Well, if the headlines discourage people from getting medically beneficial cancer screenings, the answer is likely an unfortunate “yes.” And that’s been the case with much of the coverage of a newly published study.
It’s only been a week since I turned myself over the Straub’s Endoscopy department for an overdue colonoscopy, so I was immediately interested when I saw the headlines reporting on an article published in the New England Journal of Medicine. The most prominent stories featured headlines questioning the efficacy of the procedure.
Screening Procedure Fails to Prevent Colon Cancer Deaths in Large Study (msnNow)
New study suggests benefits of colonoscopies may be overestimated (The Hill)
New study questions the effectiveness of colonoscopies (Philadelphia Tribune)
Colonoscopies: Major trial reveals uncomfortable procedure does not cut risk of cancer deaths (Daily Mail)
You get the idea. The dominant message was that this particular study concluded colonoscopies don’t work, or don’t work as well as previously thought.
Then I started reading a few of the stories.
My main takeaway? There are headline writers who need to go back to school, as their headlines are misleading at best, and mostly dangerously wrong.
I haven’t been able to read the complete study because of the New England Journal of Medicine pay wall, but the abstract is available online.
Here’s its description of the study.
METHODS We performed a pragmatic, randomized trial involving presumptively healthy men and
women 55 to 64 years of age drawn from population registries in Poland, Norway, Sweden, and the
Netherlands between 2009 and 2014. The participants were randomly assigned in a 1:2 ratio to either
receive an invitation to undergo a single screening colonoscopy (the invited group) or to receive no
invitation or screening (the usual-care group). The primary end points were the risks of colorectal
cancer and related death, and the secondary end point was death from any cause.
Two groups were compared. One group that received an invitation to get a colonoscopy, and a larger group that did not receive an invitation or undergo screening.
And here’s how the abstract summarized the findings:
CONCLUSIONS In this randomized trial, the risk of colorectal cancer at 10 years was lower among
participants who were invited to undergo screening colonoscopy than among those who were assigned
to no screening.
So right off the bat, you have to wonder where the headline writers got their wrongheaded story line that there was no effect?
First, the study wasn’t focused on the benefits of the colonoscopy procedure itself, but rather on the benefits of inviting a large population to undergo a colonoscopy screening. And even at this level, the study found measurable benefits.
But many news stories were similar to the one appearing in the Globe and Mail, which reported: “Screenings only reduced cancer cases by 18% compared to those not given one.”
That’s startlingly wrong. Merely an “invitation” to be screened, with some that actually went ahead and had the colonoscopy done, was enough to produce the 18% decline in cancer cases.
Second, although this finding is buried in the various news stories, when a direct comparison was made between those who had a colonoscopy, and those who did not, the beneficial results were substantial.
“For that slice of the population, the risk of colon cancer was about 30% lower, and their risk of death was roughly cut in half compared to the people who did not receive one,” according to the Washington Post.
It seems to me that is the most important point, misleading headlines aside.
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Mahalo for doing the deeper dive (no pun intended).
I, too, saw the headlines and questioned their veracity but did not follow through due to time constraints. Once I saw your email subject line this morning, I immediately thought of those attention-getting headlines, and am grateful that you pursued this for our benefit.
The editors of the journals that misconstrued the results of the NEJM article by using histrionic headlines should realize that they have debased the reliability of their journals.
I have to wonder why news outlets want to downplay the benefits of preventative screenings. Funded by the corporations that make money from cancer treatments, perhaps?
The headlines want to make you read the story, whether misleading or not. Nowadays, when you click on a story, there are tons of “advertising” stories surrounding the main story. It is news “Clickbait”.
What a TIMELY article, Ian!!
Yes, I too saw the misleading headline yesterday at CNN’s website and was very curious as, coincidentally, I am in the middle of undergoing the process to arrange for my first colonoscopy.
Here are two links with the first headline being very vague and could almost be translated as saying “colonoscopies are BAD” and the second headline hinting in that direction as well.
https://www.cnn.com/2022/10/10/health/colonoscopy-study-q-and-a-wellness/index.html
https://www.cnn.com/2022/10/09/health/colonoscopy-cancer-death-study
After reading the entire first article, one realizes it’s based on a study of Europeans and, in effect, says that colonoscopies are still EFFECTIVE and that one should STILL consider getting one as it’s the best method available for detecting early colon cancer possibilities. It even goes so far as to say: “Some US studies have suggested that colonoscopies are even more effective.”
