Blood based Colon Cancer Screening - NEJM papers - ECLIPSE - Guardant

Vinay Prasad, MD MPH; Physician & Professor
Hematologist/ Oncologist
Professor of Epidemiology, Biostatistics and Medicine
Author of 450+ Peer Reviewed papers, 2 Books, 2 Podcasts, 100+ op-eds.
If you want to contact me, do it here: www.vinayakkprasad.com/contact
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Personal Website: www.vinayakkprasad.com
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Podcast Website: www.plenarysessionpodcast.com
Academic Publications: www.vinayakkprasad.com/papers
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Twitter @vprasadmdmph

[@user-lm5bx1vx1f]

My BIL had stage 4 colon cancer after large bleeding and refused chemotherapy and radiation after colostomy. His Dr said he’d be dead in 6 months but it’s been 22 years and he’s now 73 and doing fine!

[@ohsweetmystery]

My father also refused all chemo and radiation after his colostomy many years ago. He is now 87.

[@wwjccsd]

These are extreme cases. Stage 4 Colorectal cancer 5 year survival rate is abysmally low, like 10% or less.

[@idee99]

@@wwjccsd 10% less for whom? Would be interesting to see the survival rates for both those undergoing chemo only, chemo with radiation, radiation only, different alternative treatments and those who did none of the above.

[@AllHandlesHaveBeenTaken]

Removing cancer causing chemicals from the food is the best anti cancer treatment

[@wwjccsd]

People will still get cancer, just at a far lower rate.

[@Aaron-cc7yq]

I am a 3rd year medical student and I agree that the better thing is probably to abolish the FDA for 2 reasons: 1. It makes doctors lazy and not actually have to think because they can just rely on whatever medication is approved by the FDA or follow what the FDA says without actually thinking about it. 2. The reason doctors who may not agree with the FDA still abide by them is because if they ever get sued the doctor can just say they were referring to the FDA guidelines.

[@jmc8076]

Also equivalents in other countries since no medical system or nation lives in a vacuum. All are hidden connected web thru money and power. Same with any system or industry. Same $ources and strings behind all.

[@flybrand]

3. The rest of the world sees all the flaws of the organization, physicians will be the last ones holding on to the remnants of its credibility.

[@kennethg9277]

Pretty silly to believe doctors would actually start doing the necessary work to think for themselves in the absence of an FDA or FDA equivalent, kiddo. Shows a lack of understanding of human nature. Pharma lobbyists would slip quite readily into whatever gap was left and exert even more influence.

[@sliglusamelius8578]

@@flybrand lol. False. A). Thalidomide disaster happened. The safety needle has to be placed not too far left, not too far right. It's tricky. B). Practicing physicians are as hamstrung by the FDA as they are benefited by it. But it's a necessary evil. It literally costs doctors lawsuits when they don't follow fda approval, and that fact is awful, but the fix is to eliminate that element from lawsuits.

[@carolann4087]

I have a question for you. How many courses or hours of education do medical students receive on nutrition?

[@brett6468]

"Vitamin D3 has been estimated to lower the incidence of colorectal cancer by 50%, which is consistent with the inverse correlation between dietary vitamin D3 intake or sunlight exposure and human colorectal cancer."

[@sufyb6432]

At 59, I miraculously found that D3 is so important in our bodies. After years of feeling like garbage, it turned from night to day in a shirt period of time. Forever grateful.

[@janinepera8338]

Unfortunately Dr Prasad is not a proponent of supplements. Also, I have not heard him speak positively about natural remedies.

[@wwjccsd]

@@janinepera8338most supplements cause expensive urine at best. Vitamin d however is low in most people in todays society, at which point supplementation is a treatment. But you have to take it with other cofactors to improve absorption if not getting it via sunlight, but rather a pill

[@axlesolace6502]

Wow, good to know.

[@walterbortz355]

Wow VP! Your face may be up on the dartboard in the FDA meeting room! Another erudite comprehensive discussion of a complex subject. Very well done!

[@brynduffy]

I would just remind the FDA not to look at Dr Prassad's tongue. Just that suggestion will force them to continuously watch his tongue no matter what their real intention is. This will be the best punishment for them. At a certain point, even with their eyes closed they will see that darting tongue wrecking their minds! It could even be a drinking game in my opinion. This brilliant physician has a superpower!

