Harry Smith’s CBS Colonoscopy: Both Too Much and Too Little Information

Finally, someone has said loudly and clearly that the emperor has no clothes—or, more specifically, that the colonoscopy that Harry Smith of the CBS Early Show got, live, on the program a week ago amounted to cheerleading for a procedure whose value is much less than the public has been led to believe.

Over at Health News Review, Gary Schwitzer of the University of Minnesota School of Journalism highlights the gap between the message that CBS pushed—if you want to avoid getting colon cancer, get a colonoscopy—and what scientific studies have found about the procedure. You should read the short post yourself, but among the evidence he cites is a recent paper concluding that "the only screening test for colon cancer shown by randomized controlled trials to decrease colon cancer mortality and incidence is fecal occult blood testing (FOBT)." That paper, to be published in the journal Gastroenterology, also notes that "the available evidence suggests that repeated screening with highly sensitive FOBT [fecal occult blood tests] may be as effective and cost effective at preventing colorectal cancer-related deaths as screening colonoscopy every 10 years."

When was the last time a TV anchor pushed FOBT?

TV anchors have a bad history of this, with Katie Couric leading the way in 2000 with a colonoscopy (though not a live one) on the Today show. But since her husband died of colon cancer two years before and since the evidence that the procedure does not save lives wasn't as solid as it is today, the media gave her a pass. (Couric was by Smith's side last week as he had his own colonoscopy.)

Schwitzer also notes last month's state-of-the-science conference at the National Institutes of Health on colorectal screening, which similarly pointed out that the evidence that colonoscopy (especially virtual colonoscopy) prevents colon cancer and saves lives is somewhere between paper thin and nonexistent.

As I've written more times that I can count (including here and here), the message that cool new high-tech tests to detect cancer in its earliest stages (or, in the case of colonoscopy, precancerous polyps) do not necessarily save lives makes the public confused and apoplectic (oh god, you mean even if I'm a good girl/boy and get all the screening tests my doctor tells me to get, I might still get and die of cancer?) and some doctors furious. Kudos to Schwitzer for calling CBS on its promotion of something that hasn't been shown to reduce the incidence of colon cancer, let alone your chance of dying from it, and on ignoring the test that does.

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