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Colonoscopy: Is It Worth The Risk?

by Konstantin Monastyrsky

Below is a verbatim transcript (and additional embedded commentaries) of my investigative report in four parts. You may find them handy if you are troubled by my accent, or speed of delivery, or too many facts, or small video size, or poor connection to the Internet, or your office restrictions on watching videos, or what have you.

Part I. The Anatomy Of A Deadly Deception

Greetings!

My name is Konstantin Monastyrsky. I am a medical writer [bio], performance nutrition consultant, and an expert in forensic nutrition [about]. This new field of life science investigates connections between supposedly healthy foods and undeniably lethal diseases.

Colorectal cancer is one of such diseases. It is the most dominant and the deadliest nutrition-related cancer — close to one hundred sixty thousand new cases diagnosed annually in the United States alone. [1]

So our desire to prevent it isn't surprising, especially when we are told that regular colonoscopies after age fifty make colorectal cancer "more than 90% curable — but only if you get tested in time." [2]

Actually, this is a lie! Screening colonoscopies do not prevent or materially reduce anyone's risk of colorectal cancer regardless of age. And if anything, they may actually increase your overall risk of cancer, and not just colorectal.

Here are the true facts:

First, according to the American Cancer Society, up till now… “…There are no prospective randomized controlled trials of screening colonoscopy for the reduction in incidence or mortality of colorectal cancer.” [3]

Cancer Journal for Clinicians

The National Cancer Institute is even more explicit:“…it is not yet known for certain whether colonoscopy can help reduce the number of deaths from colorectal cancer.” [4]

NCI Regular Colonoscopy

This means that the 90% cure rate figure cited by Ms. Couric back in 2000 is pure fiction. It also means that most of the fourteen million plus screening colonoscopies [5] performed annually in the United States to the tune of twenty to thirty billion dollars aren't recommended on the basis of rock-solid research or clinical indications, but on the willful misinformation of the American public, consumer fraud in other words…

Second, according to the analysis of actual outcomes, ‘screening colonoscopies‘ are essentially useless: “The patients in all the studies had at least one adenoma detected on colonoscopy but did not have cancer. They developed cancer in the next few years, however, at the same rate as would be expected in the general population without screening.” [6]

New York Times Colonoscopy Effectiveness

Third, colonoscopies aren't as safe and simple as you may think or are led to believe: “Colonoscopy can result in significant harms, most often associated with polypectomy, and the most common serious complication is post-polypectomy bleeding”, and “Another significant risk associated with colonoscopy is perforation,” of the colon, that is... [3]

Colonoscopy Harm

And that is even before taking into account your stress, anxiety, false positives, frequently missed polyps and tumors [7], and all of the usual recovery-related complications, such as infections, constipation, diarrhea, hemorrhoids, diverticulitis, and others.

But all these risks pale in comparison with 'computed tomography,' known as virtual colonoscopies. Incredulously, instead of preventing your risk of cancer, they actually increase it by exposing you to five to ten millisieverts of x-ray radiation required for just one abdominal scan.

 According to the United States Food and Drug Administration... "This range is not much less than the lowest doses of five to twenty millisieverts received by some of the Japanese survivors of the atomic bombs." [8]

FDA Quote

Goodness gracious... Radiation levels from a single virtual colonoscopy are similar to the atomic bomb exposure in Hiroshima, even though, according to The National Cancer Institute: “Whether virtual colonoscopy can reduce the number of deaths from colorectal cancer is not yet known.” [4]

NCI Virtual colonoscopy

But the really frightening part comes next: "This increase in the possibility of a fatal cancer from radiation can be compared to the natural incidence of fatal cancer in the U.S. population, about 1 chance in 5." [8]

FDA Quotes

In other words, a single, virtual colonoscopy turns an otherwise absolutely healthy person with a lifetime risk of colon cancer under 5% into a cancer-prone sitting duck with a 20% risk of contracting any type of cancer.

Author's commentary: Please note that my statement above is incorrect. According to the FDA document I cited, the risk of fatal cancer from a single CT-related radiation exposure isn't 1 in 5 but 1 in 2000. Neither myself, nor my editors, nor the numerous readers of this material have noticed this error until  December 5th, 2013, when I received a note from a concerned reader who has noted my error. Here is what the actual text had said:

"A CT examination with an effective dose of 10 millisieverts (abbreviated mSv; 1 mSv = 1 mGy in the case of x rays.) may be associated with an increase in the possibility of fatal cancer of approximately 1 chance in 2000. This increase in the possibility of a fatal cancer from radiation can be compared to the natural incidence of fatal cancer in the U.S. population, about 1 chance in 5. In other words, for any one person the risk of radiation-induced cancer is much smaller than the natural risk of cancer." [link]

This is a classical case of "confirmation bias," and I regret misinforming readers by making this unfortunate error. That said, I still think that anyone exposing himself/herself to CT scans in the situations that aren't life-threatening, is making a grave mistake, especially when this "anyone" is a child. The lifetime increase of cancer risk related to radiation isn't linear, but, as a note below explains, "cumulative and exponential." It is even more so in the era of near-constant exposure to cell towers, police and aviation radars, Wi-Fi routers, and the Fukushima- and Chernobul-like environmental disasters.