[@budprepper3811]

Nice to listen to an intelligent human for once 👍

[@WolfHowl71]

Dr. Prasad, you are a true champion of the people. Thank you for your work.

[@mike.chambers3605]

Better if we stopped clinging so desperately to a life that is so short...just get on with it and be KIND to others along the way. God Bless you ...you pursue TRUTH TRUTHFULLY.

[@Kiowan918]

Do you have an actual point in that backwards religious rant? Seems like you think people shouldn't screen for disease and just get on with it and die whenever. Cool idea, you first.

[@DavidAKZ]

But doesn't make MD's any money.

[@ediartiva]

@mike.chambers3605 A true religious outlook recognizes life as his gift, which obligates a person to care for him/herself in the best way possible. If screening is effective, it would be included in the obligation.

[@patbuckley4039]

We now seem to spend our whole life thinking about if we might be ill !!

[@fazole]

​@@ediartiva The problem is that patients are NOT getting a truthful explanation from the medical community and the supposed govt. experts for anything related to healthcare. Instead they get bullied or frightened into following a course of action where the advantages are exaggerated and the drawbacks are suppressed. Therefore, patients are making uninformed decisions due to ignorance or subterfuge on the part of their healthcare provider, who is also, btw, controlled and ltd. by insurance and health management conglomerates.

[@barbarabonito8881]

This is so rational. So sad politics and greed get in the way of all the great information and technology that’s available.

[@zenpig6605]

Just an old farts two cents, but we don't have a Health Care medical system any longer. We have a disease management system, which I am happy for, but all the disease management isn't worth a sh*t if we don't take care of our own health care. Eating at least 5 to 7 different natural fruits and vegetables every day. Cutting out all the high processed crap. Working out using both resistance training and aerobic training. Even doing some yoga for 20 or 30 mins in the morning to start your day. etc. IMO disease management is only half of the equation, and cannot succeed without all of us taking personal responsibility for our own health. (By the way, my dad got colon cancer in his early 60's and ended up living into his 80's. I got both the colonoscopy and the sigmoidoscopy and so far, so good). But in my later years I am done with it. Sometimes we got to know when to cut bait and just live our lives. cheers.

[@JenniferAguiartampa]

My 45 yo cousin had stage 4 colon cancer. Needed a big surgery & chemo. So far he is doing well.

[@mattp1913]

good to know about flex sig

[@jeanmarie4328]

Whatever the FDA recommends I do the exact opposite!

[@sufyb6432]

My oldest brother had colon cancer so bad that he had to have the bag and then the reconnection. Never had a colonoscopy, BUT, he is the child who hated vegetables, drank, did recreational drugs, and lived a hard life by choice. I live a life that is the complete opposite, had a completely clean colonoscopy at 50, but don't want another one because I woke up ten minutes early and was awful. I would love another option.

[@wallihaley5194]

My first colonoscopy showed a benign polyp, but 7 years later, the next polyp was precancerous. So, I am due for another colonoscopy this year to make sure there is no other precancerous polyp or worse, early stage cancer. My dad had this disease, so I am at higher risk.

[@user-xv1kp6qf7h]

Doing the lords work 🙏🏻🙏🏻 I’m not even religious. Thank you for all you do & educating the public . Thank you thank you. I miss seeing you & Zdog together

[@tpwonder99]

I am one (61) who had the free fecal test (Australia) that came back positive. Zero symptoms. Stage 1, surgery but no chemo or bag. Brilliant results for me. By the time symptoms appeared it would have much more advanced. While it might not statistically lengthen my life, for me as an individual it was a game changer.

[@JenniferAguiartampa]

That’s great to hear! Going in for a colonoscopy is such an unpleasant event because of the starvation & prep before.

[@brianog5267]

Ummmm… not really… much worse to have a colostomy and need long term chemotherapy for liver Mets…

[@brianog5267]

Sorry but if you had started colonoscopy screening typically at age 45 you would likely never have had cancer nor needed surgery etc

[@tpwonder99]

@@brianog5267 yes. My daughter had a colonoscopy at 36 and they found a polyp serrated sessile (“the one” my surgeon said). She is on a 5 year colonoscopy watch now. It was removed with just a scraping.

[@djcikla4580]

@@brianog5267 Would you please explain, how would having a colonoscopy prevent someone from getting cancer? I understand that it is done to find if it is present, not to treat it. So even if a person had it every year, from age 45 till 61, it would've only shown the presence of abnormality, but to treat it, they would've needed surgery or/and chemo, because that is how "medicine" treats cancer.

