Many middle-aged people see having a colonoscopy as a necessary but unpleasant medical procedure. Colorectal cancer is most easily detected and prevented if it is detected early, but this requires undergoing an invasive and uncomfortable procedure known as a colonoscopy once per decade after the age of 45. In the United States, it is the second leading cause of cancer-related mortality. In the United States, around 15 million colonoscopies are carried out annually. Now, a seminal research reveals that colonoscopies may have exaggerated advantages for cancer screening.

This is the first randomized experiment to directly compare colonoscopies with no cancer screening at all. The trial indicated little advantages for the invited population: an 18% decrease in colorectal cancer risk and no significant reduction in cancer mortality. The article was released in Sunday’s issue of The New England Journal of Medicine.

Dr. Michael Bretthauer, the study’s principal researcher and a gastroenterologist at the University of Oslo in Norway, expressed his dissatisfaction with the findings. Even while this research was generally well-conducted, some experts warn that its flaws mean that its findings should not discourage patients from having colonoscopies.

Only 42% of research participants who were offered a colonoscopy followed through with the procedure. The technique was shown to be more successful when the authors of the research limited their analysis to the participants who actually had colonoscopies (about 12,000 of the more than 28,000 who were invited to do so). Colorectal cancer risk was lowered by 31% and mortality from the disease was reduced by 50%.
According to Bretthauer, the real advantages of a colonoscopy are likely to be found in the middle. According to him, the minimal amount of benefit colonoscopies bring to a screened population is represented by the combined findings of the whole research (including those who did and did not get colonoscopies after being invited). He considers the outcomes of the persons who received the test to be the procedure’s greatest advantage.

From these data, he draws the conclusion that having a colonoscopy as part of a screening program may cut a person’s risk of developing colorectal cancer by 18% to 31%, and their risk of dying from it by as much as 50%.

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