Furthermore, I don't have any proof to the contrary (and nobody does for sure), but I believe that the claim that the equivalent to getting exposed to 500 regular chest x-rays carries only 1 in 2000 risk of cancer is not true. Feel free to call me a conspiracy nut, but if that risk would be, indeed, that low, people who work in radiology centers wouldn't have to hide themselves behind lead-reinforced walls and wear radiation dose monitors while at work.

Considering these odds, you are actually two hundred times safer living next-door to a Russian-built nuclear power plant your entire life than having just one single CT scan. [9]

And since virtual colonoscopies are now recommended every five years, your cumulative exposure to radiation by the time you reach your seventieth birthday will be similar to witnessing not one, not two, not three, not even four, but five nuclear blasts, and your risk of developing any kind of cancer will be five out of five, or exactly 100%

Author's commentary: The statistical representation of repetitive risk isn‘t a simple linear sum of the totals, but a regressive calculation. In other words, five identical events that increase the risk of an adverse outcome by 20% each, will increase the total risk of adverse outcome to 67%, not 100%, as I rhetorically suggested above.

This regressive analysis of mere risk, however, doesn‘t apply literally to x-ray radiation exposure from periodic CT scans alone. In this case, the rate of cancer risk increase is cumulative and exponential, because each successive irradiation of aging body carries a far greater risk than the previous one five years before.

In other words, the true risk of any cancer from five successive virtual colonoscopies between the ages of 50 and 70 is far greater than 100%. How greater — God only knows, — and I don‘t recommend anyone to attempt  find this out the hard way!

Not surprisingly, the actual incidence of colorectal cancers in the United States has grown by 30,000 more cases annually, a whopping 22% increase in just eight short years. (The incidence of colorectal cancers in the United States has increased from an estimated 129,400 new cases in 1999 [10] to 158,410 in year 2007 [11, page 4].)

Author's commentary: Someone sent me a rather nasty comment suggesting that this increase in the incidence of colorectal cancer demonstrates the success of colonoscopies in detecting and treating early cancers. It very well maybe true. There are, however, four serious problems with this argument:

— First off, the patients are urged to undergo screening colonoscopies to PREVENT colon cancer occurrence with 90% certainty, not to DETECT early colon cancer. For that, you can take a safe, simple, and more economical blood test as often as you like, and without incurring any risk of either getting killed or injured by colonoscopy, or missing a cancer in progress. And I recommend that much in part II for anyone with propensity for hypochondria.

— Second, early detection of asymptomatic colorectal cancer may actually shorten patient's life, because it automatically triggers inevitable biopsy, surgery, and chemotherapy. Otherwise it takes about 10 years for most colorectal tumors to become symptomatic (i.e. large enough to cause problems that requires surgical intervention).

— Third, if you get operated on for a two year-old asymptomatic tumor, your chances of premature death are far greater than if you get operated on for a ten year old tumor eight years later. And you get to live about the same age-adjusted lifespan after the treatment. Thus, doing nothing buys you at  least an extra eight years of normal life and care-free bliss!

— Fourth, there is greater than 95% chance that you will succumb to any other terminal disease or old age before colorectal cancer has a chance to kill you, while any attempt to eliminate that 5% risk of colorectal cancer with screening colonoscopies increases your cumulative risk of death far greater than 5%. To learn why, please watch parts III and IV.

So ask yourself this simple question: would you rather take a 5% chance of dying from a large colorectal tumor eight years from now; or undergo surgery and chemo today, wear a colectomy bag for the next eight years, and most likely die anyway before eight years are up from some other cancer, stroke, or heart attack caused by post-treatment complications?

In terms of cancer, this sharp upsurge is considered an epidemic of catastrophic proportions. So why, then, do doctors recommend colonoscopies if they are unproven, ineffective, risky, and unreliable?

A rotating pile of money, “Money, money...jingle in the background from the musicalCabaret.

That is the answer to that question!

