Drugs No Substitute for Colonoscopy

Screening for colorectal cancer more cost-effective than medication

THURSDAY, May 8, 2003 (HealthDayNews) -- It's less expensive to protect people from colon cancer by using colonoscopy rather than currently available medications.

That's the conclusion of a new study in the May issue of the American Journal of Medicine.

For someone with an average risk of colon cancer, colonoscopy would cost about $20,000 to save one "life-year," the study found. That compares to more than $230,000 for the arthritis medications known as cox 2 inhibitors, which have been shown in preliminary studies to prevent the development of polyps that can lead to colon cancer. A "life-year" is an extra year of life someone would "get back" because their cancer or polyps had been detected early.

"There has been an interest in medications that would eliminate or reduce the need for colonoscopy," says study co-author Dr. James Scheiman, an associate professor of internal medicine at the University of Michigan Medical School. "Cox 2 inhibitors may reduce polyps, but they don't reduce the need for colonoscopy."

Colonoscopy is one of the best ways to detect colon cancer. A thin, lighted tube is inserted into the rectum and then guided through the entire colon. The images are transmitted back to a monitor so a physician can see if there are any polyps or cancerous growths in the colon. Polyps can eventually develop into cancer. If pre-cancerous polyps are found, they can be removed during the procedure. Depending on your level of comfort with the procedure, you can either be sedated or not.

According to Dr. Debra Vachon, director of the colon and rectal center at Mercy Medical Center in Baltimore, you should start having screenings, such as colonoscopy, for colon cancer beginning at age 50 if you're not at high risk. People at high risk should start having colonoscopies earlier, and anyone with symptoms of colon cancer should have a prompt screening.

The problem with colonoscopy is that people are uncomfortable with the idea of the procedure, says Scheiman. Many people are embarrassed by the procedure or are put off by the preparation necessary to undergo it.

But preventing colon cancer by detecting it early is vital because colorectal cancers kill more than 57,000 Americans annually, according to the American Cancer Society. Every year, more than 150,000 new cases of colon and rectal cancer are diagnosed in the United States.

Risk factors for these cancers include a family history of the disease, a personal history of polyps, ulcerative colitis, being over 50, eating a high-fat diet, a sedentary lifestyle, being overweight, smoking and consuming a lot of alcohol, the cancer society reports.

Using a computer model, Scheiman and his colleagues compared the efficacy of colonoscopy against the use of cox 2 inhibitors, and also looked at the two in combination.

The researchers found that cox 2 inhibitors are currently far too expensive to be considered a cost-effective prevention tool for colon cancer. The drugs cost an average of more than a dollar a day, according to the study.

The other concern is that no drug is without side effects.

"There are no totally risk-free medications," says Vachon, who also points out that many people stop taking preventative medications or sometimes forget to take them because the drugs don't produce a noticeable effect.

Vachon says people who take cox 2 inhibitors for arthritis may be getting a secondary benefit from them because they may develop fewer polyps.

"These medications may decrease, but probably won't eliminate, polyp formation," Vachon says.

Scheiman adds, "If you don't reduce the risk to zero percent, you'll still need a colonoscopy."

More information

To learn more about colonoscopy, visit the National Institute of Diabetes and Digestive and Kidney Diseases. For more information on colon cancer, check the American Cancer Society.

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