Talk Evidence - aggravating acronyms, a time to prescribe, and screening (again)
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Welcome back to Talk Evidence, your monthly roundup of everything in the world of EBM. Well, maybe not everything, at least a decent chunk of it. I'm Duncan Jarvis, multimedia editor for the BMJ. And as always, I'm joined by our two favourite EBM nerds, Helen and Carl.
Hi, my name's Carl Hennigan. I am editor-in-chief of BMJ Evidence-Based Medicine, a GP and also an academic.
You're getting more important every time you come on this show.
Well, I'm sort of slightly distracted because I was thinking of the idea that we were just abreast of all the evidence in the world and we were on top of everything, which is complete nonsense.
I mean, you're a professor of EBM. Surely that is your one job.
How can anybody keep up to date? It is incredibly difficult, and if not getting harder in the world, with the amount of information that's published. Added to that is a bit of fake news. Added to that is an overwhelming number of journals that are increasing. So it's a real difficult problem. That's why you should listen to this podcast, because we distill it for you to some of the important stuff.
Or at least talk about the general big themes anyway. So, Helen, could you introduce yourself as well?
I'm Hannah MacDonald, UK Research Editor at the BMJ, and I also trained as a GP.
And I just like, as an aside, how Carl can't even wait to the rant bit of the podcast before he starts there. You're just raring to go this week. So as always, we have our what to start, what to stop. It's a nice way to open. So Helen, you generally bring the rapid recommendations and they're doing really well in the BMJ. People seem to really care about these.
Yes, they're very red. They're some of our most read content and I have another one for you. So this one is looking at the pros and cons of colorectal cancer screening in otherwise asymptomatic people who are over 50 and looking at whether it's worth it and if it's worth it, then which test is best. There are various options. You can do faecal immunochemical testing every year, every two years. You can have a one-off sigmoidoscopy or you can have a one-off colonoscopy. And at the moment, organisations around the world do tend to recommend screening, but there's quite a lot of variation on who gets screened, what test is used. In some places it's quite systematic and offered to everybody and in other places it's quite opportunistic.
And uptake varies quite a bit and hovers around 50% suggesting that there's quite a bit of variation in how people out there value this offer that's made to them. And the rapid recommendations team looked at this issue because there were some new trials that came out looking at long term outcomes on sigmoidoscopy screening published over the last couple of years, which suggested that up to 15 years later, it was still worthwhile having screening done. And also finding something quite interesting that perhaps there was less of a benefit for women. So here is our verdict or their verdict. They make weak recommendations and suggest that there is limited evidence to suggest screening is worth it if you have less than a 3% risk of colorectal cancer over the next 10 years.
And there is a handy online tool where you can go and work out what your risk of colorectal cancer is. If all of the testing options are available to you in your healthcare system, there are lots of different pros and cons of them. And mostly it's the practical issues or the convenience of those tests that's likely to drive your decision rather than there being a standout winner amongst those tests. And overall, the guidance suggests that there's really an increased need for shared decision making and discussion about what people's preferences are as to whether it's worth it.
So it's interesting. I think this concept of putting an artificial line in the sand of 3% for me creates some problems because you talk about what happens if your risk is 2.9% versus 3.1% and I think that creates an issue. How can you interpret that small difference that you go over and above the threshold?
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