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Screening by CT Colonography (CTC) for patients who would otherwise foregopreventive screening clearly improves the likelihood of early detection.However, substituting CTC for a complete colonoscopy creates the potential fora sizeable miss rate in the detection of high risk pre-cancerous lesions.
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Steven J. Morris, MD JD FACP FACG, National Coalition Board Chairpersonand CEO of Atlanta Gastroenterology Associates, LLC states "This study raisesnumerous concerns for clinicians and patients. Relying primarily on CTColonography screening exposes patients to the risk of undetected andunreported pre-cancerous growths, the need for follow-up with colonoscopy,radiation exposure, and the associated risks and unrealistic cost assumptionsabout predicted savings."
By focusing only on polyps of 6 mm or greater in size, the study authorsignored the significant number of pre-cancerous polyps that are detectedduring a Colonoscopy which are 5 mm or smaller. Equally troubling is that 17percent of study patients required subsequent referral for Colonoscopy toremove polyps, and other studies have described a referral rate thatapproaches 30%. The need for follow-up procedures creates additionalinconvenience and costs for patients and payors.
When comparing the efficacy between the two patient groups in the study[i.e., CTC versus traditional optical Colonoscopy (OC)], the researchersthemselves note "the number of polypectomies performed ... differedsignificantly between the two groups, with more than four times as many polypsremoved in the OC group as in the CTC group."
Dr. Morris added, "We are deeply troubled by the cost comparisons asdeveloped by the study authors. Reimbursement rates for various proceduresare not accurately reflected in the study, and any conclusions based uponthose inaccuracies may be equally inaccurate. For example, the total Medicarereimbursement rate for an outpatient colonoscopy does not exceed $1000 whichis significantly less than the $3000 sited in the study for colonoscopyreimbursement."
Dr. Stanford Plavin, Coalition Board Vice-Chairperson and Managing Partnerof Ambulatory Anesthesia of Atlanta, P.C. noted "CT Colonography offers noreal advantage over a Colonoscopy. The bowel still has to be cleansed andprepped for a CT Colonography. The patient will experience considerablediscomfort as a mechanical tube is inserted into the rectum to insufflate thebowel. There is no process available to immediately relieve the pressure onthe bowel when the CT Colonography is completed. Given the unnecessaryexposure to radiation, the failure to report small polyps, and the need forsubsequent Colonoscopies, CT Colonography does not measure up against theColonoscopy, which remains the Gold Standard for colorectal cancer screening."
The National Coalition is committed to making sure that patients makefully informed decisions about what prevention strategies works best whenscreening for colorectal cancer. Traditional colonoscopies remain the clearchoice for most patients both in terms of clinical outcomes and financialcosts.
Headquartered in Annapolis, Maryland, the National Coalition for QualityColorectal Cancer Screening & Care (www.preventingcolorectalcancer.org) hasbeen established to preserve the tradition of safe, comfortable and quality-based medicine. The Coalition is a nonprofit advocacy organization with itsprimary mission to educate both public and private stakeholders about theopportunities to reduce the incidence of colorectal cancer through promotingeffective screening, prevention and care options for patients
Study Source: Kim, Pickhardt, Taylor, et.al. "CT Colonography versus
Colonoscopy for the Detection of Advanced Neoplasia," The New England
Journal of Medicine, vol. 357:1403-1412 (no. 14), October 4, 2007.
SOURCE National Coalition for Quality Colorectal Cancer Screening and Care
