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.
Jennifer LaRue Huget
September 19, 2008; 7:00 AM ET
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