Thursday, October 19, 2006

Here’s welcome news for anyone alarmed by a standard “optical” colonoscopy, the oft-dreaded and unpopular exam for colon cancer that yields an accurate diagnosis, right along with patient discomfort and embarrassment.

Three-dimensional computed tomography colonography — or virtual colonoscopy — is getting high marks from the Radiological Society of North America, which is lauding both the procedure’s accuracy and appeal. Simply put, there is no 52-inch “scope” involved, and no sedation.

Colonoscopy dread is common: Fewer than 40 percent of all Americans 50 or older have been screened, according to the Centers for Disease Control and Prevention. The virtual method, which combines CT scan and computerized visual enhancement, could be enough to “entice” those who might be at risk, the society said.

“Our goal is not to take patients away from existing strategies like optical colonoscopy, but rather to attract those who are currently not being screened at all,” said Dr. Perry J. Pickhardt, associate professor of radiology at the University of Wisconsin Medical School in Madison.

Dr. Pickhardt compared the two methods in a study of more than 1,110 people whose average age was 58.

“The advantages of virtual colonoscopy over optical colonoscopy at our institution are that it is safer, faster, less costly, more convenient, involves an easier bowel prep, and yet is just as effective for detecting important polyps and cancers,” he said.

Dr. Pickhardt’s research found that only 6 percent of the patients who underwent a virtual colonoscopy required a subsequent conventional colonoscopy. The two methods were “in agreement” in 65 of those 71 patients.

The virtual method produces up to 1,000 precise, three-dimensional images of the colon’s interior, minus the lengthy scope. There is “essentially no risk of bleeding or of perforating the colon,” Dr. Pickhardt said. There also is no need for intravenous sedation, and the “attractive screening tool” costs less than conventional colonoscopy does, he said.

“Providing a less invasive, yet equally effective screening option like virtual colonoscopy has drawn many adults off the sidelines,” Dr. Pickhardt said.

The researchers also coordinated insurance coverage for the screenings, demonstrating “enormous potential for increasing compliance for colorectal cancer prevention,” Dr. Pickhardt said.

More than 150 insurance companies nationwide cover the cost of the procedure, but the companies are “highly selective,” depending on a person’s coverage limits, according to Cancer Consultants, an Idaho-based consumer research group. People who finance the procedure out of pocket can expect to pay $600 to $1,600, the group said.

Colorectal cancer remains the second leading cause of cancer deaths in the United States, according to the American Cancer Society. It estimates that 107,000 new cases will be diagnosed this year, resulting in 55,000 deaths.

Dr. Pickhardt’s study was released yesterday by the cancer society and published in the medical journal Radiology. Virtual colonoscopy also received positive reviews in similar research conducted in the past two years at the National Institutes of Health, the National Naval Medical Center and Walter Reed Army Medical Center.

In addition, the procedure has yielded surprise benefits. It has picked up “clinically important extracolonic findings,” according to a study last year at the San Francisco VA Medical Center. Virtual colonoscopy revealed kidney cancers, abdominal aneurysms and other serious conditions in 45 out of 500 patients who underwent the procedure.

“That’s a fairly large percentage,” said Dr. Judy Yee, the center’s chief of radiology and lead investigator.

Meanwhile, the American College of Gastroenterology has not yet given its blanket approval of virtual colonoscopy for routine screening. But the Maryland-based group yesterday pronounced capsule colonoscopy — in which the patient swallows a jelly bean-sized video camera that records thousands of images — a “promising new tool for colon cancer screening.” The group will release complete research findings on Monday.

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