Problem is - which of the tens of thousands of religions is right? We also can’t assume it’s any of the current ones. Maybe the Egyptians, Romans, Sumerians were right all along? And if you pray to the wrong God, under most religions you’re equally screwed!
Religion never goes away, and there is always a state religion. Harvard was founded as a theological seminary and it still is. The people running it just became so holy that God was no longer needed. There are three ways to persuade a human: Force, trade something, or use moral argument. Religion is the software operating system of a society—the moral code that it runs on. There used to be a holy word that could not be spoken that involved God. Today a different holy word must never be spoken because belief in equality has become sacred. This matters to us because we want impartial evaluation of data. Remember the Covid fiasco? Cheap paper masks became sacred talismans, and various vaccines became sacraments. Meanwhile another group worshipped freedom (or is that free dumb) and argued against the new sacraments .
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Another: James Van Der Beek, Dawson's Creek actor, dies aged 48
James Ven Der Beek, best known as Dawson in Dawson’s Creek, died at the very young age of 48. Leaving behind a wife and 6 children.
The cause of death was colorectal cancer. He first noticed changes in his bathroom habits, and tried cutting coffee before going for a screening test (presumably colonoscopy). He was diagnosed as Stage 3 in late 2023, and despite being a wealthy celebrity and presumably having great medical care, he has progressed through stage 4 and died only 2.5 years later.
Colon cancer is very slow growing in the initial stages, and he quite likely first had polyps in his late 30s and almost certainly by his early 40s. A colonoscopy in his early 40s probably would have saved his life. Very sad.
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I just read she had rectal cancer.
I remember Farah Faucet had this as well.
I looked up how we screen for this.
Screening Methods
Average-risk adults aged 45-75 should undergo regular screening with either stool-based tests or visual exams of the colon and rectum.
Stool-based options include annual highly sensitive fecal immunochemical test (FIT), guaiac-based fecal occult blood test (gFOBT), or multi-targeted stool DNA test (MT-sDNA) every 3 years.
Visual exams include colonoscopy every 10 years, CT colonography every 5 years, or flexible sigmoidoscopy every 5-10 years (sometimes combined with annual FIT).
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You mean James? BBC said “bowel cancer” and later “colorectal cancer” and talks about growths on the inner lining of the colon.
Either way anal cancer would be caught by colonoscopy because they do comment on the anus, presence of haemorrhoids etc., and obviously check inside of it!
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Confusing names for sure but rectal cancer is not anal cancer and is just a subset of colorectal cancer.
Rectal means in the last 15 cm or so of the color (it has a more specific definition). It has a different treatment approach and behaves somewhat differently than the other regions of the colon.
Anal cancer is totally different - squamous cell origin mostly. Farrah had this. Most linked to HPV. Most have symptoms early which helps survival. Also relatively rare and presumably disappearing with vaccines.
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@relaxedmeatball
Sorry, I was referring to Catherine O’Hara.
Fasting the day before a colonoscopy is brutal for me, but I even panic when I have to do labs and can’t have my latte until 9am!
And @DavidCary you are correct, I was confused by it being calling rectal cancer and not colon cancer, so I was assuming it was what Farah had. Now I know!
None of us would even be on this site without Suren’s discovery of rapamycin and it’s basic function.
Formally - Surendra Nath Sehgal** (1932–2003) was an Indian-Canadian-American microbiologist and pharmaceutical scientist most widely known for his discovery and development of *Rapamycin (Sirolimus), a immunosuppressant drug widely used in organ transplantation. Rapamycin has also attracted attention as a potential anti-cancer. Sehgal was diagnosed with stage 4 metastatic colon cancer in 1998. He died at home in Seattle on January 21, 2003.
However, he had the colon cancer completely gone when on rapamycin - it returned with a vengence in months when he stopped taking rapamycin. Listen to his story here: The Dirty Drug and the Ice Cream Tub
A person I am thankful for existing.
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Just imagine if he had a colonoscopy done earlier and had caught the cancer. Not getting a colonoscopy before 45 is reckless.
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There mus be a typo here…
Do you guys know if there is a different (other than colonoscopy) checkup/method that can detect cancer/polyps?
There are stool tests that can detect colon cancer and polyps but they are not very effective detecting polyps. They miss 50% of polyps and only detect those that are on the verge of becoming cancer. That’s way too much needless risk for me.
