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Senior Health & Medicine
Virtual Colonoscopy Makes Progress Detecting Polyps,
Studies Say
Studies find broad value and ease of CTC for
average risk patients
May 23, 2006 - With more than 100,000 people in the
U.S. diagnosed each year with colon cancer, doctors are working to
improve screening techniques through more accurate technologies and more
comfortable procedures. In research presented today at Digestive Disease
Week 2006 (DDW), studies suggest that virtual screenings may be just as
effective as standard colonoscopy at detecting colon polyps in
average-risk individuals.
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Smokers, Drinkers and Men Get Colorectal
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Disease
could strike before they become senior citizens
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friends. On average, of the older adults who currently smoke or
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Calcium, Vitamin D Supplements Offer Modest Bone Improvements,
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Feb. 16, 2006 - Calcium and vitamin D
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benefit in preserving bone mass and prevent hip fractures in
certain groups including older women but do not prevent other
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New Cancer Report Sees Declining Deaths, Stable Incident Rates
Dec. 23, 2005 The nation is making
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2005. The death rates continue to decline for the four most
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Older Adults Not Being Given Recommended Colorectal Screening
Doctors don't recommend colorectal
screening enough, report says
Oct. 12, 2005 - Since 1996, federal health
officials have recommended that people 50 years and older be
screened for colorectal cancer with a fecal occult blood test.
However, a new analysis of data shows that only 17.2 percent
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Aspirin Reduces Risk of Colon Cancer for Women but Takes 10
Years
Taking two regular aspirin a week
significantly reduced risk, study says
Aug. 23, 2005 - Women who took two or more
aspirin or NSAIDs per week for more than 10 years significantly
reduced their risk of colorectal cancer, according to an article
in the August 24/31 issue of JAMA. Women who took even more
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Virtual Colonoscopy Performance Enhanced by
Computer-Aided Detection (11/28/05)
Virtual Colonoscopy Not Ready for Widespread Use
Read more
on
Health & Medicine |
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DDW is the largest international gathering of
physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.
Computed tomographic colonography (CTC), sometimes
called "Virtual Colonoscopy," is a non-invasive and well-tolerated CT
scan, which uses an X-ray to create images of the body. The images are
transferred to a computer, creating a detailed picture of the inside of
the colon, so that a doctor can search for polyps or other abnormalities
that may need to be removed.
Following are summaries on several studies
presented today
A Prospective Evaluation and Classification of
Extra-Colonic Abnormalities Identified with Computed Tomographic
Colonography Screening in Asymptomatic, Average Risk Individuals
[Abstract 209]
Computed tomographic colonography (CTC) screening
is becoming a more prevalent option used to screen moderate-risk
individuals for colon cancer. Because of the computer assisted
technology, this procedure can also detect extra-colonic abnormalities,
such as calcified arteries and nodules. This study examined the
characteristics of the abnormalities found by the screening and the
resulting evaluation and treatment.
The research team from the National Naval Medical
Center conducted CTC for cancer screening on 979 asymptomatic, average
risk patients and recorded extra-colonic abnormalities, categorizing the
findings as critical (requiring therapeutic intervention), moderate
(requiring additional diagnostic intervention) or incidental (no further
action).
Extra-colonic abnormalities were detected in
approximately 16 percent (156 pts) of CTC screenings, the most common
being coronary artery calcifications (41 pts) and non-calcified
pulmonary nodules (33 pts). Abnormalities were found throughout the
body, including the heart and lungs, kidney, liver, bone and other
organs. While half (51.6 percent) were classified as incidental, another
33 percent were moderate and 15 percent were critical.
"Significant abnormalities requiring further action
accounted for nearly half of the abnormalities we found, suggesting that
by screening for colon cancer, we may offer early detection of other
potentially morbid conditions in some patients," said Brooks Cash, M.D.,
of the National Naval Medical Center, and senior author of the study.
"However, it is important to note that abnormalities detected by CTC
also increase the indirect costs associated with the exam, so we need to
evaluate the true outcomes associated with these findings before
recommending the routine use of this procedure."
Accuracy of Computed Tomographic Colonography for
Colorectal Cancer (CRC) Screening in Asymptomatic Individuals [Abstract
278]
In an attempt to improve rates of screening while
maintaining accuracy, researchers have been examining the optimal usage
of computed tomographic colonography (CTC) screening, a less invasive
and time consuming screening process. Studies have previously suggested
that CTC was comparable to optical colonoscopy (OC), and interim results
from this study support those findings.
For the current study, researchers recruited
participants who were asymptomatic and at average risk for colon cancer.
A total of 760 patients have undergone CTC since the start of the study.
If the CTC identified a polyp larger than 10 mm or more than three
polyps larger than 6 mm, participants underwent same-day OC, while
patients with one or two polyps measuring 6-9 mm underwent OC after one
year, and patients with no polyps greater than 6 mm had OC within five
years. The one year delay in the removal of polyps is a novel feature of
this trial, one which the investigators hope will be able to glean some
information regarding the natural history of colonic polyps in this
patient population.
Findings from the study suggest that CTC is, in
fact, comparable in accuracy to OC in detecting polyps larger than 10
mm, with an overall detection sensitivity of 96.4 percent compared to
96.3 percent with OC. While CTC sensitivity falls as polyp sizes get
smaller, CTC detection of smaller polyps (6-9 mm in size) was comparable
to that of OC with an 83.6 percent accuracy (sensitivity=77.3 percent,
specificity=85 percent). OC sensitivity for these polyps was 88.2
percent.