[@katydid2k]

Yess!! Thank you - I SO appreciate this! In the face of torrents of pressure to get a colonoscopy (after + Cologuard I was 99.9% certain was a false + ) I chose flex sig. Clean as a whistle up there. And yet *that* (flex sig) Doc nevertheless pushing as well for follow-up colonoscopy despite perfectly normal sigmoid colon. NOT going to happen, I keep assuring them. It's really something, the firehose of pressure, for a highly invasive and actually dangerous test, 'bleaching' out the whole colon, so to speak, (as Nature NEVER intended) by ingesting that godawful who-knows-what, and then undergoing anesthesia with its accompanying risks, risk of perforations by the scope: I can't believe people line up like sheep for this thing. Big $$ maker though, so...

[@HzFvr]

Same for me👍👍👍

[@TheEverCuriousJen]

I’m scheduled for a colonoscopy. Can you please tell me step by step what you did instead?

[@maxwellanderson007]

@@TheEverCuriousJen Don't do it. It's not worth the risk. I had colonoscopy 2 month ago. Now I have bunch of symptoms that I never had before colonoscopy -like bloating, farting, uncomfortable feelings in my lower abdomen. Instead do these tests: 1) fecal calprotectin 2) Fit test 3) Fit-DNA test These tests 90% of the time correct when it comes to colon cancer or any other IBD. If there all tests are negative, you don't need colonoscopy at all. Don't listen to doctors. I did, now i have a miserable life.

[@katydid2k]

@@HzFvr Well done! Smart!

[@katydid2k]

@@TheEverCuriousJen Sure. I just said NO (to colonoscopy). Then randomly learned about sigmoidoscopy as a good alternative via a KZbin video many months ago. I said to my PCP Doctor "how about a sigmoidoscopy?" and she was thrilled (that I'd at least consent to that) so she ordered that test. I set up the appt, they sent me instructions. Prep is much easier than a full colonoscopy (where they run the scope up into the entire colon; the flex sig procedure uses the same scope but examines the sigmoid colon only - rectum and first 1/3 of full colon) as Dr. Prasad mentioned. Just two enemas, that's it. No overnight fasting, no drinking the glop, no need for anesthesia (so I could just leave and drive myself home). Does that answer your question?

[@iangoldman3]

Thank you for taking your time to make your videos. As a non-medical member of the public, I really appreciate what you do.

[@NOYFB982]

Fun fact for Dr. Prasad: a little know aspect of Cologuard is that most of its diagnostic power come from doing FIT simultaneously (any patient who has done the tests can see that there are two ways the sample is used). It’s actually considered a dirty little secret.

[@puggirl415]

I was pushed to do the fit test but they never had me in to discuss the results just told me it was negative. At 61 I pushed for a colonoscopy (my first) and they didn't want to give it to me. I was incredulous. All you hear are PSA saying get your colonoscopy as soon as possible to prevent Colon cancer. And here I was asking for a colonoscopy. I asked the NP when I should get my first colonoscopy if not at 61 then when. After all they do say that you don't really have to get one after 70. She had no answer. I told her to note in my chart that she refused me this test at my age. Needless to say she ordered it since she didn't want to be responsible. Now I hear there is another test that is easier and better (flexsig) but no one ever even mentioned this. They wonder why we do our own research. It's because they are untrustworthy and likely to not mention what is available and appropriate and just send you away with no knowledge and no care. They are just trying to give as little health care as possible. So frustrating.

[@johninzurich]

Extol = praise; perhaps you mean Exhort = encourage. Love your work, many thanks

[@Cherish..2]

Sigmoidoscopy is also where they will find more of the cancer. Colonoscopy has more chance of an internal injury, possibly death. I do a FIT test every two years (canada)

[@deborahhebblethwaite1865]

Thanks again for your info. BTW I like your trimmed up clean shaven look again. Shows off your good looks🙏🙏🙏🇨🇦

[@gstlynx]

Thanks Doc. Your rigorous, logical dissections of complex problems inspires confidence in the prospects for the future.

[@janinepera8338]

This was excellent! Very helpful information. Thank you for being bold! We need more doctors like you who are willing to call out lies, deception and stupidity. I hope others will follow your lead.