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Speaking of spunky celebrities - I just watched the two part HBO documentary about Mel Brooks “The 99 year old man”. Mel is going to be 100 in June of this year, assuming he lasts. He is remarkably sharp at 99 - just super functioning near centanarian. Exceptionally good mental faculties. Here’s what’s interesting - in part 2 one of the questions is about his exercise and diet regimen. He laughs it off completely - does not seem to exercise a lick, and no special care with diet, frequent consumption of eggs (and based on “Comedians in cars getting coffee”, deli meat sandwiches daily). Meanwhile he was a pretty intense smoker for decades.
Reminds me of Dick Van Dyke - who was also a smoker but in addition a heavy duty alcoholic for decades. DVD is a cheerful centenarian who seems in robust health - but at least he does enjoy regular exercise at the gym. Whereas Mel Brooks is super sharp and NOT an exerciser. Goes to show how little we know, how relative is the importance of diet and exercise and lifestyle. Mel Brooks has horrible sleeping habits, doesn’t get to bed until practically morning and sleeps to almost noon (his entire life!) - a true night owl, which is supposed to be terrible for longevity and circadian rhythms etc.
Again - it’s the genes, at least in part. You can be a non-exerciser, indifferent diet and terrible circadian rhythm sleeper and still be exceptionally - truly exceptionally - sharp at almost 100 years. What do we take away from this? I personally take away from to not stress excessively about diet and exercise, be good in that respect, but not obessive, and focus on QOL and enjoyment. YMMV.
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I agree. Some people seem to be very genetically lucky (like Mel, living to 99 with no effort), and some are genetically cursed (cancers, autoimmunity, other chronic diseases etc).
If we assume that genetic “luck” is normally distributed, then there are the outliers mentioned above, but we also have to assume that most of us are going to be somewhere around the average, +/- one standard deviation. So most of us can likely benefit from a good enough diet and exercising enough - basically doing a good enough job that those things don’t actively cause detrimental effects. I personally reckon the 150 mins per week is a good guideline, plus some dedicated strength and mobility training.
However, IMO it’s very unlikely that diet or exercise can raise you up from a bad genetic makeup towards the longevity of somebody who was genetically lucky. Probably an uncomfortable truth for some people, I think.
No, I think he really does mean 45. End of the day, the chance of actually having colon cancer is pretty low. However, missing it can be absolutely devastating and you can be dead by 50.
To my knowledge, colonoscopy is relatively straightforward and low-risk nowadays. It’s both a screening test, diagnostic test and a treatment all in one. If they find a polyp, it’s removed there and then. If you’re all clear at 40, realistically you most likely don’t need a scan for another decade. So the cost of doing one in your early 40s is low, but the potential upside (though unlikely to occur) is literally life-saving.
I briefly looked at your post history and you’re a surgeon - do you have a different view about colonoscopies? I’d be interested to hear it.
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Certainly not a different view but using “reckless” for not getting a 40yo colonoscopy seems like an aggressive use of the term.
And to be balanced, I also took care of colon perforations.
I think, the person in question also died in like 2004 so we are really looking at a late 90s colonoscopy when 50 yo was the standard.
Colonoscopy can run up to $3k easy at a hospital based practice. It can also be $1k when costs are a bit more reasonable. The GI doc gets about $200 last I looked but using 10X is typical in the OR even if a bit less in endoscopy suite.
My quick look showed a good surgical journal listing a rate as high as .65% for perforation from a diagnostic colonoscopy in 2019. Now it was a range and a GI reference was .16% in 2017 which is probably the right number. The same article has .44% when a polypectomy was done. I’ll ignore the polypectomy for my math breakdown.
The rate of colon cancer from 20-49 increased significantly but was still 12.9 per 100,000 in 2018. This was enough to move the needle to screening at 45. But conversion gives us a screening only perforation rate of 160 per 100,000.
I can’t find a reference for cancer rate at say age 40 but just call it 5X the overall rate from 20-49 and that gives you 65 per 100,000.
Now who looks reckless? You perforate 3X as many cancers as you find.
Ok - young people perforate at a lower rate than overall. And perforations are not all the same. Sometimes it is pain and air on an X-ray and some antibiotics. Sometimes it is a colostomy. And sometimes it is death. I couldn’t find the death rate but it is probably 1 in 100,000 roughly. I happen to take care of 1 in training (was a pre-op colonoscopy before liver transplant - so not typical and why you always need to consider all the factors that impart mortality).
One data point, large retrospective review that went way back in time had a 10% rate of needing surgery after perforation with a 7% mortality in that 10%. So right around 1% of perforations lead to death which fits with my 1 in 100,000 overall.
Smart people look at this data much more than I and over 2019-2021 or so, decided 45 was the new 50. I trust them very much. When i comes to personal decision, I would consider costs that they might have considered. That would mean an earlier colonoscopy if you think that made a big difference in their decision making.