Doctors‘ profit motives aside, Katie Couric isn't exactly a benevolent Samaritan either. She began urging Americans to get screened for colon cancer while she was [being] employed by General Electric, the owner of NBC television.

GE happens to manufacture and sell CT scanners used for virtual colonoscopies. Since each of these room-sized contraptions [link] costs upward of three-and-a-half million dollars, what is a better way to keep them 'minting money' than an indirect endorsement by a big TV star.

Lo and behold, her handlers ruthlessly exploited her husband's unfortunate death from colon cancer to promote colonoscopies. Because Ms. Couric never disclosed her connection to GE Healthcare - a seventeen billion dollar subsidiary of GE and a sister company of NBC [link] — unsuspecting Americans embraced her story, and the number of screenings jumped from under one million before her famous televised colonoscopy in year 2000 to around fourteen million today.

Adding to this hypocrisy, Jay Monahan - Ms. Couric's late husband - passed away at age forty two, eight years before a first screening is even recommended. This, unfortunately, means that neither him nor anyone else in his predicament would have likely been saved…

Based on all the above evidence, I pleaded with Mr. Couric first by mail [link], second on her blog [link], and finally on my site, to stop endorsing or recommending colon cancer screening to 95% of Americans, who are in a low-risk group. Regretfully, she ignored my pleas and never responded.

One change I noticed… After Ms. Couric left NBC for greener pastures at CBS, she no longer refers to the 90% cure rate [link]. Now, it is just a measly 5% reduction of "colon cancer death."

 Katie Couric: “Colon cancer is the second leading cancer killer. But if it is detected early, it has better than 90% cure rate.” (from 2000, [link])

And seven years later…

 Katie Couric: "Colon cancer death are down almost 5% among men, and 4.5 among women." (from 2007, [link])

Sadly, even this small reduction isn't likely related to screenings, and I discuss its probable reasons [link] on this video's transcript page.

After this report had already been taped, the Annals of Internal Medicine — a preeminent publication of the American College of Physicians — released a new research paper concerning the considerable failure of screening colonoscopies to detect and prevent colorectal cancer, particularly in the right colon.

The editorial commentary by Dr. David Ransohoff, the Professor of Medicine at the University of North Carolina at Chapel Hill, states the following [12]:

A goal of avoiding all deaths from colon cancer may be admirable, but we do not have evidence that we can achieve it.

Although colonoscopy is generally safe, it is still an invasive procedure with a 0.2% rate of serious complications —10 times higher than for any other commonly used, cancer-screening test. Repeated examinations over time may incur a substantial cumulative rate of complications, not even counting hard-to-detect complications (if they occur), such as silent myocardial infarction [heart attack — KM].”

Colonoscopy is an effective intervention, but, as Baxter and colleagues suggest, we must realize that current evidence is indirect and does not support a claim of 90% effectiveness.

— So, who, then, should get screened for colon cancer, if anyone?

You‘ll find the answer to this question in the second part of this investigative report.

Author's commentary: After watching/reading the above section, you may ask yourself this completely sensible question:

— How can a scornful Ms. Couric claim a 90% reduction of colon cancer risk while an indignant Mr. Monastyrsky claims no reduction, only an increase?

Oh, that's easy… Just like a horse race, any clinical study can be easily fixed to deliver the desired outcome either by falsifying the trial design, or by manipulating outcome statistics, or both. That's how this 90% figure came about, and until this day I can't locate the original sourcing for this figure.

From this point on, these scams are managed using well-learned and well-practiced formula:

By using cherry-picked references from prestigious medical journals. The articles in many of these journals aren't generally available to the general public, so it's easy to obscure undesirable outcomes and conclusions;

By donating money to not-for-profit associations, whose sole function is to promote their donors. The National Colorectal Cancer Research Alliance was co-founded by Katie Couric specifically for this purpose to funnel “blood money” to promote screening colonoscopies.

By hiring so-called “expert spokespersons” who will endorse and champion anyone willing to pay up, and so on.

And this obfuscation was particularly easy to accomplish in cases of screening colonoscopies, because, unlike drugs, medical equipment, or lab tests, the diagnostic protocols do not, I repeat, do not require anyone's approval or oversight.

As far as my indignation goes, once you too realize that screening colonoscopy can't reduce anyone's risk of colon cancer for the same fundamental reasons you can't crossbreed a cat with a dog, you'll no longer question it.

Part II. Turning A Probable Death Sentence Into A Manageable Risk

Welcome back!

Lets begin by addressing the last question from Part I: Who should get screened for colorectal cancer, if anyone at all?