[@eldergeektromeo9868]

Hey Doc: its always such a pleasure to listen to what you have to say. All the best! And, Thank You!!

[@leewilson4686]

Good info. My siblings and I are at higher family risk and definitely don’t want to be convinced to just do this blood work and possibly give up our colonoscopies. God bless!

[@simonwiltshire7089]

Marcia Angell had the last word on the NEJM - it is a pharma owned marketing rag.

[@SK-fq1by3977]

What is the infatuation with living forever that has taken over society?!

[@kennethg9277]

Hubris. Why would one want a long life addicted to youtube, twitter and tiktok for goodness sake?

[@Gringo124]

Only a person who perceives himself as healthy asks this. Once you are sick that question goes out the hospital window

[@kathynewkirk683]

Quality rather than quantity, people are living longer, but just because they are being pumped with pharmaceuticals, sickcare not healthcare, It depends what you’re listening too. I get a lot of helpful information on you tube. On health, and what it involves as well as spirituality….

[@doesnotFempute]

absence of faith. They don't believe in a higher power or any point to our existence... yet they cling to their own.

[@doesnotFempute]

​@@Gringo124 quite the opposite. Sick people tend to eventually accept their mortality. Some of us accept it before becoming mortally ill. Although, I work around a lot of de'ath and know none of us escape. Health, age - all means ultimately nothing when nobody is promised tomorrow.

[@alexanderjamieson7971]

I wonder how often people walk around for decades with precancerous, stage 1, and stage 2 cancer unbeknownst to them, and they're just fine.

[@katydid2k]

Exactly. And then die decades later from some other cause. (Can you tell I'm not a big fan of screening tests? Which I call "looking for trouble where there is none."

[@TheEverCuriousJen]

@@katydid2k And there’s studies now that Fasting can help with getting rid of cancer cells.

[@TheEverCuriousJen]

And there’s studies now that Fasting can help with getting rid of cancer cells.

[@manichairdo9265]

My 64 year old, fit, sister in law went to a hospital for tests after feeling increasingly fatigued. A few hours later, she died. It was undetected leukaemia and had caused a heart attack. Grneral blood tests had failed to spot it sooner.

[@user-kv5gh6le6y]

Controlled study showed that those with the highest level risk type of precancerous lesions have about twice the risk of development of colon cancer as those who had no polyps or lesions, over 18 years. Actual risk reduction is about two in a hundred. Very likely a poorer life outcome if you let them get all up your ass.

[@meenakshimuralidhar6498]

❤ Keep up your Great Work, Vinay👏🏾👋

[@siaf2398]

thank you Vinay! please stay

[@AndiS-dz4pq]

As always, thank you Dr Prasad.

[@sunantrakirk292]

Thank you so much! Keep posting

[@ShadowMan66]

BIG cancer increase in all cancers. Elephant in the room is HUGE.

[@keepingitreal618]

More and more screening is being done hence detecting more. Majority of people believe they are going to die of cancer. Majority believe they are never going to make it to old age.

[@jacquieloller8504]

This is so informative. Thank you !!!

[@agfairfield8575]

another great vid!!

[@Maggie-tr2kd]

I knew a lady who went in for a "routine" colonoscopy. She had no symptoms. Her doctor just kept pressuring her to do it. She had the procedure, was discharged home, developed an internal infection from an apparent undetected perforation, re-admitted to hospital, and died. So, I'm still saying "no" to colonoscopy despite the pressure to have it. I've not been offered any alternative tests but I would consider them. I'm not considered high risk for colon cancer and I have no worrying symptoms.

[@taryncornelius548]

Thanks Doc for this information

[@kimberlyshaw6655]

Thank you for your time and passion!

[@juliobro1]

Dr. Philip MacMillan announced there's a paper suggesting that spike protein is causing an autoimmune response. Please look into that.

[@JennyJean.]

Wonderful ❤ Thank you

[@missygixxer]

Have u discussed the practice of removing abnormal cells found in a pap smear? It’s supposedly preventative but it’s a surgical procedure for a “maybe” I’d love your thoughts on this matter!

[@jackyflowers3493]

Great knowledge shared. Thank you, Doctor.

[@susanmonty791]

Love your videos. Glad you’re bringing the truth to the public.

[@SuzanneBryan]

Thank you. always interesting and thought provoking.

