CT Scans Gain Favor as Option for Colonoscopy

[question everything]

OCTOBER 28, 2008

CT Scans Gain Favor as Option for Colonoscopy
By RHONDA L. RUNDLE
The WSJ



When Janice Rodefeld turned 50, her doctor began hounding her to get a colonoscopy. But Ms. Rodefeld was afraid to have the test, which involves snaking a thin tube through the large intestine. It wasn't until she recently was offered a noninvasive "virtual colonoscopy" that she relented. The test, a type of CT scan in which the patient lies on a table that slides in and out of a tunnel of X-ray detectors, revealed several suspicious growths, called polyps, on the inner wall of Ms. Rodefeld's colon. To remove them, she underwent a standard colonoscopy later the same day. "I'm glad I finally went ahead because those can turn into full-blown cancer," says the 58-year-old retiree in Cottage Grove, Wis.

Virtual colonoscopy, formally known as computed tomographic, or CT, colonography, has been available for some time. But more medical centers are gearing up to offer the procedure at a time when new research shows it can be about as effective at finding large polyps as a standard colonoscopy. The cost of the virtual test can run from $500 to $1,500, or less than half the total cost of a standard colonoscopy. But the newer procedure is rarely covered by health insurers for routine cancer screening.

As in Ms. Rodefeld's case, patients who opt for a virtual colonoscopy may not be able to avoid undergoing the standard procedure as well. That's because when large polyps are detected during the virtual test, doctors must perform a standard colonoscopy to remove them. When smaller polyps are found, doctors aren't in agreement about what to do. All such growths are routinely removed during standard colonoscopy. But CT colonography researchers are still figuring out when it's safe to leave tiny polyps, and how often to repeat the imaging test. The American Cancer Society recommends that a virtual colonoscopy for healthy men and women 50 or older be repeated every five years if no polyps are found. For standard colonoscopy, the group's recommendation for healthy individuals is every 10 years.

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Until recently, virtual colonoscopies' accuracy in detecting polyps has been questioned, partly because results varied widely in tests at different centers. But a large new study conducted at 15 U.S. medical centers by the American College of Radiology Imaging Network, and sponsored by the National Cancer Institute, has convinced more medical professionals of the test's effectiveness. The results, published in the New England Journal of Medicine in September, "provide evidence that CT colonography is approximately as successful as standard colonoscopy in the detection of colonic polyps," says Dr. Halvorsen, one of the study's co-authors. "It is also much easier for patients, does not require the patient to be sedated, miss a full day of work, or have someone to drive them home," he says. Many physicians expect the new study to help push the Centers for Medicare & Medicaid Services, which oversees the big government insurance programs, to start covering virtual colonoscopies as soon as next year, a move that private insurers are likely to follow. The agency says its coverage review is set for completion in February.

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After Ms. Rodefeld completed her virtual colonoscopy last month, she was sent home and told to continue fasting until her results were reviewed. A couple hours later, she received a call telling her that polyps had been found and a standard colonoscopy would be needed to remove them. "I said 'I don't want to drink that stuff again, so I'll do it today. Let's get this over with,'" she recalls. The CT imaging test, which took just 15 minutes, was at an outpatient facility affiliated with the University of Wisconsin near her home and she was able to drive herself; the 90-minute colonoscopy was at the university hospital in Madison, further away, and her husband drove her. It required sedation and monitoring that aren't available at the outpatient center. By five o'clock, Ms. Rodefeld was finished and sent home.

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http://online.wsj.com/article/SB122515172081974303.html (subscription)

[MercutioATC]

1. Less invasive = good

...especially in this particular area...