Well, for starters, lets keep the mortality rate from colorectal cancer in perspective. Even a person in a high-risk group is 12 times as likely to die from heart disease; 10 times — from any other cancer, 6 times — from a medical error [13], 3 times from stroke, and twice as likely to die from an accident… [14]

CDC Mortaility Stats

Considering these stats, the paranoia whipped up by Ms. Couric and her paymasters wasn't, obviously, about saving your life, but about making a buck.

You have also learned by now that regular screenings 5 or 10 years apart are more or less useless, and, adding insult to injury, that virtual colonoscopies may cause all kinds of other cancers.

But even if you ignore all these facts, and decide to get screened as often as every year, consider the outcome of the Minnesota Colon Cancer Control Study [15]. It included 46 thousand patients between the ages of 50 and 80 and lasted for a whopping 18 years.

Minesota Control Study

But in the end, it demonstrated only 0.62% reduction in the incidence of colorectal cancer. Statistically speaking, a difference this tiny was purely a chance happening.

Minesota Control Study

Another prominent trial, known as the Telemark Polyp Study I [16], have been equally discouraging. The absolute difference in the incidence of colorectal cancer between screened patients and controls was only 2%, while the mortally rate from all causes in the screened group was 157% higher than among those who hadn't been screened (In the video I mistakenly indicate 57% instead of 157% — KM) .

 

Here is what it all means:Telemark Polyp Study Result

First, If you are in a low-risk group, regular screenings will very likely increase your chances of death or disease from all other causes;

Second, If you are in a high-risk group, even annual screenings aren't materially helpful.

— And third, if screenings are indeed useless, then a strategy of life-long prevention is the only viable way to escape colorectal cancer, especially for high-risk individuals.

These three conclusions bring up three equally crucial questions:

First, how do you determine if you or your loved ones are at risk?

Second, is it actually possible to prevent colorectal cancer?

— And, third — if it is, indeed, possible to prevent it, what should you do?

So lets address the first question first:

Are you or your loved ones in the high-risk group for colorectal cancer?

I know the answer to this question better than most because I myself have a genetic predisposition to colorectal cancer through my Ashkenazi Jewish heredity and a long history of colorectal disorders. Also, my wife's dad had colon cancer, and this places Tatyana in the high risk group too. And both of us are well past fifty.

Considering this backdrop, we are just as scared as anyone would be in our shoes. So, if you are a confirmed hypochondriac, you may definitely pursue safe and non-invasive stool tests for colon cancer markers as often as you like.

 Stool Tests For Colon Cancer Markers:
— Guaiac [pronounced
gwahy-ak] fecal occult blood test (gFOBT);
— Stool DNA test (sDNA);
— Fecal immunochemical test (FIT)]

If these tests prove positive or there are any unexplained symptoms, you should definitely undergo conventional colonoscopy.

And now, lets address the next question:

— Is it possible to prevent colorectal cancer?

Absolutely! The majority of colorectal cancers aren't hereditary, and the majority of people in the high-risk group never develop one either. This means that colorectal cancer is connected to lifestyle factors just like lung cancer is connected to one's smoking. Eliminate these risk factors, and you'll reduce your chances of getting hit with colorectal cancer for the same reasons not smoking reduces the risk of lung cancer. This ain't rocket science, that's for sure…

Just like with any other cancer, this is not a foolproof enterprise, but for anyone in the high risk group, a strategy of life-long prevention turns a probable death sentence into a manageable risk, and for anyone in the low risk group it just about eliminates the possibility.

Finally, lets address the last question:

— What should you do to eliminate as many risks of colorectal cancer as humanly possible?

There are several external, and, therefore, well-controllable risk factors. They are, respectively: wrong diet, malnutrition, poor bowel habits; side effects of drugs; poor immunity; common colorectal disorders, such as IBS, inflammatory bowel disease; damaged intestinal flora, and some others. To a large extent, all of them are interdependent. This means fixing one positively affects the rest, while neglecting one makes all others more damaging.

To sort out and eliminate all of these risks, please visit my web site GutSense.org. In addition to colon cancer prevention, it also addresses chronic constipation, diarrhea, irritable bowel syndrome, diverticular disease, and related complications. These widespread disorders commonly precede polyposis — the formations of polyps that may eventually turn into deadly tumors.

Obviously, to prevent polyposis, you must eliminate these conditions first. Otherwise, you can zap polyps all you want, but as long as their causes are still there, new ones will pop-up long before your next screening. That, essentially, explains why colonoscopies are so ineffective.