[@novascheller5957]

Thank you as always! Flex sig, eh? Going to ask for this at the next screening. 😊

[@hotbutterwell194]

Thank you!

[@davina5514]

Hey my Friend, L♥️VE listening to your Views ALWAYS 👌🏾👍

[@isaacwhull]

yes, the dollar bill is at the bottom.

[@sliglusamelius8578]

So don't do a colonoscopy. What Vinay neglected to consider is that mortality is not the only endpoint to be avoided or measured. A simple cancerous polyp that grows to block your intestine at any level is Bad, you don't want that, because now you're looking at a colectomy. No thanks. Do your colonoscopy screening and that won't likely happen to you. I know a guy with stage 4 colon cancer who could have had a simply polypectomy a few years earlier if it had been picked up on a colonoscopy, now he's toast. Some things make sense to do at the individual level even if not at the population level.

[@isaacwhull]

@@sliglusamelius8578 yours was excellent analysis. I'm very skeptical because I received notice that my part of Medicare is $175/mo, that's 20% of my retirement social security and that payment puts me into even more extreme poverty- then I get notice that my primary care doctor wants me to get a colonoscopy! the irony is shocking. I watched Vinay all throughout the pandemic and that event was our introduction so when I saw him addressing this subject I couldn't resist leaving an irreverent comment. I know nothing of cancer, luckily I also know nothing of covid, I simply changed my diet and ignored the entire event and without a sniffle watched the catastrophic mismanagement of the whole affair- that, has eerie similarities with colonoscopy.

[@dinahsoar6982]

My older doctors believe that colonoscopy is the gold standard for testing for colon cancer...my younger doctors prefer stool tests and if blood is found, then do a scope.

[@geauxp]

Flex-sig, got it, will talk to my doc. Her mum died from infection after colonoscopy

[@DavidEppersonMusic]

Thank you for the data! I wish local doctors knew all these things...but I am suspicious of the money incentive.

[@rezakian9829]

Thank you Doctor Prasad for the informative video. What are your thoughts on Endoscopic Ultrasound Scope (EUS)? Does the use of ultrasound imaging help identify non polypoid cancers, pre-cancerous, and early stage cancers?

[@sonjadidyk-tn4cc]

Thank you

[@andrewmiller5032]

You know when the colonoscopy is finished, it's when you see the Mercedes sign!

[@lisao9486]

I went through a traditional colonoscopy yesterday, which was thankfully clear. I have seen all the commercials for Cologuard etc. But as someone with 2 previous cancer diagnoses this was correctly not an option my doctor would allow.

[@jmc8076]

See Canadian Task Force on colon screening from 2016. Close to what your advocating. I talked to GI doc about it when subject came up. His only caveat was if high risk based on last scope and or personal/family medical history the sigmoid or colonoscopy s/b done every 5 yrs < 75 yo. Fair?But many docs since added upper endo with sigmoid/colon (same time.) My GI doesn’t.

[@karenwhite1541]

Thank you for this valuable information-I was debating whether to have my hubs do another colonoscopy or the assay for his screening-I’m looking into the flex-sig. He is due for his screening-although he has zero family history for any cancer and eats a very healthy diet. I on the other hand have small intestine cancer in my family history-(mother) even though it’s rare I have been told to have a colonoscopy every 3 years -thoughts on a flex-sig for me?

[@davidr9876]

We all die with cancer, some of us die from cancer. We need to focus on preventing death FROM cancer.

[@sliglusamelius8578]

Lots of luck stratifying patients that way. It's happening with prostate cancer, but it's easier said than done.

[@brianog5267]

Ummm THATS THE WHOLE LOONT OF SCREENING COLONOSCOPY!!!!!!!

[@antoniolum1506]

This video comes at an interesting time. Family member just diagnosed with colon cancer. Next step advice will be essential.

[@sliglusamelius8578]

How was it diagnosed? Because Vinay is making a mistake if he is waiting only for proof of concept that routine screening saves lives. Other end points like colonic blockage matter, and it could be true that mortality is lower with routine screening even if it hasn't been proved.

[@brianog5267]

Ummm…. If first degree relative… especially if young when diagnosed??…. Do yourself a favor… go get a colonoscopy per guidelines

[@antoniolum1506]

@@sliglusamelius8578 I believe biopsy of a polyp by the NHS. Is there something a miss?

