Do you really need a colonoscopy? | UC Health

UC Berkeley Wellness Letter: Other tests may be just as good, encourage more to be tested.

Screening for colorectal cancer ? that is, cancers of the colon (large intestine) and rectum ? is a proven lifesaver. This is partly due to the fact that this is one cancer which screening can actually prevent, since it can lead to the detection and removal of polyps, some of which may progress to cancer.

So why are anywhere from one-third to one-half of Americans over 50 not getting the recommended tests for colorectal cancer? One reason this screening rate lags behind those for some other cancers may be an overemphasis on colonoscopy as the screening test of choice in this country.

For years many experts, organizations and media spokespeople (such as Katie Couric) have promoted colonoscopy as the best colorectal screening test. As a result, it has become the most frequently used screening test for colorectal cancer in the U.S. Most doctors today do not even discuss alternatives with their patients.

Offering only colonoscopies discourages some people from getting tested, since they may dread the bowel-cleansing prep (clear liquid diet, strong laxatives and high fluid intake), are scared or embarrassed about the procedure itself, worry about potential complications and/or can?t afford its high price. Medicare and private insurance cover colonoscopy (and other screening tests), but that leaves out uninsured people, who are only half as likely to be screened for colorectal cancer as the insured.

Colonoscopy is a good test, though not perfect. You should know your other screening options as well. ?Much more screening will be carried out if primary-care providers and the American public are not made to feel that screening tests other than colonoscopy are ineffective,? says Dr. James Allison, professor emeritus of medicine at the University of California, San Francisco, and a leading expert on colorectal cancer screening.

Colonoscopy: strengths and weaknesses

Colonoscopy examines the colon via a flexible scope that transmits the images to a video screen while the patient is sedated. The claim that it is the best screening option has been based on assumptions and expectations about what it can do ? allow a doctor to examine the entire colon and rectum and remove polyps during the procedure. But colonoscopy?s superiority has never been proven in randomized controlled trials (the ?gold standard?) comparing its effectiveness to other tests.

Other kinds of studies have suggested that colonoscopy (typically done every ten years if no cancer or polyps are found) doesn?t save more lives than sigmoidoscopy, which examines only the lower part of the colon and is usually done every five years. In some studies, sigmoidoscopy was combined with stool tests (see below). Two large randomized controlled studies comparing colonoscopy with stool tests are underway, but results won?t be available for years.

[Editor?s note: In February, shortly after this article went to press, a major study on colonoscopy was published in the New England Journal of Medicine. It confirmed that colonoscopy, by detecting and removing polyps, can prevent cancer and save lives. In fact, it cut the death rate from the disease by half. But the study was not a randomized controlled study, did not look at colonoscopy as a screening test for the general public, and didn?t compare it to stool tests or sigmoidoscopy. It included only people with polyps, some of which were detected by these other tests.]

One problem with colonoscopy is that it?s less effective in detecting polyps and cancer in the right side of the colon (the upper portion, including the ascending colon and cecum) than the left side. This is because many polyps and cancers in the right side are flat, pale and difficult to identify and remove completely. Also, bowel cleansing may be less complete in the right side of the colon, making detection more difficult there.

Other factors can also reduce colonoscopy?s accuracy. For instance, it tends to be less accurate when done comparatively quickly, by less experienced doctors (typically those who are not gastroenterologists) and/or when patients don?t prep adequately to empty the colon.

In addition, though colorectal cancer starts in certain adenomas and other polyps, the vast majority of polyps detected and removed (including most ademonas) are harmless. It?s estimated that 30 to 50 percent of Americans over 50 have or will develop adenomas, and that between 1 and 10 percent of these polyps will progress to cancer in 5 to 10 years.

Finally, colonoscopy poses a small ? but not insignificant ? risk of serious complications such as bleeding or colon perforation.

