Evolving Role of CT Colonography in Colon Cancer Screening
Evolving Role of CT Colonography in Colon Cancer Screening
Computed tomographic colonography (CTC) is a relatively new imaging modality for the examination of patients for colorectal polyps and cancer. It has been validated in its accuracy for the detection of colon cancer and larger polyps (more than likely premalignant). CTC, however, is not widely accepted as a primary screening modality in the United States at present by many third-party payers, including Medicare, and its exact role in screening is evolving. Moreover, there has been opposition to incorporating CTC as an accepted screening instrument, especially by gastroenterologists. Heretofore, optical colonoscopy has been the mainstay in this screening. We discuss these issues and the continuing controversies concerning CTC.
Colorectal carcinoma (CRC) is a significant burden to US society. It is estimated that in 2012, there will be approximately 143,00 new cases and 52,000 deaths attributed to colorectal cancer in the United States. It is the second most commonly diagnosed cancer and the second leading cause of cancer death. Fortunately, compliance with screening recommendations has increased dramatically since 2002, with a modest decrease in CRC mortality. There is an immense cost, however, for screening, including the performance of millions of colonoscopies annually in the United States, and the cost of treating patients with established CRC is significant.
Colonoscopy remains the mainstay of CRC screening and allows the removal of precancerous adenomatous polyps that are considered precursors for most colon cancers; however, colonoscopy and polypectomy have clear risks and technical/aesthetic barriers to performance. Air-contrast barium enema (ACBE), sigmoidoscopy, and testing random stool samples for occult blood have been, along with colonoscopy, the modalities used traditionally to screen the general population for CRC. More recently, computed tomographic colonography (CTC) and stool analysis for DNA markers for polyps/malignancy have been accepted by some organizations and authorities as additional acceptable screening modalities. CTC, also known as virtual colonoscopy or virtual colonography, has emerged as a potentially powerful instrument for CRC screening; however, CTC is not accepted by many third-party payers, including Medicare, as a primary screening modality, and its use has been questioned by gastroenterologists and others. We discuss CTC in light of this controversy and consider its future niche in CRC screening.
Abstract and Introduction
Abstract
Computed tomographic colonography (CTC) is a relatively new imaging modality for the examination of patients for colorectal polyps and cancer. It has been validated in its accuracy for the detection of colon cancer and larger polyps (more than likely premalignant). CTC, however, is not widely accepted as a primary screening modality in the United States at present by many third-party payers, including Medicare, and its exact role in screening is evolving. Moreover, there has been opposition to incorporating CTC as an accepted screening instrument, especially by gastroenterologists. Heretofore, optical colonoscopy has been the mainstay in this screening. We discuss these issues and the continuing controversies concerning CTC.
Introduction
Colorectal carcinoma (CRC) is a significant burden to US society. It is estimated that in 2012, there will be approximately 143,00 new cases and 52,000 deaths attributed to colorectal cancer in the United States. It is the second most commonly diagnosed cancer and the second leading cause of cancer death. Fortunately, compliance with screening recommendations has increased dramatically since 2002, with a modest decrease in CRC mortality. There is an immense cost, however, for screening, including the performance of millions of colonoscopies annually in the United States, and the cost of treating patients with established CRC is significant.
Colonoscopy remains the mainstay of CRC screening and allows the removal of precancerous adenomatous polyps that are considered precursors for most colon cancers; however, colonoscopy and polypectomy have clear risks and technical/aesthetic barriers to performance. Air-contrast barium enema (ACBE), sigmoidoscopy, and testing random stool samples for occult blood have been, along with colonoscopy, the modalities used traditionally to screen the general population for CRC. More recently, computed tomographic colonography (CTC) and stool analysis for DNA markers for polyps/malignancy have been accepted by some organizations and authorities as additional acceptable screening modalities. CTC, also known as virtual colonoscopy or virtual colonography, has emerged as a potentially powerful instrument for CRC screening; however, CTC is not accepted by many third-party payers, including Medicare, as a primary screening modality, and its use has been questioned by gastroenterologists and others. We discuss CTC in light of this controversy and consider its future niche in CRC screening.
Source...