[@antoniolum1506]

@@brianog5267 They are an immediate relative in their mid 60s. They tried a colonoscopy but they said it was too tight even under sedation. The endoscopy was successful though. Not sure what you're referring to as per guidelines. Seems you're both assuming they got self diagnosed or something? "Diagnosed with colon cancer" should be pretty clear. Preparations for assessing the stage are underway.

[@jewelleryaddict]

How 7 doing this 8 I u the 80s 7

[@ann2252]

Two or three years ago you said you were going to look at the biggest study with the veterans admin. Sigmoidoscopy is worth considering but not for African Americans where almost 50% have right sided primaries (30% is rate otherwise). With less symptoms on the right and shorter survival in Stage 4, this is important. A colonoscopy at 50 makes sense as BRAF patients are 10% of patients and more common on right. Early stage BRAF mutations may be curable by surgery and chemo.

[@ssimon311]

45 here, was told to get a colonoscopy here in the Bay Area (Stanford), ended up cancelling it due to other health issues. I planned on doing it but want to look into this other option, flex sig.

[@user-xf6qf7pm7w]

Vinay needs to check with his health insurer. There was a $2,000 bill at the end of my last colonoscopy.

[@katydid2k]

My thought, too (but I think around these parts, it's even north of $2K)

[@mwellh113]

My total out-of-pocket cost was around the same, and the bulk of it was for the anesthesia. I was 26 with blood in stools, and the doctor found a polyp, so I’m glad I went through with it.

[@ohsweetmystery]

Stop getting them.

[@ohsweetmystery]

@@mwellh113No need for anesthesia. For decades, no other countries except the US even offered anesthesia and drugs during colonoscopy.

[@rubygreta1]

They use FIT in Canada. Colonoscopies only for those at risk. Are their outcomes worse? You think the CDC would do a study. Instead we lower the age to 45 FOR ALL. $$$$$$$

[@rebeccar1036]

Some US insurance companies do not cover a colonoscopy after a positive FIT test, or so I have read. Ridiculous

[@rubygreta1]

@@rebeccar1036 WHAT?

[@rebeccar1036]

@@rubygreta1 I know of a few people who had the FIT test, needed to have a subsequent colonoscopy and the insurance would not pay for it because it no longer fell under the category of “screening”… they only covered one screening and it was the FIT. The subsequent colonoscopy was now considered a procedure and not fully covered. I believe some insurance companies and Medicare have made some changes after backlash…

[@rubygreta1]

@@rebeccar1036 FIT test is cheap. Pay cash. Get a positive result and then request a colonoscopy from a different doctor. They'll never know (I think).

[@njcanuck]

​@rebeccar1036 a followup colonoscopy would be free here in Canada. Who makes these health decisions at US insurance companies? Really dumb.

[@willsumnall3499]

Here in the UK all adults between 60 and 74 are offered colon cancer screening every two years for free under the NHS. Only anecdotal I know but I know of two people who had positive tests and went on to have colonoscopy, one had stage 1 cancer removed by laparoscopic surgery the other had polypectomy via colonoscopy. All done on the NHS of course.

[@trippinggauntlet4520]

I had to get tested for hepatitis A B C and HIV after the nhs gave me a colonoscopy, dirty equipment, and the hospital did everything they could to down play and discourage me from finding out what they wanted to test me for. I wasn't the only patient that it happened to. Only anecdotal I know but if it goes wrong don't expect care or honesty, they will protect their back and screw the patient.

[@taryncornelius548]

Free here in the USA under most insurance and definitely under Medicare

[@rubygreta1]

How do they do the colon cancer screening?

[@rubygreta1]

@@taryncornelius548 It's not free. It wipes out your deductible.

[@willsumnall3499]

@@rubygreta1 The NHS screening programme uses a faecal immunochemical test. A kit is mailed to all eligible individuals every two years. Anyone with a positive test is invited to have a colonoscopy.

[@nbrown5907]

Can polyps be reabsorbed like skin tags? I have had skin tags in the groin area be reabsorbed. My concern is our tendency to leap before we look. I understand taking measures with a high risk but cutting off body parts due to high risk is INSANE to me. An actress, Angelina Jolie I think did that. Her right but still crazy to me.

[@katydid2k]

My sentiments exactly. They act upon "ideas" about what helps, what's right, what's beneficial without (apparently) the proof that it's actually so. I.e. "we must remove polyps before they become cancerous". Says who?