The most tragic aspect of this sad story is also the deadliest… The promoters of this fraud continue to intimidate unsuspecting Americans and their well-meaning doctors into the false belief that 'screening colonoscopies' are the only viable way of preventing colorectal cancer:

Voice of Katie Couric from March, 2007 video [YouTube link]:

“A colon is it's own container. If you can remove the polyp, even before it's cancerous, then you literally nip the disease in the bud.”

Voice of Konstantin Monastyrsky:

For goodness sake, Ms. Couric, please stop lying! The truth is (the following four slides displayed while Mr. Monastyrsky reads highlighted sections) :

From the National Cancer Institute web site [4]:

“…it is not yet known for certain whether colonoscopy can help reduce the number of deaths from colorectal cancer.”

From 'A Cancer Journal for Clinicians' [3]:

“…There are no prospective randomized controlled trials of screening colonoscopy for the reduction in incidence or mortality of CRC [colorectal cancer - KM].”

From The New York Times [6]:

“The patients in all the studies had at least one adenoma detected on colonoscopy but did not have cancer. They developed cancer in the next few years, however, at the same rate as would be expected in the general population without screening.”

From the Annals of Internal Medicine [12]:

A goal of avoiding all deaths from colon cancer may be admirable, but we do not have evidence that we can achieve it.

Colonoscopy is an effective intervention, but, as Baxter and colleagues suggest, we must realize that current evidence is indirect and does not support a claim of 90% effectiveness.

As a result, most people over fifty do nothing to materially prevent it, except praying for the best, and waiting in fear for yet another useless screening that may harm them even more.

I hope this isn‘t you!

Thank you for watching!

I wish you and your family good luck and good health!

Part III. Why Screening Colonoscopy Increases the Risk of Colorectal Cancer

The whole premise of using screening colonoscopy to prevent colon cancer is built around the idea of polypectomy - a medical term for locating and removing precancerous polyps inside the colon, just like explained in this advertorial by “doctor” Couric:

Voice of Katie Couric from March, 2007 video [link]:

“If you can remove the polyp, even before it's cancerous, then you literally nip the disease in the bud.”

But that is not what the polypectomy actually delivers:

First, an estimated 95% of all polyps are benign, they will never become cancers, so removing them makes just as much sense as zapping the moles off your buttocks to prevent melanoma…

Second, not all colorectal cancers are preceded by detectable polyps. It is believed an even larger share of colon cancers start from flat lesions that no one is suggesting to remove, even though they are considered five time as cancerous as large polyps....

Third, removing polyps or even doing biopsies releases cancer cells into the blood stream and the colon's lumen. In turn, these cells may seed all other cancers throughout the body. This phenomenon, of course, is well known to cancer specialists. How do you think researchers infect experimental animals with cancers – they simply collect cancer cells from a donor and inject them into any desired site. In essence, taking out a precancerous polyps may be riskier than leaving it alone.

Fourth, it is a well established fact that new polyps spring like weeds following polypectomy, and probably for the same reason I just mentioned – the release of cancer cells into the body. Unfortunately, as the number of polyps goes up, so do the odds of one of them eventually turning into a cancerous tumor.

Fifth, even the most thorough endoscopists may miss up to 30% of detectable polyps, and the less rigorous routinely miss up to 60%, including actual cancer tumors. All of them, regardless of skill or attention, miss 100% of all polyps in the right colon. Come to think of it, missing polyps may not be such a bad thing, considering just how risky their removal may be.

Sixth, the average age for colorectal cancer diagnosis is 72 years [close to the average lifespan for American men, and just a few years short of the average lifespan for American women – KM.] So commencing invasive screening and polypectomies in asymptomatic people at age 50 is just as absurd as taking contraceptives after menopause;

Finally, seventh, if you have poor blood coagulation, or take regular aspirin as most people past 50 do, or are on a blood thinner such as warfarin [generic name for brands known as Coumadin, Jantoven, Marevan, and Waran – ed.], polypectomy profoundly increases your risk of death from hard to detect internal bleeding which may lead to ischemic stroke, myocardial ischemia, cardiac arrest, or sudden cardiac death.

So, do the simple math to realize just how pointless and dangerous this whole charade is: almost all polyps are benign; removing them is riskier than leaving them alone; more than half of all polyps are undetectable; most cancers don't start from polyps but lesions; you are likely to die from old age before colon cancer strikes you; and your risk of dying from a colonoscopy-related complications may exceed your risk of ever getting colon cancer in the first place.

Or, how about this undeniable fact for proof: If screening colonoscopies and resulting polypectomies were, indeed, effective, with about half of Americans past age fifty getting screened, we should have enjoyed at least a 50% reduction in the incidence and mortality of colon cancer. But, instead, we have a 22% increase in incidence, while the number of deaths remains practically the same. If that is not a proof, what, then, is?