Sigmoidoscopy has some advantages over colonoscopy. It costs only a fraction as much, is quicker and can be done well by primary care doctors. The prep is simpler, and sedation is usually not needed. But it too misses some cancers, especially since it can?t examine the upper portion of the colon. And if suspicious polyps are found, you?ll need a colonoscopy to remove them and check the upper colon.

Starting with stool

Not too long ago, annual stool tests were the primary way to screen for colorectal cancer in the U.S. In most countries they still are. Called fecal occult blood tests (FOBT), they detect hidden (?occult?) blood in stool, a possible sign of colorectal cancer. Your doctor gives you a kit to take home; you then provide one to three stool samples to be analyzed, depending on the type of FOBT. You?ll be referred for a colonoscopy if blood is detected.

The standard stool tests are called guaiac tests, named for the compound used on the test cards. The early versions have increasingly been replaced by more sensitive guaiac tests. However, they still often produce false-positive results because of blood that comes from something besides polyps or cancer; certain foods or medications (even vitamin C) can also throw off the results. And they miss some advanced polyps and cancers, especially those that don?t bleed or do so intermittently. That?s why screening should be done every year ? repeated testing provides multiple opportunities to identify advanced polyps before they become malignant and early cancers before they become life-threatening.

A 2010 review paper in Gastroenterology concluded that annual highly sensitive FOBT is indeed effective at identifying colon cancer and reducing deaths from it. Because it is inexpensive, more people can afford FOBT, so it may save more lives than colonoscopy, according to some analyses. But FOBT is most effective only if people are compliant?take the test annually and do the follow-up tests when necessary.

A more advanced form of FOBT is the fecal immunochemical test (FIT), which is superior in several ways. For one thing, it requires only one stool sample. It is more accurate than standard FOBT because it identifies antigens in blood that may be in the stool, and it can?t be thrown off by food or medication. And it only detects blood originating in the colon or rectum. What?s more, the processing and reading of the test can be automated for quality assurance. Used primarily in Europe, Australia, Japan and Israel, FIT is being used more and more in the U.S., even though it is more expensive than standard stool tests.

Wellness Letter?s advice

Everybody age 50 to 75 should be screened for colorectal cancer, whichever test they use. People at high risk ? notably those with a family history, a known genetic risk, inflammatory bowel disease or certain other disorders ? should start earlier.

Discuss the screening options with your doctor. Colonoscopy is not the only test ? which is fortunate, since there aren?t enough skilled practitioners to screen all eligible people. Nor is it necessarily the best. All the tests have strengths and weaknesses, which you and your doctor need to weigh. Here are the options:

? Colonoscopy every 10 years, unless polyps have been found or you are at high risk, in which case more frequent testing will be needed. Despite that standard guideline, many people, especially those over 65, have colonoscopies repeated in less than seven years, even though there is no clear reason for them to repeat the exam that soon, according to a study in the Archives of Internal Medicine last year.

? Sigmoidoscopy every five years, along with stool tests (preferably FIT) every three years.

? Annual stool tests. Ask your doctor about FIT, or at least make sure you?re getting a highly sensitive FOBT.

? People at elevated risk or with a history of polyps and/or colon cancer should have colonoscopies ? and perhaps FIT during the intervals.

Your doctor should consider your personal preferences. For instance, some people want to steer clear of colonoscopy because of its prep, invasiveness and/or cost. Others prefer colonoscopy because it usually needs to be done only once a decade rather than every year like stool tests, and it allows for the removal of polyps, if present. (It?s worth noting that some colon-cleansing preps and regimens are easier and still effective ? we?ll discuss this in an upcoming issue.)

You can stop being screened after 75 if you?ve always had normal results and have no symptoms, and all screening should stop after age 85, according to federal guidelines. With increasing age, the benefits of screening decline, while the risks from sigmoidoscopy and especially colonoscopy increase.

