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Colon Screening: Ready to Go Virtual?

I almost filed this blog entry under The Checkup's "Popular Procedures" heading. But I thought better of it: For all the potentially life-saving benefits it offers, colonoscopy is hardly what you'd call a popular procedure. Just mention it out loud and watch the wincing begin.

But two studies in yesterday's edition of the New England Journal of Medicine suggest that for those who dread this standard screening procedure -- which, given the rate at which people opt to skip it , is apparently lots of us -- the end may be in sight.

One study showed that virtual (in this case CT, or computed tomography) examination of the colon identified 90 percent of the patients with large lesions. That percentage is in keeping with standard colonoscopy's track record, the study notes.

Virtual colonoscopy costs a fraction of what a standard colonoscopy costs -- $300 to $800 versus about $3,000 -- it doesn't require the patient to be sedated, and it takes a fraction of the time (a colonoscopy pretty much blows a whole day); it also entails less risk of injury, but it does involve exposing the body to possibly harmful radiation. Still, regular colonscopies have a big advantage: if a polyp (a lesion that can be benign, cancerous, or precancerous) is found during the course of the procedure, it can be removed right then and sent for a biopsy. Polyps detected by virtual screening require a second procedure to remove them.

One way or another, patients undergoing either procedure need to clear their colons by by taking medication beforehand. Many folks say that experience is far worse than the colonoscopy itself.

The second study showed that people whose coloncopies show them to be polyp-free are unlikely to develop colon cancer during the subsequent five years. That finding suggests that people at average risk of colon cancer don't need to be rescreened every five years or sooner, though how long they actually can wait remains unresolved.

Another recent study, released September 8 by the journal of the American Cancer Society, Cancer, showed that most people who've had surgery to treat colon cancer don't receive adequate followup screenings to make sure the cancer hasn't returned. About 40 percent of the 4,426 older people in the study got all the tests they needed, including doctor visits, blood tests, and colonoscopies. And it wasn't the patients' fault: they went to the doctor when they were supposed to; most got the requisite colonoscopies, but not many of their doctors ordered the blood tests that can tip them off to the cancer's return.

Have you had a colonoscopy, or are you putting it off? If you had a choice -- and you don't really, yet, as virtual colon screening's not yet approved by insurers and isn't yet in widespread practice -- would you opt for that easier procedure? Or would you rather go the distance with standard colonoscopy, knowing that any polyps detected will be removed on the spot?

And if you've had colon cancer, what's your take on all this?

Here are the American Cancer Society's current guidelines for colon-cancer screening.

By Jennifer LaRue Huget  |  September 19, 2008; 7:00 AM ET
Categories:  Prevention  
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Comments

I've had one colonoscopy so far, am due for another one next year. You're right about the preparation stage -- drinking that horrible liquid and then sitting on the john all night is worse than the actual procedure. My biggest problem is finding a ride to the clinic to get it done. Since they knock you out you can't drive yourself home.

Posted by: South of the Beltway | September 19, 2008 8:51 AM | Report abuse

I've had one colonoscopy, and yes, the night before is much worse than the procedure itself. But it's not as horrible as people would have you think.

My concern with the virtual colonoscopy is that radiologists who read the CT scan are not yet well-experienced in virtual colonoscopies. The gastroenterologist who did my procedure has done hundreds, maybe thousands, of them. This is what he does for a living. I have to think that his eyes are more likely to see something dangerous than those of a radiologist who's on the beginning of the learning curve.

Posted by: WashingtonDame | September 19, 2008 10:09 AM | Report abuse

As long as you're going to get cleaned out you might as well have the doctor actually look at the tissue as well as looking for polyps. Like a dermatologist a well trained doctor can identify emerging problems, get a biopsy sample when he feels it's necessary and determine how long you should wait before the next exam. Then there is also the path reports on polyps and other biopsy plugs. You simply cannot get a reading on a CT scan that is equal to a path report, especially for the non-polyp biopsy samples.

On the other side (or other end) if you have reflux or other stomach problems while you're "under" you can get the stomach scoped as well. Older people are at risk of obstructive sleep apnea which causes reflux and other problems and it's helpful to keep an eye out for potential damage from the reflux.

Posted by: Ken | September 19, 2008 11:19 AM | Report abuse

Promising, yet CT scans pose a potential health hazard themselves.

Check out:

Too Much of a Good Thing?
The Growing Use of CT Scans Fuels Medical Concerns About Radiation Exposure
By Rob Stein
Tuesday, January 15, 2008; Page HE01

Posted by: CU10 | September 19, 2008 11:43 AM | Report abuse

Had a regular colonoscopy at 49 because everyone in my family has gotten colon cancer at one time or another, and they found an early cancerous polyp, removed it, then I had a partial colectomy (half the colon was removed). No cancer found anywhere else so no chemo (yeh!). Its been 5 years so I guess I'm ok. The blood tests are done yearly and should have stopped a few ago but considering my family history we are continuing them. Its just a simple blood draw once a year. No biggie.

Since then I've had followup colonoscopies every year or two. A few tiny polyps found which I doubt a virtual colonscopy could have found and if it did would your doctor call for a real colonscopy to remove a 1/8 inch polyp?

