From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: FlexibleSigmoidoscopy
Date: 29 Dec 1999 10:06:39 GMT

In <mN1efLAlgca4EwNm@nevis-view.demon.co.uk> Surfer!
<nevis-view@nospam.demon.co.uk> writes:
>
>In article <84bn03$r26$1@nnrp1.deja.com>, josey5602@my-deja.com writes
><snip>
>
>> Please give advice.  I am overcome with fear.
>>My husband is to go for colonoscopy screening in
>>2 weeks, even tho he has no symptoms. He is 51
>>yrs. and dr.recommends this screening because his
>>dad died of colon cancer at age of 70. I am
>>terrified of my husband going through this
>>invasive procedure for a screening. The procedure
>>itself sounds very painful and humiliating.
><snip>
>
>Colon cancer is easily cured if caught in time, but still people die of
>it. I'm sure you don't want your husband to be one of them.
>
>Given all the postings which have been flying around I can understand
>your panic, but so far we have had no data on the cross-infection rate
>posted by 'Vindicator'. However you might want to ask some questions of
>the people doing the procedure - after all it's not an emergency. It's
>good that your doctor recognises that your husband is at increased risk
>because of his family background.
>
>On the 'painful and humiliating' bit. We have had several posts from
>people who have had this procedure and they have reported a variety of
>pain levels from a little discomfort to somewhat painful, but no-one has
>reported unbearable pain (unless I missed their posting). As for
>humiliating - as a woman you will have probably had examinations which
>seem at face value to be humiliating (legs in stirrups and so on) but the
>clinical setting and the way in which these things are handled should
>prevent this being so.



   And last but not least, if you want to compare things that are
potentially painful and humiliating, you might want to watch somebody
die of colon cancer, or talk with someone who has.  It's rather
difficult to do this completely gracefully.  Harder than dealing with
any effect of colonoscopy, trust me.  Women put up with pap smears and
mammography because the alternative is far worse.  Colonoscopy is much
the same kind of thing.

   And BTW, I would recommend colonoscopy in place of flexible
signoidoscopy, contrary to official AMA and ACS recommendations.
Flexible sigmoidoscopy doesn't see as much, and (overall, counting in
the comparable lack of anaesthesia) it is on average the more painful
procedure.  It is recommended purely out of cost-benefit analysis, by
statisticians who haven't had one.  The AMA, I would say, needs to
personally experience a few more of them, so that they can add a few
intangibles to their math.

                                    Steve Harris, M.D.

(And no, I'm not a gastroenterologist, so this post is not
self-serving).

From: David Rind <drind@caregroup.harvard.edu>
Newsgroups: sci.med
Subject: Re: FlexibleSigmoidoscopy
Date: Wed, 29 Dec 1999 10:04:10 -0500

"Steven B. Harris" wrote:
>    And BTW, I would recommend colonoscopy in place of flexible
> signoidoscopy, contrary to official AMA and ACS recommendations.
> Flexible sigmoidoscopy doesn't see as much, and (overall, counting in
> the comparable lack of anaesthesia) it is on average the more painful
> procedure.  It is recommended purely out of cost-benefit analysis, by
> statisticians who haven't had one.  The AMA, I would say, needs to
> personally experience a few more of them, so that they can add a few
> intangibles to their math.

Although I agree with Dr. Harris about the relative discomfort
of the two procedures, and also suspect that he will be proven
correct that colonoscopy is the more sensible screening procedure,
the main difference at present is that we have data that screening
with flexible sigmoidoscopy saves lives, and we have no equivalent
studies of colonoscopy.  Since colonoscopy carries a non-negligible
risk of perforation of the colon, it would be nice to have some
solid data before using it as a screening test.  (This is not
meant to apply to the patient asked about by the previous poster:
screening in someone whose father had colon cancer at a young age
is different from screening in the general population.)

--
David Rind
drind@caregroup.harvard.edu