Interestingly, a reason colonoscopies are not popular in Europe is that Europeans do not get sedation, unlike in the US.
One large issue behind the scenes is what portion of our national wealth should be spent on medical care as opposed to food, housing, police protection, military readiness, etc. Drug companies, doctors, hospitals want a higher percent. So they will stress the alleged importance of new drugs, screening tests, etc.; whereas other economic sectors and institutions, competing for those dollars, will stress their alleged worthlessness or low level of usefulness. Who pays for newspaper ads, or which institutions own the newspapers, determines which way the headlines get skewed.
Another large issue is the aging of our population, causing greater demand for increased percentage of national wealth to be spent on life-extending drugs. Our society socializes medical expense — very few people individually pay the costs for the drugs and medical services they demand — those costs are shifted to the bottomless cornucopia of the federal budget paid for by taxes imposed on younger people. So if old folks think some expensive drug or procedure might help them live a few months longer, they’ll demand it, knowing someone else will pay for it.
I recall a few years ago a new drug was approved for lung cancer, and ads were constantly on TV “Here’s a chance to live longer, take these drugs” but the cost turned out to be some huge amount like $100,000; and when I read the small print it turned out that the median lengthening of lifespan for those who took the drug was 1.2 months! Ridiculous! More recently another new drug was alleged to help slow dementia for Alzheimers patients, but Medicare decided not to pay for it because it was too costly for too little slowing of dementia.
So the battle of the headlines tries to skew public opinion in favor of expensive drugs or procedures that send megabucks to the health industry, vs. skewing public opinion against those drugs or procedures so that the megabucks can go instead to pay for food, housing, police, military, etc. If people had to pay for their own drugs and medical procedures, they would be much more careful which ones they would choose. If you individually had to pay the full cost of your colonoscopy screening just on the off chance that you might (or might not) have a suspicious polyp, would you pay? Or would you rather spend the money on screening for lung cancer, or diabetes, or heart disease? Or maybe donate the money to feed the homeless? You can’t do it all, so make your choice. But if the government (i.e., everyone else’s taxes) pays for it all, then you’ll demand it all and claim a right to have it all.
What a ridiculous argument Ken.
I am 69 years young and believe that I have paid my fair share and more of taxes and insurance premiums and will continue to pay taxes at the grocery, pharmacy, gas pump, dmv etc. So don’t guilt trip yourself or others about the poor younger generation, plzzzz!
Reactionary readers are half the population and half the consumer base and in my humble opinion may have half or less of critical reasoning skills…
It is a blessing to live in a country that gives me an option to chose my health care and I will not squander that privilege at the polls in a few short weeks.
Thank you for your clear discussion of the NordICC study (as they call it). I think journalists had a hard time getting their heads around the fact that the study focused on comparing people who simply were *invited* to have a colonoscopy versus a another group that did not receive such an invitation.
I thought the CNN reports that another commenter referred to were pretty good. One of them stated:
“When the study authors restricted the results to the people who actually received colonoscopies – about 12,000 out of the more than 28,000 who were invited to do so – the procedure was found to be more effective. It reduced the risk of colorectal cancer by 31% and cut the risk of dying of that cancer by 50%.
“Researcher Dr. Michael Bretthauer, a gastroenterologist who leads the clinical effectiveness group at the University of Oslo in Norway, said he found the results disappointing.
But as a researcher, he has to follow the science, “so I think we have to embrace it,” he said. “And we may have oversold the message for the last 10 years or so, and we have to wind it back a little.”
“Other experts say that as good as this study was, it has important limitations, and these results shouldn’t deter people from getting colonoscopies.
“I think it’s just hard to know the value of a screening test when the majority of people in the screening didn’t get it done,” said Dr. William Dahut, chief scientific officer at the American Cancer Society, who was not involved in the study.
“Bretthauer said the true benefits of colonoscopy probably lie somewhere in the middle. He said he thinks of the results of the full study – including people who did and didn’t get colonoscopies after they were invited – as the minimum amount of benefit colonoscopies provide to a screened population. He thinks of the results from the subset of people who actually got the test as the maximum benefit people could expect from the procedure.”
Also interesting to read commentary by the European Society For Medical Oncology:
https://www.esmo.org/oncology-news/modest-effectiveness-of-screening-colonoscopy-for-the-prevention-of-colorectal-cancer-in-a-large-population-based-randomised-study