5.19 - NEJM's first ever RCT of Colonoscopy-- Explained

Plenary Session

Vinay Prasad, MD MPH

Health, Medicine, Policy, Oncology, Science & Medicine

4.7 • 789 Ratings

🗓️ 9 October 2022

⏱️ 31 minutes

🔗️ Recording | iTunes | RSS

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Summary

I break down the history and data for the first ever randomized trial of colonoscopy, appearing in NEJM on Oct 9, 2022

Transcript

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0:00.0	A bombshell new paper is just out in the New England Journal of Medicine.
0:03.0	Let me walk you through it on this channel and this video and on the podcast plenary session.
0:08.0	The paper is entitled The Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death.
0:14.0	It's the Nordic trial. This is the first randomized control trial of colonoscopy that's ever been conducted.
0:20.0	We've had randomized trials of FOBT and FlexSig. We're going to ever been conducted. We've had randomized trials of
0:21.0	FobT and FlexSig. We're going to run through what we haven't had randomized trials of, but one of
0:25.7	those things was colonoscopy. There has not been a published report of a randomized trial
0:31.0	of colonoscopy. This is the first one. And spoiler alert, it's negative. It is negative on
0:36.0	colorectal cancer, death negative on all-cause mortality.
0:38.3	We're going to talk about what it means, what are the implications in this video.
0:41.3	Let me walk you through it. This is the paper just came out on the New England Journal of Medicine website.
0:46.3	First, I think we need to get a little bit of background. This is a 2016 paper that I wrote with colleagues in the British Medical Journal, and it
0:54.5	was about why cancer screening has not been shown to save lives.
0:58.6	There's an important distinction in cancer screening, and that's the distinction between
1:02.4	dying from colon cancer and dying for any reason.
1:07.3	All cancer screening tests are trying to prevent you from dying from a particular type of cancer.
1:13.0	Mammograms, breast cancer. CET screening lung cancer. Colenoscopy flexig, colon cancer. PSA, prostate
1:21.2	cancer. Now there are new blood-based cancer screenings that are supposedly trying to protect you from
1:26.0	dying from several cancers.
1:28.3	The goal of a cancer screening test is to find cancer.
1:31.3	It's not, it's to find cancer or pre-cancer before it otherwise would declare itself in a state where you can
1:37.3	interdict upon it, where you can act upon it, cut it out, remove it, and you will get a benefit that you otherwise wouldn't have gotten had you found it
	...

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