Related:
View an accompany editorial

Source: http://health.universityofcalifornia.edu/2012/03/28/do-you-really-need-a-colonoscopy/

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WSJ: Google Planning To Sell Tablets Straight To Consumers

Here we go again: the rumors of Google branching out into the tablet space have been floating around for what seems like ages now, and the Wall Street Journal has jumped into the fray. They cite the usual handful of unnamed sources, who this time say that Google is planning to open up their own online store a la Amazon to sell Android tablets. Not just any Android tablets, mind you -- co-branded ones that bear Google's name along with that of the manufacturer. Google does many things (some better than other), but they're definitely not in the consumer hardware production game.

Source: http://feedproxy.google.com/~r/Techcrunch/~3/UV2HZCcm_i8/

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Raindrops In Rock: Clues To A Perplexing Paradox

Enlarge W. Alterman/University of Pretoria

Researchers have analyzed the fossil imprints of of raindrops, like the ones shown here, to study the atmosphere of the Earth, as it was 2.7 billion years ago. The rule at the top is 5 centimeters, or about 2 inches, long.

W. Alterman/University of Pretoria

Researchers have analyzed the fossil imprints of of raindrops, like the ones shown here, to study the atmosphere of the Earth, as it was 2.7 billion years ago. The rule at the top is 5 centimeters, or about 2 inches, long.

The late astronomer Carl Sagan presented this paradox to his colleagues: We know the sun was a lot fainter two billion years ago. So why wasn't the Earth frozen solid?

We know it wasn't because there's plenty of evidence for warm seas and flowing water way back then. The question is still puzzling scientists.

But new clues to that paradox come from an unlikely source: fossilized raindrops, from 2.7 billion years ago. Back then, the Earth had no trees or flowers or animals birds or fish. But it did have volcanoes. And it did rain.

You can see evidence of that in a remarkable fossil, found in South Africa. It records an ancient downpour.

"So it rained 2.7 billion years ago on volcanic ash," says scientist Sanjoy Som. "The ash was covered by a very thin but very resistant layer of ash, and all that was again covered by more volcanic ash."

That ash turned to rock. And even today, you can still see the little rims around the small impact craters the raindrops created.

"So they're flawlessly preserved, which is surprising for rocks that are that old."

Som was getting his Ph.D. at the University of Washington, and his advisor suggested that Som examine those fossilized raindrops to see what he might learn about the ancient atmosphere.

"Because I have background in aeronautical engineering I found that challenge super exciting and jumped on it," says Som, who is now at NASA's Ames Research Center.

The scientists knew that the size of raindrops would tell them how thick the atmosphere was back then. Raindrops fall more slowly through thick air than through thin air. So the thicker the air, the more gently they will fall to earth, and the smaller the craters will be.

And the raindrop craters they found were similar to those you get on dusty lava today. So Som and his colleagues conclude that the atmosphere back then was a lot like it is today, maybe a bit thinner, but surely no more than twice as dense.

Theories About Earth's Atmospheric History

It's just plain cool to figure out something like that. But the journal Nature highlighted this finding because it touches on Carl Sagan's paradox ? that the early earth was warm even though the sun was young and dim.

"Something was keeping the planet warm back then because the sun was fainter, yet there's plenty of evidence in the geological record of ocean sediments and river sediments," Som says.

The easiest answer is that the atmosphere served as an insulating blanket, as it does today. We'd still be a frozen planet if we didn't have the natural greenhouse effect to keep us warm. But it turns out you need a much bigger greenhouse effect to compensate for a faint sun.

"You either need higher CO₂ [carbon dioxide concentrations in the atmosphere] or higher CO₂ in combination with other greenhouse gases like methane," says Jim Kasting at Penn State University, who has been puzzling over this paradox for years.

But according to some controversial evidence from ancient rocks, there wasn't enough carbon dioxide in the air to get the job done. That's led other people to suggest that maybe the atmosphere was thick with nitrogen.

