Mixed feelings about an “easier” colon test

Last month, a new study of a seemingly more user-friendly approach to colon cancer screening generated quite a buzz.

“Scans provide alternative to colonoscopies in spotting cancer,” read one headline. “Virtual colonoscopies ready for prime time” said another.

For anyone who could think of a thousand things they’d rather be doing than undergoing a traditional colonoscopy, it sounded like wonderful news. A federal study of CT colonography or “virtual colonoscopy” determined that the X-ray procedure was effective at detecting large cancers and precancerous growths in people with an average risk of colon cancer.

No general anesthesia? No need to take a day off from work? No problem! Those were no doubt the thoughts of many patients who are skittish about traditional colonoscopies – and the bowel preparation that accompanies them. Some experts expressed hopes that this vote of confidence in an alternative screening method which is less invasive and cumbersome would encourage more people to be checked for colon cancer, the second leading cause of cancer deaths in the United States.

Now, I am all for appropriate colon screening. But as a practicing physician for more than 30 years, I have strong feelings against this procedure, and here’s why:

• The test exposes patients to radiation, every 5 years if guidelines are followed. Traditional colonoscopy, on the other hand, uses a camera rather than X-ray, and is recommended only every 10 years in many cases.
• The preparation for CT colonography is no less onerous than that for a traditional colonoscopy, with a patient’s bowel still needing to be cleaned out the night before.
• Many patients will experience some discomfort during the procedure, as the colon is inflated with gas to obtain better images. The vast majority of people who have a CT colonography, in fact, feel as if they need to pass gas. This can be uncomfortable since, unlike inflation during colonoscopy, there is no sedation. The plus, of course, is that patients do not have to sleep off the effects of anesthesia, and can resume some normal activities much quicker.
• CT colonography is much less sensitive than colonoscopy at detecting small precancerous lesions, and is not recommended for anyone with an above-average risk of colon cancer – the very people who most need to be examined.
• If the screening test does detect abnormalities, the patient will need a colonoscopy anyway to biopsy and possibly remove the polyps. This means a second colon cleansing and a second time-consuming procedure.

Although the colonography sounds easier and less invasive, it isn’t fun by any stretch of the imagination. I have had patients who did both – and opted for a colonoscopy in the future.

That said, while I am all for doing the most definitive procedure – namely colonoscopy – I strongly urge patients to undergo any appropriate colon screening. The researchers behind the new study are right about one key factor. Motivating more people to undergo careful colon examination is a good thing. And if colonography encourages additional people to get screened, bravo. Studies have shown that regular screening results in reduced mortality rates from colon cancer, and people at average risk are encouraged to undergo screening beginning at age 50.

Unfortunately, while many doctors – including me – have embraced traditional colonoscopy as a powerful screening tool, many patients have not. As a result, only 60 percent of adults aged 50 and older were up to date with their colon cancer screening in 2006, according to an analysis by the Centers for Disease Control and Prevention released earlier this year.

While the rate is considered very low for a disease that claims more than 50,000 American lives annually, it could be – and has been – much worse. After former “Today” show host Katie Couric underwent a colonoscopy on live television in March 2000, formerly abysmal screening rates began to soar, jumping more than 20 percent within the first few months. Screening rates have continued to rise, a phenomenon scientists have dubbed the “Katie Couric Effect.”

Yet many experts will tell you we should be doing an even better job.

“While we are encouraged to see an increase in colorectal cancer screening rates, certain groups are still not getting screened as recommended,” cautioned Dr. Djenaba A. Joseph, the lead author of the CDC study. “We need to ensure that all adults have access to these life-saving tests because there is strong scientific evidence that screening can prevent colorectal cancer deaths.”

So what are you waiting for? If you’re due for a colonoscopy – or would prefer a CT colonography – make an appointment for one today. Weigh the pros and cons in making your decision. But no matter what procedure you choose, as long as you decide to get screened regularly, you’ll know it’s a good decision.

As Couric, who lost husband Jay Monahan to colon cancer in 1998, puts it, “a colonoscopy may not be on the top of your to-do list, but it is a lot more fun than being diagnosed with cancer.”