James Hubbard, M.D., M.P.H.

News flash.  Medicine is not perfect.  A few years ago, I finished my advice to a patient by saying, I might be wrong.  She sarcastically said she was going to go straight home and call her doctor son-in-law to give him the news. “A doctor said he might be wrong. Who knew?”

Reading the recent news about colonoscopies made me think of this.  Why do we need scientific studies to document that therapies work?  Because we can’t rely on our intuitions and preconceived notions.  Every diagnostic test and treatment needs to be scrutinized objectively.  Even the ones we’re sure of.

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by James Hubbard, M.D., M.P.H.

We thought colonoscopy could prevent 90 percent of colon cancers.  We were wrong.  If the results in the new Annals of Internal Medicine hold up, it’s more like 60 percent.  A colonoscopy is still excellent for a screening test, but far from perfect, we discover.

The investigators did a case-control study.  That’s when you find people with a diagnosis and work your way backwards. In this case, the researchers found people with colorectal cancer and looked back to see whether they’d had a normal colonoscopy six months to seven years before their diagnosis. They compared them to similar people who didn’t have colorectal cancer.

What the investigators found surprised them so much, they asked that the data be looked at a second time.

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by James Hubbard, M.D., M.P.H.

The Journal of the National Cancer Institute reported good news in its annual report to the nation on the status of cancer.  Newly diagnosed cancer rates in men declined 1.6 percent per year from 2001 to 2005. In women, they declined 0.6 percent per year from 1997 to 2005.  Ten out of 15 of the most common cancers went down.

Not all was good news, as you will see below, but it is a start.

Specifically, the cancers that declined in women were:

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by James Hubbard, M.D., M.P.H.

The New England Journal of Medicine published a study last week that found virtual colonoscopy is almost as accurate as the standard one in detecting polyps that can lead to colorectal cancer.

A virtual colonoscopy, called a computerized tomographic (CT) colonography in medicalese, is a fancy CAT scan that uses X-rays to look for polyps in your colon.  A regular colonoscopy (the gold standard of colorectal cancer screening) requires a long tube, with a camera on the end, inserted in the rectum, and snaked through your entire colon to look directly for abnormalities.  You remember Katie Couric’s live colonoscopy on Today, don’t you? (See video below.)

A polyp is a small stalk, usually less than 1/2 inch in diameter, growing from the lining of your intestine, that can progress to a cancerous polyp (usually takes five to 10 years for the progression).  Removing the polyps can prevent as many as 75 percent of colorectal cancers, according to the National Cancer Institute.

The problem is that people are not getting their screening colonoscopies.  What good is a test you if don’t get it? Physicians have been trying to find an alternative.  Will the virtual colonoscopy be it?

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