[@snowbird6855]

She had the Braca genes, very high probability

[@kennethg9277]

​@@snowbird6855there are disbenefits to pre-emptive surgery that patients don't take into account. Physicians don't inform people very well about them for starters. Suffice it to say that there is no risk free intervention, and we are bad at assessing risk as a species. Humility is necessary but rare.

[@mrs.m4002]

I'm going to embroider "America is a delusional country" on napkins.

[@bluestarrbeauty]

Make me one for Canada too pls!

[@kathya1956]

I’d like to see you as Director of CDC

[@carolsmist4508]

Either that or the FDA!

[@danielmccarthyy]

Extoll means praise.

[@fazole]

I want know what they do in other developed countries. The doctor said it's not common in Europe. What about Asia? And also what is the rate of colon cancer in Japan, Taiwan, Korea?

[@heathermcmurray5590]

It used to be a traditional family md did the sigmoid every year. It was part of a annual physical, which for women included GYN exam and pap smear. That md office did xrays, drew blood, and kept people way healthier than the "new medicine". What a shame.

[@mignonowens2350]

I got an email from my doctor to come in and have one of these tests. I am thinking about looking for a new doctor.

[@garysattman4048]

This reminds me of Thyroseq, a hyped-up test that is great at generating money for those involved but does very little for the patients screening out Thyroid cancer. Do you have any thoughts on this money-making test Dr. ?

[@terrorists-are-among-us]

You make sense to me. Why don't you make sense to them 🤯

[@michaels908]

What's you opinion, chemotherapy vs. immune therapy?

[@stevdaughtr6098]

V.. I have been explaining symptoms to Doctor and was shocking to me as they recommend the colonoscopy because of my age but don’t want to do any of the testing for the symptoms that I have. I doubt very much that you’re going to see this but I wondered because I saw you do a debate with somebody from the medical College of Wisconsin whether you practice there or in the Midwest if so, it would be nice if you developed a comprehensive list of decent doctors that’s what we are needing

[@sliglusamelius8578]

Is mortality the only endpoint that matters in cancer screening? I don't want a blocked colon that requires a colectomy at any level of my gut. I'll stick with a full colonoscopy screening.

[@carolynbrightfield8911]

I've lived with the right hemicolectomy and splenectomy for 17 years. Aged 53, neither of the two general practitioners I saw sent me for a colonoscopy. Eventually I could neither shit, wee or eat for a week. I'd been told I was just menopausal. Yes, I'm alive (stage 2B colon cancer dx). More colonoscopies than I remember. All clear. But, quality of digestive system lousy. Better than the alternative. My husband - no sympotoms. I insisted he have a colonoscopy. Yep, repeated pre-cancerous polyps fried off regularly over the last 17 years.

[@sliglusamelius8578]

@@carolynbrightfield8911 I'm happy that you're doing well! Vinay, listen to this story! I love your channel but you missed the mark here on colonoscopies.

[@gailmoss8275]

What do you think of testing blood for genetic cancers that significantly elevate your risk for colon cancer as in test for Lynch Syndrome. I heard 3 to 5 percent of colon cancers are found with this genetic mutation. Of course a colonoscopy should also be done if test positive.

[@thegamejunkie1]

👍

[@kathya1956]

Sir, what do you think about cancer patients using metabolic diet cancer therapy (ketosis) along with conventional chemo/radiation.

[@luke53285]

Hey I'm really hoping you see this. I am about to start working for a company doing these blood screenings for cancer. They're specific assay is supposed to detect a wide array of cancers. They were published in JAMA and subsequently a few scientists published their review of it. It wasn't good. They've gone back and forth in the publication. The job I've been hired to do is to validate their robotic systems. I'm not sure if that can be done given the fp/fn rate of these assays, at least not in a meaningful way. Any thoughts

[@nancygaa5541]

Vinay for surgeon general!

[@richt8288]

How can the flexsig be more effective than the colonscopy? Doesn't the latter look at the sigmoid colon (left) and the rest? So a colonscopy would at the very least find what the sigmoidoscopy does?

[@DovidM]

Polyps can be present without FOBT indicating any issue.

[@karenday2261]

How can I find a Dr willing to do a flexible sig? I’ve called several GI docs & can’t find one. It’s colonoscopy or nothing with them!

[@kathynewkirk683]

Like to know what you do on the front side as a preventative measure….