Author's commentary: True, in a best case scenario, screening colonoscopy may catch a colorectal cancer already in progress. But even this chance is actually slim because a 5 to 10 years interval between screenings turns this enterprise into a veritable Russian roulette. And even when a small, early tumor is caught in time, a mandatory biopsy releases cancer cells into the body, setting you up for metastases all over, for unavoidable chemotherapy, and for all other cancers...

In no way am I denying or obscuring the tragic aspects of colon cancer. It is a costly, devastating, and deadly disease. All I am saying is this: Look at the facts - screening colonoscopies make colon cancer even more costly, even more devastating, and even more deadly!

And they do absolutely nothing to prevent colon cancer. To the contrary – by creating a false sense of security, screenings make most people even more reckless and even more exposed to all other cancers. Indeed, why bother with prevention, when you believe that a single doctor's visit every five or ten years will “nip the disease in the bud!” with 90% certainty…

Finally, everyone keeps asking me the same question over and over again:

But how come, Mr. Monastyrsky, does all this information come from you, and not from the doctors?

Let me quote 'The New York Times' for you:

New York Times Quotes

And this is particularly true for cancer, because there is no business more profitable than the cancer business – between diagnosis and death, an average well-insured patient is worth $200,000 to $300,000 to doctors, hospitals, diagnostic labs, and big Pharma. The average healthy patient is worth exactly nothing.

Thank you for watching!

Please click the orange Subscribe button in the upper right hand corner [this applies to videos watched on YouTube], so you don't miss the next episode. Information like this may actually save your life!

Part IV. Why Screening Colonoscopy Increases Mortality?

 

Greetings,

It is an open secret that screening colonoscopies increase mortality.

As far back as in 1996, the Telemark Polyp Study 1 demonstrated that two-and-a-half times as many screened patients had died from all other causes than had been presumably saved from colon cancer by the colonoscopy in the first place.

Author‘s commentary: It‘s worth noting that the Telemark‘s colonoscopies were performed “by the book” at a major metropolitan hospital by experienced GI surgeons, and without any profit considerations or time constraints. Alas, the average endoscopist at a local colonoscopy mill compares to these surgeons just like the presidential physician at the White House compares to a part-time doctor at a neighborhood walk-in clinic, and so do the outcomes.

In no way I wish to disparage the hard work of any doctor at any clinic regardless of its income potential or location. The difference lies in the amount of time and attention allotted to each individual patient, while the President is the one and only patient. This factor alone reduces inadvertent medical errors by a mile.

Just like with any abdominal surgery, there are four primary factors that contribute to colonoscopy-related complications. These are the side effects of colon prep, the aftermath of general anesthesia, endoscopy-related surgical wounds, and medical errors.

Lets review them one-by-one, with emphasis on risk and mortality:

I‘ll start with the side-effects of colon preparation. Normally, the large intestine is filled with fecal matter throughout its entire length. To have an unobstructed view, all feces must be purged clean with a laxative, a procedure known as “colon prep” or “lavage.”  Severe dehydration, kidney damage, and bowel movement disruption are the most common side effects of this step.

With the number of screening colonoscopies growing, the problem became significant enough to get the Federal Drug Administration into the action:

FDA Quote on Phosphate Nephropathy

“FDA has become aware of reports of acute phosphate nephropathy, a type of acute kidney injury, associated with the use of oral sodium phosphate products (OSP) for bowel cleansing prior to colonoscopy or other procedures.”

Over 85,000 people die annually from kidney failure [link] — that is almost 50% more than from colorectal cancer. I believe many of these deaths have been precipitated by a careless and damaging colon prep.

Author‘s commentary: Kidney damage is an especially high hazard for tens of millions of older Americans with diabetes and prediabetes who may already have weakened kidneys. If you are taking the most common hypertension and heart disease medicines, you too are at increased risk.

According to the article entitled "Acute phosphate nephropathy following oral sodium phosphate bowel purgative: an under-recognized cause of chronic renal failure." (J Am Soc Nephrol 16:3389-3396, 2005), the acute phosphate nephropathy — that‘s a term for kidney damage by an osmotic laxative used for prep — may occur in up to 1 in 1000 patients who receive oral sodium phosphate products.

This means that the annual rate of kidney damage related to screening colonoscopy is at least 14,000 cases. Because kidney damage is difficult to detect quickly, the actual rate may be higher. I came across more recent articles that indicated the damage rate as high as 1%, or 140,000 cases.

