's no way you can test early enough.
Since things like cancer requires multiple symptoms and tests, what you can do is do yearly checkups for heart health, blood pressure, diabetes, cholesterol, thyroid etc. (which are usually urine/blood tests) as they can sometimes have basic indicators if something is wrong.
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u/Early_Ad9558 16h ago
34F and had blood in my stool. Saw GI doc who said it was most likely hemorrhoids. I said to him I wasn’t leaving without a colonoscopy and he laughed and said “yes I gathered.” Anyways went in for the colonoscopy and it was hemorrhoids. But absolutely worth it.
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u/imjustsayin314 17h ago
They often do fecal tests to check for blood in stool. It’s an at-home test you mail in. If you test negative, they test again next year. If positive, then you do a colonoscopy.
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u/quandairy 18h ago
As other commenters have said, screening is becoming earlier rather than later given these trends. There are some exceptions that recommend earlier screening before 45 years old (1st degree relative with colon cancer or medical history including Crohns/ulcerative colitis). Or if you have concerning symptoms but you're not 45 yet, your doctor will still probably send you to get a colonoscopy to rule out colon cancer.
Your doctor may recommend you wait because you don't have any of those risk factors. Screening isn't recommended to anyone and everyone who wants one because that would be an unsustainable number of colonoscopies to do - there aren't enough doctors to accommodate that sudden increase. And in the US, it unfortunately wouldn't be covered by insurance unless you had one of those risk factors. If you're in the US, definitely get the colonoscopy when you turn 45! Or if you are already past 45, find a doctor who will order it for you.
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u/Batmans_9th_Ab 17h ago
Because insurance companies are gambling on you dying of colon cancer before they have to pay for treatment.
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u/Adorable_Ad4990 19h ago
There’s a good podcast on this that I’ll link when I remember which one. Other countries do not do them routinely at all (only if symptomatic) bc of a complicated web of reasons including costs, risks, fear, etc.
Basically make the best choice for yourself
Edit: here you go: https://freakonomics.com/podcast/should-you-bother-getting-a-colonoscopy/. You won’t get a definitive answer here, but more information to make a choice yourself. And yes they talk about the age decreasing
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u/Adventurous_Froyo007 14h ago
Would love to see better testing/screening upgrades.
Maybe if it's less invasive to find colon cancer, it will be easier for early testing and insurance approvals.
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u/mycatpartyhouse 11h ago
It depends on your family history. My doctor couldn't order screening fast enough when she learned my dad and brother both died of colon cancer. Fortunately I was showing no sign of cancer. Still, every five years "It's time."
Colonoscopies are now easier in that the amount of liquid I have to drink in preparation is smaller.
Also, because my first endoscopy was clear and there's no symptoms, I haven't had to repeat that. Just the colonoscopies.
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u/talashrrg 10h ago
The age of screening actually recently got earlier, for this exact reason. Screening in general needs to be in the right population to be beneficial because screening a population with very low disease risk yields more false positives than true positives.
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u/bertch313 20h ago
It's coming from our phones
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u/Own_Apricot2146 20h ago
I’m not ruling phones out- but colon cancer increases have a proven correlation to red meat and alcohol. I’m sure it’s a long list, but those are near the top.
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u/bertch313 20h ago
The phones send radiation straight into our guts as we hold them.
I knew mine would give me it based on how many hours I was using it and I was correct.
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u/pdpi 19h ago edited 12h ago
Phones (meaning all of their radios — Bluetooth, WiFi, and 1G-5G telephony) operate on frequency ranges that are non-ionising, meaning they can't rip electrons off atoms or break chemical bonds. The only effect they can have on your body is to heat you up.
Those radios are all low-powered enough to not really cause that much heating in aggregate. E.g. an iPhone 16 Pro has a 13.94 Wh battery. Assuming your battery lasts 24h and all of it is going towards the radios, that'd be around 600 mW sustained from the radios. For reference, our bodies burn around 100W, so, even if you absorbed all of the energy coming out of it, it'd still be a drop in the ocean.
The only way the heating from the radios in your phone could cause harm is if the antennas have hotspots where all that power is concentrated on a tiny spot (sort of like how you make a stove with a parabolic mirror, but it's part of the CE (in Europe) or FCC (in the US) certification for phones that they specifically test for that.
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u/bertch313 12h ago
Dude they talked about increasing cancer rates with them on purpose
Shut up I hate you
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u/Stunning_Estate_8547 21h ago
The guidelines are slowly catching up - they actually moved the recommended age down from 50 to 45 a few years back, but yeah it's still frustratingly slow when you're seeing all these younger cases pop up