Overview:

Too many false positives led the U.S. medical establishment to de-emphasize certain tests, like prostate exams. A colonoscopy revealed a fatal flaw in that policy.

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If reports about a new European study that questions the effectiveness of colonoscopies are causing you to question whether you should get one, don’t let them.

I make this recommendation due to my own life-changing personal experience with that undignified cancer-detecting procedure more than a year ago.

If the routine, every-5-years colonoscopy I underwent in late 2020 didn’t save my life outright, it almost certainly extended it.

After the colonoscopy specialist threaded a narrow, flexible tube into my rectum (don’t worry, a sedative ensured I was sound asleep), he guided it through my long, curving colon, looking for tissue anomalies and aberrations that his extensive training and skill I trusted would help him detect.

He found two important issues: (1) pre-cancerous polyps and tissues, which he excised (the primary purposes of these screenings), and (2) a worrisome hardness in my enlarged prostate pressing against the exterior colon wall, which he detected in a digital rectal exam conducted in conjunction with the colonoscopy (the prostate and rectum are adjacent structures).

I understand polyps are generally as unconcerning as skin cancers if treated early, except as heralds of a potential susceptibility to colon cancer. The doctor was far more alarmed by my overly firm prostate, which, due to his exceptional thoroughness, he literally “bumped into” during the exam.

Soon thereafter, I was lying in my urologist’s office again voluntarily having my rectum invaded—this time by physician-guided needles (largely painless, to my surprise), which harvested tiny tissue samples in various parts of my prostate through the rectum wall.

The diagnosis was, to put it mildly, alarming: Stage 4 prostate cancer, the worst level. As it was explained to me, Stage 4 meant a large part of the organ was involved and the cancer had mutated in hiding over quite a bit of time into strange-looking and potentially very aggressive cells.

Medically, the primary worry with these alien cancer cells was possible, even likely, metastasis: imperial colonization of them throughout the body.

Thankfully, high-tech body scans found zero evidence of metastasis, but because of the Stage 4 diagnosis, I underwent arthroscopic prostate removal surgery (executed with a very cool, multi-armed robotic contraption) followed by six weeks of five-days-a-week radiation therapy to try and fry any undetected cancer cells still hanging around.

The minimally invasive surgery and recovery, and nuclear therapy, though inconvenient, weren’t particularly painful, and I didn’t experience any nasty physical side effects, although endemic urinary incontinence issues common with this kind of surgery and radiation can be a figuratively nasty “pain.”

I’m optimistic. My surgeon says he would not be at all surprised if I lived to 85 and ultimately died of something else entirely. I appreciate that, but, of course, cancer being the sneaky devil that it often is, we’ll see.

The reason I bring all this up is the recent release of the above-mentioned new study, the Nordic-European Initiative on Colorectal Cancer (NordICC) trial.

Researchers in the trial characterized the results as “surprising and disappointing.” And many Americans have interpreted their meaning as worrying.

Conducted from 2009 to 2014, the trial examined 85,000 people between ages 55 and 64 from countries including Poland, Norway, Sweden, and the Netherlands.

Results of the study suggested that colonoscopies are not nearly as effective in identifying cancer and cutting death rates from the disease than the American medical establishment has broadly accepted for more than two decades. In fact, data of prior American studies repeatedly suggested that colonoscopies are far more effectual that the NordICC trial suggests.

When this new study was released, a lot of breathless news reports came out in the U.S., spreading alarm about a procedure that has been an article of faith for American gastroenterologists for a long time.

Fortunately, cooler heads in the medical world quickly prevailed in media interviews, op-eds and the like, stressing that it was just one study, that plausible, non-scary reasons existed for the differing study results, and that Americans should absolutely still get their routine colonoscopies, which have provably have saved countless lives.

Dr. Jason Dominitz, director of gastroenterology for the Veterans Health Administration, and co-author of an editorial that accompanies the new study in The New England Journal of Medicine, told CNN:

I think the most important message is that colon cancer screening is effective, and you should get screened.

Although my own colonoscopy in 2020 did not reveal one iota of evidence for colorectal cancer, it indirectly revealed a ton of evidence for advanced prostate cancer.

What had caused concern is that the Nordic-European trial suggested only a modest 18 percent reduction in colorectal cancer over 10 years among invitees—those who chose to receive colonoscopies—and a “not significant” drop in risk of death in that same group due to the cancer.

Previous studies’ data on those occurrences, the Nordic-Euro study also noted, suggested a 40% to 69% drop in colorectal cancer risk and a 29% to 88% reduction in death risk.

One U.S. study published in 2013 in The New England Journal of Medicine followed nearly 100,000 health-care professionals over 22 years, some choosing to receive colonoscopies and some not. The study suggested that screening for colorectal cancer with colonoscopies was associated with a 40% drop in cancer risk and 68% less risk in death from the disease.


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So what are we to make of the more pessimistic discrepancy in the Nordic-European study?

One plausible factor, experts say, is that colonoscopies are not broadly recommended in Europe and Scandinavia, and the only subjects studied in that trial had agreed to colonoscopies when invited (more than 40% declined). Those declining colonoscopies may have been more or less likely to contract cancer than study subjects, thus possibly skewing the results.

The Nordic-European subjects who agreed to colonoscopies may have been concerned about personal underlying health conditions that may have signaled colorectal issues to them. They may have been a more at-risk population.

In America, by comparison, colonoscopies are recommended by the top medical organizations and routinely administered across the population, and the test has been normalized in the culture as an integral part of regular health care. Americans presumably then may be more willing to receive colonoscopies, and, thus, studies of them might reflect broader, more accurate results.

Another reason for differences in the Nordic-European and American studies, Dominitz suspects, might be the fact that only 23% of patients in the Noric-Euro study received sedation for their colonoscopies; in the U.S. virtually everyone routinely does.

The CNN report on the new study explained,

Colonoscopies can be uncomfortable, and doctors [who don’t sedate their patients] might, without even realizing it, be less thorough if people are in pain. Thoroughness—getting the scope into the folds and crevices of the colon—is important for finding growths called polyps. The more polyps doctors are able to find, the more they can reduce the person’s risk of being diagnosed with or dying from colon cancer.

So, the bottom line, according to a consensus of American health-care professionals, is don’t let this new study keep you from getting your regularly scheduled colonoscopy, as unfun as the procedure may be.

Although my own colonoscopy in 2020 did not reveal one iota of evidence for colorectal cancer, it indirectly revealed a ton of evidence for advanced prostate cancer.

The irony is that some years ago, the U.S. medical establishment had reversed its longstanding recommendation that men undergo routine PSA (prostate specific antigen) blood tests for detecting occult cancers as well as “digital” (finger) exams of the prostate by a physician to identify any suspicious hard spots.

I wish they hadn’t reversed the policy. I hadn’t had either prostate test for years (as advised by my family doctor) before a colonoscopy inadvertently did their jobs for them. But it was far too late for comfort, if you ask me.

Always keep in mind that colonoscopies can bring to light much, much more than what they set out to illuminate. And that could end up at least extending—if not literally saving—your life.

All you will have to endure if you opt for a colonoscopy is a little inconvenience and having to drink about a quart or two of an unpalatable laxative mixer the day before.

A pretty good trade-off, I’d say, considering the stakes.

And, guys, while you’re at it, you might consider asking your doctor to begin regular PSA blood tests and digital prostate exams. After all, policies against them didn’t work so well for me.

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Rick Snedeker

Rick Snedeker is a retired American journalist/editor who now writes in various media and pens nonfiction books. He has received nine past top South Dakota state awards for newspaper column, editorial,...