I agree with the other poster. If you're gonna sit on the john for 4 hours the night before you might as well get the real thing. And if virtual colonscopy is going to become routine, shouldn't it also be geared for looking at other things, like the prostate, kidneys, liver, etc, which will get scanned anyway? I can see a virtual abdominal scan to check for a whole host of issues, including colon cancer. Now that might be a great screening tool.

And after a real colonscopy the rest of the day is not shot. I felt fine enough to have lunch right after the procedure. You are not supposed to drive for the rest of the day or operate heavy machinery, but you can certainly return to a desk job.

One thing, scedule your colonscopy in the morning. You take the prep and sit on the john the night before and cannot have even water the next morning, so the earlier you have it done the earlier you can get some food and water.

Posted by: Fate | September 19, 2008 12:17 PM | Report abuse

Here's the best way to stay healthy: AVOID DOCTORS LIKE THE PLAGUE! Routine screening is a fraud. Any benefits caused by early detection are balanced out (or outweighed) by the rampant medical error which runs through our system. You will always hear from the people who benefited from routine screening, but you never hear from the victims. Not to mention that there is an entire industry whose job is to convince you to undergo more and more routine screening so they can line their pockets.

If you have a symptom which needs treatment, see a doctor. Otherwise, stay out of the system. Counterintuitive but true...

Posted by: Ace | September 19, 2008 12:48 PM | Report abuse

I've been putting it off. I'll qualify that by saying I have no family history or sympthoms that would make me think anything is wrong in the colon department.

I'm going to talk with my Doctor about the new DNA-sensitive fecal test. While I'm not keen on having the invasive colon test the prospect of smearing a little poo on a slide doesn't sound so bad. I raised two children, you get used to things like poo after that. Then I could not worry about it.

I accompanied my husband to his colonoscopy and while he was up and around after the test he wasn't allowed to drive himself home. They suggested he follow a clear liquid diet for the rest of the day, which he ignored and then he didn't feel so good later in the day. He went to a pre-appointment, did the cleanse procedure the day before and took the day off when he had the test. Since I needed to drive him to and fro I took the day off also. Nobody ever counts the patients time into the costs of these things, but that amounted to nearly 3 patient days.

Posted by: RoseG | September 19, 2008 1:03 PM | Report abuse

I'm 53. My mother and grandmother died of colon cancer before age 65. I had my first colonoscopy 2 years ago and was terrified. I lost it just before the anesthesiologist put me under, sobbing, crying, just terrified out of my mind. Fortunately, my doctor knows me well and immediately after awakening, he popped his head into the room to tell me everything was fine - as he said, clean as a whistle. Everyone at increased risk needs to do this. I felt then, and fell now, that an enormous weight had been lifted from my shoulders.

Posted by: Anonymous | September 19, 2008 1:25 PM | Report abuse

I'm a senior and have had a half-dozen colonoscopies. The worst part is indeed the prep period which is lengthened by having to consume only broth and jello the day before. I agree with the need for an early morning appt. The procedure itself lasts only 8-10 minutes and the drug cocktail you are given largely softens your feeling and memory of the event.

Posted by: Bartolo | September 19, 2008 2:24 PM | Report abuse

I've had one and I'm only 35, I had one at 32. It's not bad at all I don't know why people freak out, you are sedated so you have no clue what's going on anyway and you feel nothing. I'd rather have the regular colonoscopy and have them be able to cut out any polyps right then and there then.

Posted by: Yep | September 19, 2008 5:01 PM | Report abuse

The prep indeed is the worst: sickly sweet Jello and salty broth, followed by a nauseatingly salty bowel cleanser. I wound up both starving and with a headache. The exam itself is dulled by pain killers and Valium, a delightful combination that will leave you floating gently downstream, feeling all is right in the world.

Posted by: Anonymous | September 20, 2008 11:15 PM | Report abuse

I absolutely agree with the post that says a colonoscopy is no big deal whatsoever. When I went for my first one I had trepidation because of what I read . When it was over I was astounded that I didn't feel a thing . I can honestly say getting a jab is worse .

Posted by: John Joyce | September 21, 2008 5:58 AM | Report abuse

Hey, ace. I wonder if anyone reading your warning to avoid too much contact with the medical establishment -- including colonoscopies -- will take your advice seriously. Your counsel, plus their own unwillingness to undergo the procedure, could cost their lives. There's just a possibility that you're wrong, dead wrong.

Posted by: Jack | September 21, 2008 4:02 PM | Report abuse

OK Folks...the prep for the virtual is much worse than the prep for the sedated. I've done them both. For the virtual, pills, enema & nasty beverage & cramping, up all night "pooping". For the sedated: 2 pills(OsmoPrep) every 3 hours, poop one or two times within the next 40 minutes, no cramps at all and sleep through the night (for an 8 AM procedure) REASON (per my GI doc): For the virtual, you have to have a pristine clean colon. For the sedated, they will do a quick "rinse" while you are sleeping and the pills are sufficient. We have a family Hx of colon cancer, so I see no reason to have to repeat. The sedation cocktail is a wonderful "nap". Just my opinion

Posted by: Hate to Poop | September 21, 2008 7:01 PM | Report abuse

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