"For patients who are not at high risk for colon
cancer or who do not have alarming signs or symptoms, CTC is an
effective method to screen for precancerous colorectal lesions at our
institution," said Brooks Cash, M.D., of the National Naval Medical
Center, and lead author of the study. "However, for patients who are at
increased risk or whose screening results are unclear, we still
recommend the use of optical colonoscopy to properly evaluate their
colon health. It is also important to realize that we are at the
vanguard of this technology and our results may not be indicative of the
results that would be obtained in the general community. CTC remains an
innovative practice that needs more study before it can be widely
recommended, though our current results are certainly very promising."
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Medicare Preventive Services |
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Medicare preventive services provides coverage for
colorectal cancer screening procedures including
(1) annual fecal-occult
blood tests for persons age 50 and over,
(2) flexible sigmoidoscopy for
persons age 50 and over, every 4 years,
(3) colonoscopy for persons at
high risk for colorectal cancer, every 2 years, and
(4) other procedures
the HHS Secretary finds appropriate.
Barium enemas are also covered, as
an alternative to flexible sigmoidoscopy or colonoscopy. The coverage
of screening colonoscopies includes all beneficiaries, not just those at
high risk for colorectal cancer as was the rule.
Generally, physicians recommend that patients begin
screening at age 50. However, physicians might recommend that
individuals with certain risk factors, including family history, begin
screening at earlier ages.
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Histopathology of Small Polyps Removed in the
Videoendoscopic Era [Abstract T1344]
Colorectal polyps are common in most of the adult
population over 50 and while many are benign, others have the potential
to develop into cancerous tumors. Current practice standards call for
close monitoring of polyps under 1.0 cm, but do not require that these
polyps be removed as a precautionary measure. Study authors from the
Indiana University Medical Center closely evaluated more than 10,000
polyps under 1.0 cm and found that if all of these polyps are ignored, a
substantial majority of colorectal neoplasms will be left in place to
grow. Researchers examined 8,798 (81.6 percent) polyps that were smaller
than 6.0mm and an additional 1,282 polyps that were between 6.0 mm and
9.9 mm. Analysis showed that almost half of the polyps smaller than 6.0
mm were either adenomas or advanced adenomas (49.86 percent). This rate
was even higher for polyps between 6.0 mm and 9.9 mm; adenomas made up
58.7 percent of these polyps and an additional 5.7 percent were advanced
adenomas.
"If we move to a policy of leaving polyps less than
one centimeter in place, as has been suggested by some experts for
patients who undergo virtual colonoscopy, then we'll be leaving more
than 90 percent of the neoplasms in the colon in place," said Douglas
Rex, M.D., of the Indiana University Medical Center and senior author of
the study. "This would be a major paradigm shift in our colorectal
cancer prevention strategy, which currently is based on colonoscopy with
resection of all detected neoplasms. As such, it requires very careful
evaluation."
Impact of a Virtual Colonoscopy Screening Program
on Optical Colonoscopy in Clinical Practice: One Year Data [Abstract
288]
Since the introduction of virtual colonoscopy (VC),
its potential impact on the use of traditional optical colonoscopy (OC)
has been cause for much speculation. University of Wisconsin Medical
School researchers have conducted the first "real life" analysis of the
effects of VC on utilization rates of OC and found that while there has
not been a decrease in the number of OC procedures performed, there has
been a significant reduction in OC referrals.
Study authors reviewed data from the three month
period before VC screening was introduced at the University of Wisconsin
hospital; the period three months before to five months after VC was
introduced; the 14 month period after the introduction of VC; and,
finally, the six to 14 month period after VC screening was initiated.
Period T4 is defined as the time when VC screening has reached its
"steady-state," marked by an increase in VC procedures performed and an
increase in provider and patient knowledge of the procedure. The average
number of OC screenings performed each month did not change
significantly after VC was introduced and the percentage of OC involving
removal of polyps also remained constant. However, the percentage of OC
screening referrals decreased significantly, from 247 per month to 203
per month after VC screening was initiated. According to the
researchers, the trend may be an early indicator that there will be an
eventual decrease in demand for OC screening.
"This study shows a potential change in the tide of
colonoscopy choices. As more medical institutions and health care
service providers adopt and reimburse for virtual colonoscopies, we may
see a significant decrease in the popularity of more traditional
colonoscopy techniques," said Darren C. Schwartz, M.D., University of
Wisconsin Medical School and lead study author. "However, differences in
accuracy do still exist so it is important for patients and their
physicians, especially those at high risk for colon cancer, carefully
consider their options when choosing a screening technique."
About Digestive Disease Week
Digestive Disease Week (DDW) is the largest
international gathering of physicians, researchers and academics in the
fields of gastroenterology, hepatology, endoscopy and gastrointestinal
surgery. Jointly sponsored by the American Association for the Study of
Liver Diseases (AASLD), the American Gastroenterological Association
(AGA), the American Society for Gastrointestinal Endoscopy (ASGE) and
the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place
May 20-25, 2006 in Los Angeles, California. The meeting showcases more
than 5,000 abstracts and hundreds of lectures on the latest advances in
GI research, medicine and technology.
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