What the mainstream media is hiding
The cash register pays: From April 1, Germany’s women under the age of 55 can have their colon examined, just like men over 50. Applause for optimized cancer prevention? Proponents deceive us about the limited benefits, risks, and alternatives.
by Dr.Harald Wiesendanger– Klartext
Every year, almost 55,000 Germans receive the horrific diagnosis of colon cancer, and 23,000 die from it. Only lung and breast cancer are more common. It affects men slightly more often than women. This is why colon cancer screening for the two sexes has been regulated differently up to now. Now, it is being harmonized. Women under 55, like men over 50, will also be entitled to a colonoscopy – twice at ten-year intervals – as the Federal Joint Committee of doctors, hospitals, and health insurance companies decided on January 16, 2025. Previously, women between the ages of 50 and 54 were only reimbursed for an annual test for occult blood in the stool.
Around 560,000 colonoscopies take place in Germany annually – so there will now be even more of them, to the delight of gastroenterologists and medical technology manufacturers. But how much benefit does it have to those who have undergone colonoscopy?
An operation with risks and alternatives
During a colonoscopy, a doctor uses a thin, flexible tube, about 1.5 meters long and 1 cm thick. At the end of this is an endoscope: a light source and a tiny video camera, which he uses to search the intestinal wall. If he discovers polyps or suspicious areas of mucous membrane that could develop into cancer over time, he removes them immediately with a small loop or forceps. He then has the suspicious tissue examined in the laboratory.
A colonoscopy is, therefore, not just for diagnosis but can also involve a surgical procedure.
It’s best to take it with a gallows sense of humor…
However, colonoscopy is not the only way to detect colon cancer early. Stool examinations have long been proven to be effective, particularly the immunological fecal occult blood test (iFOBT). (Also called fecal immunochemical test (FIT). “FOBT” stands for fecal occult blood test.) It detects hemoglobin and red blood cells in stool with the help of antibodies. (1) For those with statutory insurance in Germany, health insurance companies pay for the iFOBT as part of the early detection of colon cancer.
How many patients find out in advance about these and other (2) alternatives and their respective advantages and risks? How can they give “informed consent” to the procedure if they have no idea that they actually have a choice?
Instead, many doctors recommend colonoscopy alone – for medical reasons alone? It costs 200 to 500 euros, while the iFOBT brings the doctor a mere six euros and the laboratory eight.
Patients are thereby misled into overlooking, or at least underestimating, significant disadvantages.
Fewer cancer diagnoses, but not fewer deaths
A large-scale study by the Northern-European Initiative on Colon Cancer (NordICC) published in 2022 in the renowned New England Journal of Medicine found that the benefits of colonoscopies are far less than conventional medicine, health policymakers, and the media would have us believe.
84,585 adults between the ages of 55 and 64 took part. None of them had previously undergone a colonoscopy. They were “randomized” into two groups: some received an invitation to a colonoscopy, and others did not. After 10 years, those who had a colonoscopy had an 18% lower risk of colon cancer than those who had not been examined. However, the risk of dying from colon cancer had not decreased statistically significantly among those who had undergone a colonoscopy. This did not change even after a further five years of observation:
“The risk of dying from colon cancer was 0.28% in the group invited to a colonoscopy and 0.31% in the group receiving standard care (…) The number of people who had to be invited to participate in screening to prevent one case of colon cancer was 455 (…) The risk of dying from any cause was 11.03% in the invited group and 11.04% in the group receiving standard care.”
However, only 42% of those invited had actually undergone the examination. When the researchers restricted their analysis to those people who actually had a colonoscopy, the procedure reduced the risk of colon cancer by 31% and the risk of dying from colon cancer by 50%.
“Over-hyped”
After all, a third less risk of colon cancer, only half as many colon cancer deaths: Aren’t these rates encouraging? Absolutely – but they roughly correspond to the reduction achieved by other, cheaper, and less invasive tests, especially stool tests.
Having proven this for the first time makes the study “groundbreaking,” comments gastroenterologist Dr. Samir Gupta: “It is the first randomized study to show the results of colonoscopy screening compared to no colonoscopy. And I think we all expected colonoscopy to do better. Maybe colonoscopy is not as good as we always thought.” A co-author of the study, Dr. Michael Bretthauer, confirms this impression:
“It is not the miracle cure we thought it was. I think we may have praised colonoscopy too much. The gastroenterological societies (…) have spoken of a 70, 80, or even 90 percent reduction in colon cancer if everyone went for a colonoscopy. This is not what these data show at all.”
Carcinoma is discovered in 0.9% of those who have a colonoscopy, and adenomas, precursors of colon cancer, are discovered in 19.4% – stool tests can undoubtedly keep up with that. “If we compare a preventive colonoscopy performed every ten years with an immunological stool test performed annually, it can be seen that the iFOBT comes very close to the effectiveness of a colonoscopy in terms of reducing mortality from colon cancer,” confirms Professor Dr. Frank Kolligs, foundation curator and head of internal medicine and gastroenterology at the Helios Klinikum Berlin-Buch.