The prep-related dehydration may result in dizziness, syncope, ischemic stroke, blood clotting, sudden cardiac death, a fall or an accident, medication overdose, and other complications. The death rate related to these side effects is not known.

Bowel movement disruption following colonoscopy commonly leads to chronic constipation, severe diarrhea, diverticulitis, and bowel obstruction. All of these conditions constitute a primary cause of inflammatory bowel disease (Crohn's disease and ulcerative colitis — ed.), that alone increases the risk of colon cancer by 32 times!

Inflammatory Bowel Disease

That‘s right – 3,200%.

Now, lets review the most common side-effects of general anesthesia.

Author‘s commentary: If you have ever experienced even mild flatulence, you must know what the pain from gas pressure feels like. To keep the colon wide-open, doctors pump compressed air into the colon at several times the pressure of gases. For this and other reasons colonoscopy without anesthesia is an extremely painful procedure.

Unfortunately, all types of general anesthesia are extremely risky because it affects blood circulation, heart and lung function, and turns off immunity. Just the confirmed rate of severe cardiovascular risk from general anesthesia for low-risk surgical procedures, such as colonoscopy, ranges from 0.27% to 1.1% within the first six days after the surgery.

Cardiact Complications

Author‘s commentary: According to the same source, “Severe cardiac complications included cardiac death, cardiac arrest, myocardial infarction, ventricular tachycardia, and fibrillation and pulmonary edema.”

That‘s why an anesthesiologist or nurse anesthesiologist must be present for the entire length of the colonoscopy in order to administer the anesthetic and monitor your vital signs.

Deep vein thrombosis and pulmonary embolism is another common side effect related to general anesthesia, even a brief one. Pulmonary embolism causes or contributes to up to 200,000 deaths annually in the United States [link].

Author‘s commentary: Deep vein thrombosis (DVT) is, essentially, blood clotting due to immobility and the slowdown of blood circulation, caused by the anesthetic. The risk of clotting increases with the anesthesia‘s duration. That is why a thorough colonoscopy lasting an hour or more is much riskier than the assembly-line hack jobs that usually take under 10 minutes. It may take weeks for a clot to dislodge and travel up to the lungs, so it‘s hard to connect this outcome to the colonoscopy.

An estimated 25% of all people develop chest infections after general anesthesia, and many older people die weeks or months later from acute pneumonia. Mortality rate from pneumonia is 5%, and about 60,000 people die annually — slightly more than from colorectal cancer.

Finally, lets account for surgical wounds and medical errors.

Accidental colon perforation with endoscope, injuries from air insufflation and/or endoscope, and bleeding from polyp removal with a wire loop are the primary immediate complications of the colonoscopy procedure itself.

According to the “Complications of Colonoscopy in an Integrated Health Care Delivery System” report, the rate of complications from conventional diagnostic colonoscopy, such as colon perforation, bleeding, and diverticulitis, reported at 5 in 1,000, or 0.5%. [link]

  Annals of Internal Medicine

Author‘s commentary: The above study authors indicated that “much of the information on complications has come from studies or referral centers and might not reflect what actually happens in the general community.” This is coded language for “actually, it may be much higher, but we don‘t know just how much higher…”

According to numerous published reports, only [up to — ed.] 20% of all medical errors are ever reported. With this in mind, the actual rate of screening colonoscopy complications may be as high as 20 in 1000, or 2%.

Author‘s commentary: Since the colon‘s environment isn‘t exactly “dry and clean,” an infection often occurs at the polypectomy site and in diverticula, and some of them may require follow-up abdominal surgery to remove the affected portion of the colon.

Finally, don‘t ignore the release of cancer cells into the body caused by polypectomies and biopsies, particularly among younger people. It takes ten years for one polyp in twenty to grow into a cancer tumor. But it takes only a fraction of this time for these cells to turn into all other cancers once they are released into the blood by the very doctor who is trying to protect you from colon cancer.

Our final conclusions “ain‘t” pretty:

— Up to 14,000 potential deaths from kidney damage. That‘s a low-ball estimate.

— The number of deaths from pulmonary embolism related to general anesthesia isn‘t known, but it may be considerable. Knee replacement surgery, for example, causes 1 case of pulmonary embolism per 100 surgeries [link]. In the case of colonoscopy, even one case in 500 is enough to kill 7,000 people annually.

— At least 70,000 patients get injured by colonoscopy according to actual reports. The unreported injury rate may be close to 280,000 or 2%. Considering the type of complications — internal bleeding, colon perforation, diverticulitis, and infections — many of these patients end up dead!

— The annual incidence of colorectal cancer in the United States is up by 30,000 more cases since the colonoscopies begun in earnest in the year 2000. Most likely this increase is directly related to colonoscopy‘s complications. At least 10,000 patients will die shortly after the diagnosis.