Nitrogen doesn't trap heat, but if there's a lot of nitrogen in the air, it makes carbon dioxide a better insulating blanket. However, the raindrop results say the atmosphere was not super-thick back then. So you can apparently rule out the nitrogen hypothesis. The paradox remains.

There are lots of other ideas still to test, but precious little evidence from the early days of earth.

And, by the way, while you're puzzling over that, here's something else to think about. The sun is still getting brighter. That is happening so slowly it can't explain our current trend of global warming. But Kasting says it does matter in the very long run.

"Within about a billion years, it should be 10 percent brighter, and that could actually spell the end for earth because in our models that's enough to drive off the earth's water."

And Earth will not be so much fun when the oceans have boiled away. But we have a billion years to figure a way out of that jam.

Source: http://www.npr.org/2012/03/28/149527582/raindrops-in-rock-clues-to-a-perplexing-paradox?ft=1&f=1007

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Source: http://health-articles.co.uk/bsn-true-mass-6-advantages-to-know-regarding-this-sports-supplement/

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Lisa Firestone: Are We Still Condemning Women for Their Sexuality?

Weeks have passed since Rush Limbaugh apologized for the scathing insults he spewed about a female student who spoke out before congress on the importance of birth control to young women. Yet, echoes of the terms Limbaugh used, "slut," "prostitute" and "feminazi," should still be ringing in our ears. Moreover, they should force us to look beyond extremist political personalities and examine how society itself views a woman's sexuality and what effect this is having on women.

In 1960, the birth control pill put women in charge of their bodies and their sexuality. In the following years, The Feminist Movement demanded women get equal opportunity, pay, responsibility and choice. The degree to which society has shifted since then is considerable. However, we somehow still find ourselves living in a world where our culture persists in sending women mixed messages about their sexuality. We want women to be objects of sexual desire, yet we expect them to be pure. We ask them to own their sexuality but deny them easy access to birth control. Women who've taken an equal position to men in acknowledging their sexual nature are often accused of being "easy" or "manipulative."

One of the most shameful insults to a man is the accusation that he is not masculine. For a woman, it is that she is sexually loose or a slut. For a man, sleeping with a lot of women can be a point of pride. For a woman, it's a point of shame. These contradictions and double standards should have us asking why it's considered shameful for a woman to be sexual.

Despite our social advances, our culture is still guilty of casting women as what author Estela Welldon described as "Mother, Madonna, [or] Whore." To put a woman into any of these categories is to deny essential aspects of who she is. Common opinions about female sexuality range from accusing women of being prudish or withholding of sex to being seductive and using their sexuality as a source of power or manipulation. These skewed views steer us away from seeing the reality that, just like men, women have a natural and healthy desire to be sexual.

Pushing the idea that men are from Mars and women are from Venus only helps make the sexes feel more alien from each other. In fact, when it comes to an untainted expression of sexuality, women and men are much more similar to each other than you may think. In explaining "The Gender Similarities Hypothesis," researcher Janet Hyde emphasized that although gender difference is "large for incidences of masturbation and for attitudes about sex in an uncommitted relationship, the gender difference in reported sexual satisfaction is close to zero."

Some stereotypes regarding women's sexuality are based on the fact that because of influences from both society and family, many women are less likely to reveal their sexual desire. Society's point of view reminds us that men are designed to want sex, while women are designed to withhold it. These attitudes drive a man to hide a lack of sex drive for fear of facing the same negative scrutiny a woman dreads for showcasing her sexuality. When a person's sexual nature is stripped of these hurtful and shaming cultural and psychological influences, a man and woman's desire for sex is basically the same.

A common distortion in our society views men as wanting sex more than women. In my personal experience as a therapist, I have found this to be untrue. Many couples I've seen have complained of the opposite dynamic, with the woman feeling frustrated over her partner's lack of interest in sex. Other therapists have noticed the same. In an article on WebMD, Louanne Cole Weston, Ph.D. stated, "When people wrote in about the discrepancy of frequency and desire [for sex], about 40% of the time it was men wanting less." Irwin Goldstein, M.D., director of sexual medicine at San Diego's Alvarado Hospital and editor in chief of The Journal of Sexual Medicine further stated to WebMD that one in five men have a low libido, and "almost 30% of women say they have more interest in sex than their partner has."