Is a colonoscopy guaranteed to help detect malignant growths at an early stage? Experts assure us that the reliability is high: around 97% of existing adenomas, possible precursors of carcinoma, are detected. A British-Indian study, however, revealed a misdiagnosis rate of 17%. According to this study, in almost one in five cases, a colonoscopy causes false alarms, causing unfounded panic – or a false sense of security. The iFOBT stool test performs even better: it only produces false positive results for 8.1% of the stool samples examined.
Where is the balance between benefits and risks?
Patients must weigh up the limited benefits of a colonoscopy against the underestimated risks. One in 350 leads to serious harm.
These include bleeding after precancerous polyps have been removed. The risk of this is approximately 24 per 10,000 procedures. (3) They can occur up to ten days later. Surgery, a blood transfusion, or the administration of blood components are necessary in rare cases.
Perforation can also occur: a rare but serious complication in which the wall of the intestine is accidentally pierced or injured. This leads to a hole in the intestinal wall through which intestinal contents and bacteria can enter the abdominal cavity. This then threatens sepsis (blood poisoning), which requires the use of antibiotics. A systematic review and meta-analysis found that perforation occurs in approximately 6 per 10,000 procedures after a colonoscopy. (4) Another study found it in 0.2 to 5% of procedures. The risk of perforation increases the older the patient is and the more other diseases they have. 52 out of 1,000 people whose colon was perforated died within the first 14 days.
Negligible, hardly worth mentioning? For the unlucky ones, it is.
Depending on where the procedure takes place and how qualified the doctor performing it is, these risks can increase considerably – sometimes well above the usual post-operative bleeding rate of 0.15%, the normal perforation rate of 0.02%.
The risk of appendicitis increases after a colonoscopy, as Marc D. Basson, Dean of the University of North Dakota School of Medicine, concluded in 2018 from data from almost 400,000 US citizens who had colonoscopy between 2009 and 2014. “In the first week afterward, the likelihood of developing appendicitis was four times higher than during the rest of the year,” he noted.
If sedatives are used in too high a dose or an allergic reaction to administered medication occurs, respiratory and cardiac/circulatory disorders can occur – in the worst case, even cardiac arrest.
Anaesthesia can cause further complications (5), including aspiration pneumonia (): a lung infection that occurs when foreign material enters the lungs and triggers an inflammatory reaction or infection.
(“Intraperitoneal”) bleeding into the abdominal cavity is also possible. What makes it particularly insidious is that it is often not immediately recognizable and can lead to life-threatening conditions within hours. If there is significant blood loss, there is a risk of hemorrhagic shock, with progressive drop in blood pressure, reduced organ blood flow, cellular dysfunction, destruction of anatomical barriers, disruption of the immune system, and organ failure.
In the United States, anesthesia is used for one in three patients undergoing a colonoscopy, and in Germany, the figure is as high as 90%. In the northeast of the USA, anesthesia was associated with a 12% increased risk of complications, while for colonoscopies in the west, this figure rose to 60%. Patients who suffer from sleep apnea, obesity, high blood pressure, or diabetes are particularly frequently affected.
Is sedation even necessary? In a study by three American gastroenterologists, patients were given the opportunity to undergo a colonoscopy without prior medication immediately after the procedure, and two and five days later, the researchers asked about the severity of the pain and their willingness to undergo the procedure again without anesthesia. Only 5% said they felt no pain; 41% had mild pain, 34% reported moderate pain, and 20% said they felt severe pain. Despite this, 73% were willing to forgo anesthesia the next time; only 18% said they would request sedation next time.
Many of those examined not only find the procedure painful – they find what happens to them extraordinarily embarrassing and even humiliating. Some licensed colon whisperers (“My studies were a total waste of time”) therefore try to ease the tense atmosphere with offbeat humor. They then jokingly refer to the journey through the intestine as a “great harbor tour,” “inner contemplation,” “endoscopic adventure,” “intestinal inspection,” or “interior illumination.” The amusement on the part of those who are illuminated from the inside is usually limited.
A mess: dirty equipment
How carefully are colonoscopy devices disinfected between two procedures on different patients? Endoscopes often contain expensive, sensitive equipment that cannot be heat-sterilized. And unfortunately, manufacturers are not required to produce an endoscope that can be sterilized in this way. During the examination, the doctor may, therefore, be unable to see through the endoscope because it is blocked by human tissue from a previous examination. In this case, he must pull the endoscope out and replace it with another one. According to US microbiologist Dr. David Lewis – retired whistleblower and employee of the Environmental Protection Agency (EPA) – up to 80% of hospitals sterilize flexible endoscopes with glutaraldehyde (Cidex), which does not dissolve the tissue in the endoscope but preserves it. When the doctor then inserts sharp biopsy tools through the tube, he scrapes off patient material from previous tests and possibly transports it into their body.
Therefore, patients should be sure that the practice or clinic of their choice uses peracetic acid, similar to vinegar, and dissolves the proteins in the flexible endoscopes to sterilize the equipment thoroughly. Anyone who wants to undergo an endoscopic examination should, in their own interest, be brave enough to call ahead and ask: “How is the endoscope cleaned between patients? What cleaning agent is used? How many of your colonoscopy patients have had to be hospitalized due to infections?”