— The potential long-term death toll from all other cancers caused by polypectomy-related contamination, and radiation exposure from virtual colonoscopies will be in the millions.

— Lives saved by screening colonoscopy? Even according to Katie Couric, who has a penchant for exaggeration, just 2,500 a year… — In this statistical and logistical context, considering a screening colonoscopy for prevention is akin to committing suicide at the age of 50 to prevent dying from colon cancer by the age 72.

Knowing all this information now, would you bet your bet your life, health, and future on a screening colonoscopy instead of elementary prevention? I hope not.

***

References

Click the [link] to view the source site or document in the new window (when available). The references for this essay were compiled in December 2008 —February 2009. Some of the links may not match at a later date because publishers may revise their web sites. In this case, try searching cached pages on Google, or contact the respective publishers.

1. American Cancer Society. Cancer Facts & Figures 2007. Atlanta: American Cancer Society; 2007. [link]

2. The National Colorectal Cancer Research Alliance, Don't end up saying "if only." Get tested." [link]

3. Levin, B., at al.; Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology CA Cancer J Clin 2008 58: 130-160 [link]

4. Colorectal Cancer Screening; National Cancer Institute; Oct 2008; [link]

5. Seeff LC, et al.; How many endoscopies are performed for colorectal cancer screening? Results from CDC's survey of endoscopic capacity. Gastroenterology. 2004;127: 1670-1677. [link]

6. Study Questions Colonoscopy Effectiveness; The New York Times; G. Colata; Dec 14, 2006; [link]

7. Barclay, R., at al.; Colonoscopic Withdrawal Times and Adenoma Detection during Screening Colonoscopy N Engl J Med 2006 355: 2533-2541

8. What are the Radiation Risks From CT?; U.S. Food and Drug Administration; Center For Devices and Radiological Health; August 6th,2008; [link]

9. Jerry M. Cuttler; What Becomes of Nuclear Risk Assessment in Light of Radiation Hormesis? Proceedings of the 25th Annual Conference of the Canadian Nuclear Society, Toronto, June 6-9, 2004 [link, Word document]

10. Rudy, D, et al.; Update on Colorectal Cancer; American Family Physician; March 15, 2000; [link]

11. Cancer Facts & Figures, 2007; Atlanta: American Cancer Society; 2007, page 4  [link]

12. Ransohoff, D.; How Much Does Colonoscopy Reduce Colon Cancer Mortality? Ann Intern Med 2008; 60520-308. [link]

13. D. W. Bates; et al.; Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group JAMA. 1995;274(1):29-34. [link]

14. FASTSTATS A to Z; National Center for Health Statistics, Centers for Disease and Prevention; [link]

15. Mandel, J, at al.; The Effect of Fecal Occult-Blood Screening on the Incidence of Colorectal Cancer; N Engl J Med 2000 343: 1603-1607 [link]

16. Thiis-Evensen E, et al.; Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I.; Scand J Gastroenterol. 1999 Apr;34(4):414-20. [link]

 

The following references apply to the sources mentioned on the Home page and throughout this section:

— Complications of Colonoscopy in an Integrated Health Care Delivery System; T. R. Levin, W. Zhao, C. Conell, L. C. Seeff, D. L. Manninen, J. A. Shapiro and J. Schulman; Ann Intern Med 2006; 880-886. [link]

— Virtual Colonoscopy Misses Nearl One Third of Lesions; The proceeds of the 68th annual scientific meeting of the American College of Gastroenterology; Oct 15, 2003; [link]

— Association of Colonoscopy and Death From Colorectal Cancer; N. N. Baxter, M. A. Goldwasser, L. F. Paszat, R. Saskin, D. R. Urbach and L. Rabeneck; Ann Intern Med 2009; 1-8; [link]

— Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology; Levin, Bernard, at al; CA Cancer J Clin 2008 58: 130-160; [link]

— The Effect of Fecal Occult-Blood Screening on the Incidence of Colorectal Cancer; Mandel, Jack S., Church, Timothy R., Bond, John H., Ederer, Fred, Geisser, Mindy S., Mongin, Steven J., Snover, Dale C., Schuman, Leonard M.; N Engl J Med 2000 343: 1603-1607; [link]

— Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I.; Thiis-Evensen E, Hoff GS, Sauar J, Langmark F, Majak BM, Vatn MH.; Scand J Gastroenterol. 1999 Apr;34(4):414-20; [link]

— Colorectal Cancer Risk Assessment Tool; National Cancer Institute; [link]