[@Pseudify]

I wonder if the FDA approves so many interventions simply because they don’t want to discourage research. That’s perhaps the generous perspective. The not so generous one is that there is deliberate collusion between the FDA and the research industry.

[@kackpoo]

Vinay, love all you do. why talk so fast? Res ipsa loquitur.

[@user-yd8wp8rz2b]

If his natural tempo is too fast for you, go to SETTINGS (right bottom of video) and reduce "playback speed" to your preference.

[@sufyb6432]

I can keep up with him.

[@thebigskyguy]

So what procedure would you suggest aside from a colonoscopy or blood test?

[@borabora4480]

CT colonography

[@njcanuck]

Have you done a video on thyroid issues in older folks? Will have to check your list. My sister is seeing an anesthetist privately who is doing "holistic" health. He ordered tests not usually done by family docs here in Canada. Has been told there is "inflammation" (the word du jour) destroying her thyroid and is following a book written by a Ph.D. pharmacist (not an endocrinologist). Everyone is colouring outside their lines these days.

[@NOYFB982]

Having worked for decades in the in vitro diagnostic industry, I can say that the FDA is very poor at medicine in that field and applies their regulations capriciously. As noted, instead of focusing on what is clinically relevant, they often focus on meaningless statistics, that is some cases make it too easy to get clearance/approval, and in others, keep clinically valuable diagnostics from the market (e.g., having a too high hurdle, when a more modest hurdle still provides significant clinical value). They seem to pick their stats out of the air, often listening to chemists or statisticians who don’t have a solid clinical grasp of specific conditions, so hamhandedly apply rules of thumb from those that are irrelevant.

[@timswack7230]

When are you going to cover the "studies" surrounding gender affirming care?

[@kennethg9277]

That'd be like shooting fish in a barrel. Gender ideology is simply a ludicrous religious cult at this stage.

[@user-cc5od3zk4p]

My doctor suggested a colonoscopy (over 50 now). There have been no symptoms, no history in my family. I’m healthy, fit, do the usual right things. I told her no. Make her money off someone else.

[@wallihaley5194]

Unfortunately, there seems to be an unexplained increase in colon cancer among younger people, even among those with no family history of it.

[@colleenackert5022]

Unexplained😂

[@idee99]

Dr. Vinay, for someone who has had surgery to remove colon cancer and lymph nodes that were found to have cancer cells.... do you suggest chemo and or radiation if the cancer was thought to have been all removed? Why would a PET scan not be used to determine any residual cancer? I have several friends who have been diagnosed with cancer, but refused a PET scan.

[@danielleosentoski520]

Can you remove polyps with a flex sig?

[@drillbabydrill892]

I’d like to hear Dr. Prasad discuss CT colonoscopy. It’s difficult to find locations where I live in the NE US that performs this test. Many CT places mention CT colonoscopy on their websites but when I contact them they say they don’t perform them.

[@lovemyhoney1352]

In Virginia military medical system I had several (I’m old now, ha ha). Moved to FL. Had to argue and insist but finally won. Both husband and I had issues on other organs that the CT scan picked up. We go for CT scan for just that reason.

[@StoryThyme100]

@@lovemyhoney1352 Thank you for this info. I've stalled on pushing to schedule a virtual colonoscopy since due to motility issues I can't get cleaned out enough for a normal colonoscopy. Working with a wonderful neurogastroenterologist through Penn Medicine in PA

[@borabora4480]

I have had three of these CT scans with great success. I was pushing for it with my doctor prior to it even being covered by insurance. I held off until the insurers changed their policy (I was not high risk). Once the regulators came out with the same efficacy rate as a traditional colonoscopy the insurers were willing to cover the proceedure and I went forward with them. They are widely available now in most if not all major US cities.

[@aikimommee]

My Dad had colon cancer and there is so much pressure put on me to do a colonoscopy but I know TWO people who had issues after one - 1 person got a perforation and another got cdiff (could be coincidental but enough to scare the crap out of me)

[@sufyb6432]

No pun intended?

[@keepingitreal618]

Everyone has a horror story. If you have a strong history very different to routine screening.

[@Shwettyapple]

I know a number of people who were perforated during colonoscopies; these tests are not without risks.

[@AlabamaRatties]

What if the stool dna test is employed just to fill dna data banks?? Something to consider.

[@jesussavemetoday975]

Yup, that has crossed my mind too!