Over 500 deaths per year: not worth mentioning?
Even the slightest risk of death is worth mentioning. One study puts the risk of dying from a colonoscopy at 1 in 16,318. (It found serious complications in 82 people.) Another study found a death rate of 3 per 100,000 colonoscopies and serious adverse events at 44 per 10,000. According to another study, the mortality rate is even 1 per 1,000 procedures. With 560,000 colonoscopies performed in Germany every year, this would mean that over 500 fellow citizens do not survive.
Barely worth mentioning?
Do people of the same age need the same level of monitoring?
How much sense do preventive screenings by age group actually make? Current guidelines urge preventive screening for all people over 50, regardless of their individual risk. But can’t the obese, junk food-addicted couch potato at 30 be much closer to being diagnosed with colon cancer than a health-conscious 70-year-old? Therefore, practice guidelines such as those published by the British Medical Journal in 2019 are extremely advisable. They recommend that doctors use a tool to estimate a person’s potential risk of developing colon cancer in the next 15 years. Only people who have a risk of at least 3% should get checked. However, most healthy people over 50 are below this value, and the guidelines recommend “no screening at all” for them.
Real cancer prevention: a healthy lifestyle
It corresponds to the pathetic state of our sick healthcare system: the semantic distortion of the innocent term “prevention.” The medical-industrial complex has brainwashed itself into a clientele that believes the more willing they are to undergo as many highly profitable diagnostic procedures as possible as early as possible, the better “prevention.” Shouldn’t we do everything we can to ensure that nothing threatening is diagnosed in the first place?
The risk of developing cancer can be proactively reduced. Only 5 to 10% of all cancer cases are due to genetic defects. When colon cancer occurs and progresses, lifestyle factors play a major role. (6) These include alcohol and smoking, lack of exercise, and medication. However, according to researchers at the University of South Carolina School of Medicine, up to 70% of cases are related to diet. An effective preventive strategy includes
– losing excess weight
– avoiding too much salt, too much sugar, too much red meat
– avoiding ready meals and other ultra-processed products – they are associated with an increased risk of developing and dying from cancer.
– eating more fruit and vegetables
– consuming more fiber.
“Let food be your medicine,” Hippocrates taught 2400 years ago. Will we ever have to have a camera shoved up our butts as long as we stick to it consistently?
(Harald Wiesendanger)
Notes
(1) Until March 2017, the guaiac-based test for occult blood in the stool (gFOBT) was used in Germany for the early detection of colon cancer. However, it was more prone to errors because it also reacted positively to animal hemoglobin (e.g. from meat) or other substances (e.g. plant substances such as peroxidase from raw fruit/vegetables). From April 2017, it was replaced by the immunological fecal occult blood test (iFOBT). This has a higher sensitivity and specificity – it only reacts to human hemoglobin. The costs for the iFOBT consist of two components. Issue and consultation by the doctor: For this, the fee schedule item (GOP) 01737 is set at 57 points, which corresponds to around 6 euros. The laboratory examination of the stool sample is billed at 75 points, which is approximately 7.90 euros. All in all, the cost of the iFOBT is around 13.90 euros.
(2) Another procedure combines the iFOBT with a test for altered DNA in the stool. The so-called “small colonoscopy”, the flexible sigmoidoscopy, would also be possible: It is similar to a colonoscopy, but uses a shorter and smaller endoscope that does not allow as much of a view into the colon. An additional option would be colonography using a computer tomograph (CT), also called “virtual colonoscopy”.
(3) https://www.statnews.com/2022/10/09/in-gold-standard-trial-colonoscopy-fails-to-reduce-rate-of-cancer-deaths/; https://pmc.ncbi.nlm.nih.gov/articles/PMC4264696/
(4) https://www.statnews.com/2022/10/09/in-gold-standard-trial-colonoscopy-fails-to-reduce-rate-of-cancer-deaths/; https://pmc.ncbi.nlm.nih.gov/articles/PMC4264696/
(5) Another relatively harmless problem is dysbiosis and other intestinal disorders that arise from flushing the intestinal tract with strong laxatives before the procedure. A study published in the journal Cell suggests that even short-term use of laxatives can trigger an immune reaction. Studies on an animal model showed that the treatment eliminated beneficial intestinal bacteria. Two weeks after stopping the laxatives, the bacteria showed a reduced diversity. However, the intestinal flora can be quickly rebuilt: through a diet with easily digestible food, natural yogurt, prebiotic and fiber-rich foods, with plenty of fluids (still water, tea, diluted juices, vegetable broth) and probiotics. (https://www.divocare.de/blog/essen-nach-darmspiegelung/, https://www.t-online.de/gesundheit/krankheiten-symptome/krebserkrankungen/id_92334846/essen-nach-darmspiegelung-darauf-sollten-sie-besser-verzichten.html)
(6) https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776517; https://journals.sagepub.com/doi/10.1177/10732748211056692; https://link.springer.com/article/10.1007/s10552-013-0201-5