I think 45 is right and costs weren’t a major concern. I think cologuard on balance is likely harmful. At age 40, might be the right answer. And I suppose do annual cologuards from 35-44 if cost was not an issue. But after 45, cologuard is used to cut costs (insurance companies like to encourage it) and give people a choice to delay or avoid one of the most important screening in modern medicine. I suspect they did the math and decided it was worth it for the increased number of people that would get screened. I tell people they are making a choice that is only available because of ignorant people (those who avoid colonoscopy) changing the numbers.
My understanding is they are looking at age 40 but have stuck with 45. So any personal concern, do 40 but it will cost you $.
Anyone doing a cologuard should know that you may have a 7% rate of needing a colonoscopy after and that will not be free. Screening colonoscopy is free. Diagnostic after a positive cologuard hits deductibles and copays in most US based insurance. Always appeal to the pocket book.
It is like if we allowed ultrasound for breast cancer screening because mammograms are too painful. I just came up with this and I think it is a pretty good analogy.
Since we are talking celebrity deaths, Catherine O’hare’s death was likely because of a choice she made to not have a colonoscopy. That was reckless. I said likely because we don’t know all the details but she mentioned avoiding procedures and modern medicine in interviews.
TLDR. Scopes have risk and at 45 the benefit outweighs it. And every year after 45, the benefit skyrockets. No issue doing a scope at 40 but not reckless to wait.
Ok, are you sorry you asked my opinion?
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This is a blast from the past. LE was (I think) the first book I bought on the subject, some time in the 1980s. It was from a lovely bookshop in Camden Town (London) that is long gone.
I haven’t re-read it in decades and I expect that a lot of its content is wrong, but it was a pioneering text and clearly influential to people on this forum.
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I’m biased as I had precancerous polyps detected and removed at 35. Based on the sheer number of precancerous polyps I have had removed every 3 years, I have no doubt I would have had colon cancer before age 45. With this new breed of colon cancer, you need earlier screening. I would say at 40, is best.
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Absolutely not, haha! You gave a nuanced, rational and informed counter-argument - what’s not to love about that? I don’t have any ideology on this, and I’ll be swayed by evidence, no problem.
Just to be clear, the recent death from colon cancer was the guy from Dawsons Creek, who died aged 48. He was diagnosed with stage 3 colon cancer in 2023 (i.e. aged 45) and he just died in January 2026. 2.5 years after diagnosis, despite multiple treatments. So for him, a colonoscopy at 40 perhaps would have saved his life, and one at 45 was evidently too late. I think that’s what triggered this particular discussion about early intervention.
Anecdotally I also know a guy who had a polyp removed at age 41. Would he have been ok if he’d waited until age 45? I guess we have no way of knowing.
That is a very nice way of framing it. There is a cost of acting, and a cost of not acting. My counter point is that, as you said, the death rate from the perforation is 1%, and I have to assume the death rate from colon cancer is higher?
This is a very interesting point. I agree with you that the experts would have made their judgments based on a lot more evidence than I am able to assess. But as you said, they’re thinking about population-level guidelines, considering the cost, risk, benefits at a population level. For people on this forum, who are obviously more pro-active than average, I think our mentally is to do things “more” and “faster” and “earlier”.
I’m also aware that guidelines generally lag behind the evidence, and clinical practice lags even further behind. They certainly do in the cardiovascular field (which is my specialty), and we still have doctors saying LDL-C of 100mg/dl is normal, and they don’t order ApoB, and haven’t even heard of Lp(a). I can only imagine that something like this happens in the cancer screening research too?
I agree. I looked up the numbers and they’re fairly poor. 90% sensitivity for full-blown cancer, and 40% sensitivity for advanced pre-cancerous polyps. So basically it will miss quite a lot of early cases, but it’s reasonably good at telling you that you already have cancer.
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This is exactly why I am very aggressive about my health and willing to try unproven things. If I left it all up to my heathy lifestyle, I most likely wouldn’t see old age, and certainly not a healthy one. If looking at my family, I don’t even know what that would look like. If I had better genes, I most likely wouldn’t be here.
@DavidCary I thought your response was very interesting. And to your point, I never think of the risks of a colonoscopy (only the dreaded one day fast)… I simply asked my regular doc who to go to… it never occurred to me to check out his credentials.
Edit: David, I also appreciated your advice about diagnostic vs screening… I remember learning that hard cold truth $$$. I find it maddening! If I ever have something done, I am sure to say, nope, everything is perfect!
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