In the U.S., 15 to 20 percent of couples reportedly have sex no more than 10 times a year, which experts define as a sexless marriage, and 20 to 30 percent of men and 30 to 50 percent of women say they have little or no sex drive. The reasons for this are complex. Many of our attitudes toward sex are shaped by how we were raised and how sexuality was portrayed to us in our families and in our communities. It also has to do with how much we've matured and developed our capacity to tolerate mental and physical intimacy.

If women are in fact less sexual than men, there is a certain degree of explanation in the family dynamic. Families tend to be more protective toward their daughters. Parents impose their own moral, religious or personal views toward sex onto their children, and this is particularly the case with girls. Feelings of guilt and shame are born in the household and at a very young age, when little girls are taught to hide or repress their physical selves. As they reach adolescence and start dating, protective or critical attitudes from parental figures tend to teach young women to suppress or resist their sexuality. Everyone from their parents to their peers may be sending them the message that being sexual is synonymous with being a slut.

Of course, not every woman is brought up with an unhealthy or repressive view of sex. Many young girls are well-educated and rightly taught to respect their bodies and that developing as a sexual woman is a natural and enjoyable part of becoming an adult. Nevertheless, a parent's outlook toward his or her own sexuality also impacts their children's perspective on sex. The subtle attitudes we indicate to our children do not go unheard, and the conversations we have or fail to have help shape their feelings toward themselves, their bodies, and their sexuality. When we are critical, intolerant, or not accepting toward them, we teach them to feel these ways toward themselves. Teaching our children, with our words or our example, that sex is shameful, dirty, or not to be talked about leaves an impression that is hard to outgrow.

People often cite their young adulthood as the years they were the most sexually free or "themselves." As we get older, our responsibilities increase, and we often become involved in long-term, committed relationships. Three reasons are typically given for a woman's decreased sexual desire at this stage in her life: marriage, career and kids. Yet, it isn't just a lack of time or an influx of responsibility that disconnects us from our sexuality.

Marriages and long-term relationships tend to deaden when each party pulls away from being close, attractive, attracted and alive. This naturally affects our sexuality. When we become too dependent on each other or become disrespectful in our familiarity, or restrictive of one another's freedom and individuality, we become less sexually attracted to each other.

For many women, becoming a mother and shifting her focus onto her children can further interfere with her desire for her partner. Most of us didn't see our mothers as romantic, and we tend to mimic these tendencies when we become mothers ourselves. Society feeds into this notion, indicating to women that now that they are a mother, it's no longer appropriate to be sexual. Being free is deemed irresponsible, and being spontaneous is shunned as immature. The same can be said of work. Being overly focused on a career or parenthood disconnects a woman from her sexuality, allowing her life to get out of balance in a way that fails to acknowledge her as a complete person.

The primary goal for every individual in a close, sexual relationship should be equality. Having a personal, honest and emotional exchange is the best we can hope for in regard to intimacy. When a woman gives up her sexuality, she sacrifices an essential part of who she is. It's not just about having sex, but about being acknowledged and acknowledging of her full self, her physicality, and her wants. Failing to recognize or repressing this part of ourselves can have serious consequences. Every person must feel they can accept themselves and their whole identity. If you are cut off from such an essential feeling, you become less alive and less you. That is why it is so important to debunk the myths about a women's sexuality and allow every individual to live freely as their fullest selves.

Read more from Dr. Lisa Firestone on relationships at PsychAlive - Alive to Intimacy.

See Webinars with Dr. Lisa Firestone on relationships and more.

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Source: http://www.huffingtonpost.com/lisa-firestone/women-and-sex_b_1382892.html

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