The Big Screen
Could a new test for colon cancer reduce fatalities? The discussion is politically charged, but a local health insurer sees the possibility of great benefits for patients.
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Dr. Parag Lodhavia, a gastroenterologist in Dover, is concerned about the sensitivity of the virtual colonoscopy, as well as the overall experience and comfort of the patient. Lodhavia points to a 2006 study published in the American Journal of Medicine that compared traditional and virtual colonoscopy.
“As far as patient satisfaction is concerned, patients found colonoscopy much more acceptable based on overall experience,” says Lodhavia. The virtual colonoscopy, performed without anesthesia, can be quite uncomfortable for some patients, he says. “The hardest part about this is the preparation, and you have to do that with both of them.”
Among his concerns about effectiveness, “There is a lot of variability with the CT colonography,” Lodhavia says. “It’s a question of what percentage of the actual disease do you actually pick up.”
One criticism of virtual colonoscopy is that it misses polyps smaller than a centimeter. Lodhavia says that, with traditional colonoscopy, “most of what we find are less than a centimeter.” Though polyps measuring larger than a centimeter indicate a greater risk for cancer, “Size is not the only factor,” says Lodhavia. “Pathology of polyps is just as important as the dysplasia of the cells.”
Patrick disagrees. “I wouldn’t want people to be alarmed by diminutive polyps (under 6 millimeters), because it is generally well accepted that these extremely small lesions represent little to no risk,” she says.
Patrick also notes the advances in the virtual colonoscopy. “In the last five years, the technology has really gotten to where it needs to be a great screener,” she says.
She points to a study on virtual colonoscopies in the September 2008 New England Journal of Medicine that she says validates the technology. The article concludes that “virtual colonoscopies and the traditional colonoscopies are on a par with each other.”
“It’s a great choice,” she says. “We’re not saying one over the other because some people are not coming in for anything, and that’s why colon cancer rates are so high. No test is perfect, but when you look at what the test can add by increasing the screening rates by 25 percent, the concerns are surmountable.”
“It’s very politically charged because the current practice models could be disrupted, especially if radiologists did virtual colonoscopies,” Patrick says. “It’s a bit of a turf war between radiologists and GIs.” She believes “the integrated approach is good for patients and good for GIs.”
Kaplan says Blue Cross hopes for open communication with all doctors about the pilot program. “Our goal is also to understand what integrating this technology into the community means,” he says. He points to a “potential for improvement in health care—and potential for disruption in health care.”
Patricia Hogue, chief mission officer with the American Cancer Society, says that the virtual colonoscopy is another good screening tool, with advantages and disadvantages compared to traditional colonoscopy. “Anything that can convince people to have a colon exam is better than nothing,” she says. “The best colon screening test is the one that a person takes.”