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Colon Cancer ScreeningAlison Little, MD, MPH
Medical Director, Medicaid
Colon Cancer Screening
Colon Cancer Screening
Overdiagnosis
When an individual is diagnosed with a condition that will never cause
symptoms or death
Colon Cancer Screening
Overdiagnosis
Makes people feel vulnerable and less healthy
Leads to excessive treatment, which can cause significant harm
Colon Cancer Screening
Overdiagnosis Case Study
Lara – 55 yo W female - asymptomatic• Screening DEXA finds T score + -1.8, started HRT • HRT stopped after WHI study• Put on bisphosphonate, developed severe esophagitis
(diagnosed by EGD)• Put on raloxefine, developed painful rash• Sent to endocrinologist to treat her osteopenia• Endocrinologist exams her thyroid, finds a mass• Has ultrasound, finds 3 nodules• Had a needle biopsy, finds possible malignancy• She gets lucky…. The surgeon she is referred to stops, noting
that there are 1600 annual deaths from thyroid cancer per year in US, compared to 37,000 diagnoses
Colon Cancer Screening
Examples of overdiagnosis (lower and lower threshholds for “disease”, better and better ways of finding abnormalities):• Hypertension• Diabetes• Hyperlipidemia• Osteoporosis• Gallstones• Meniscal tears• Vertebral disc disease• Aortic aneurism• Cancer
– Breast– Prostate– Thyroid– Lung– Melanoma
Colon Cancer Screening
Two cancers with little or no overdiagnsois: Colon and Cervical
Colon Cancer:– Screening for 25 years– Number of diagnosis has not risen, but instead has
fallen since 1985– Number of deaths from colon cancer has also fallen– If this was due to finding cancer precursors and
removing them, true success story– But, polypectomy uncommon until mid 1990s, 10
years after the onset of the decline in colon cancer
Colon Cancer Screening
Overdiagnosis associated with colon cancer screening is diagnosis of polyps
Many polyps removed that will never become cancer
Identification of polyps results in increased screening, and associated harms of overdiagnosis
Colon Cancer Screening