Colorectal screening
I listened to the recent podcast on colorectal screening. Lots of good information, specific recommendations include:
- starting colonoscopies at age 40, and then every five years
- cologuard at the midpoint between colonoscopies
He noted that colonoscopies can often miss polyps (IIRC, around a 24% miss rate), so waiting ten years between them increases risk. He also noted that cologuard has a high miss rate, so he doesn't recommend it as the primary screening approach.
He discussed metrics to evaluate doctors before, and questions to ask after, and the importance of following prep instructions. Recommendation was that doctors should have an adenoma detection rate (ADR) of at least 30% for men, and 20% for women. Also ensure that the post-exam Boston Bowel Prep score was at least a 6 (and preferably a 9).
He also discussed the relative risks from complications like perforations and anesthesia and how they are microscopic compared to the risk of getting colon cancer.