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National Coalition for Quality Colorectal Cancer Screening and Care Conveys Concerns over CT Colonography

ANNAPOLIS, Md., Oct. 13 /PRNewswire/ -- The National Coalition for Quality Colorectal Cancer Screening and Care is highlighting concerns over the National CT Colonography Study published September 18 in the New England Journal of Medicine. The evidence must be closely evaluated, and patients need to recognize that CT Colonography is not without significant potential risks. The National Coalition reminds patients that Colonoscopy remains the "Gold Standard" for colorectal cancer screening, given its excellent sensitivity in detecting polyps and its potential for removing them at the same sitting.

Screening by CT Colonography (CTC) for patients who would otherwise forego preventive screening clearly improves the likelihood of early detection. However, substituting CTC for a complete colonoscopy creates the potential for a sizeable miss rate in the detection of high risk pre-cancerous lesions.

Steven J. Morris, MD JD FACP FACG, National Coalition Board Chairperson and CEO of Atlanta Gastroenterology Associates, LLC states "This study raises numerous concerns for clinicians and patients. Relying primarily on CT Colonography screening exposes patients to the risk of undetected and unreported pre-cancerous growths, the need for follow-up with colonoscopy, radiation exposure, and the associated risks and unrealistic cost assumptions about predicted savings."

By focusing only on polyps of 6 mm or greater in size, the study authors ignored the significant number of pre-cancerous polyps that are detected during a Colonoscopy which are 5 mm or smaller. Equally troubling is that 17 percent of study patients required subsequent referral for Colonoscopy to remove polyps, and other studies have described a referral rate that approaches 30%. The need for follow-up procedures creates additional inconvenience and costs for patients and payors.

When comparing the efficacy between the two patient groups in the study [i.e., CTC versus traditional optical Colonoscopy (OC)], the researchers themselves note "the number of polypectomies performed ... differed significantly between the two groups, with more than four times as many polyps removed in the OC group as in the CTC group."

Dr. Morris added, "We are deeply troubled by the cost comparisons as developed by the study authors. Reimbursement rates for various procedures are not accurately reflected in the study, and any conclusions based upon those inaccuracies may be equally inaccurate. For example, the total Medicare reimbursement rate for an outpatient colonoscopy does not exceed $1000 which is significantly less than the $3000 sited in the study for colonoscopy reimbursement."

Dr. Stanford Plavin, Coalition Board Vice-Chairperson and Managing Partner of Ambulatory Anesthesia of Atlanta, P.C. noted "CT Colonography offers no real advantage over a Colonoscopy. The bowel still has to be cleansed and prepped for a CT Colonography. The patient will experience considerable discomfort as a mechanical tube is inserted into the rectum to insufflate the bowel. There is no process available to immediately relieve the pressure on the bowel when the CT Colonography is completed. Given the unnecessary exposure to radiation, the failure to report small polyps, and the need for subsequent Colonoscopies, CT Colonography does not measure up against the Colonoscopy, which remains the Gold Standard for colorectal cancer screening."

The National Coalition is committed to making sure that patients make fully informed decisions about what prevention strategies works best when screening for colorectal cancer. Traditional colonoscopies remain the clear choice for most patients both in terms of clinical outcomes and financial costs.

Headquartered in Annapolis, Maryland, the National Coalition for Quality Colorectal Cancer Screening & Care ( has been established to preserve the tradition of safe, comfortable and quality- based medicine. The Coalition is a nonprofit advocacy organization with its primary mission to educate both public and private stakeholders about the opportunities to reduce the incidence of colorectal cancer through promoting effective screening, prevention and care options for patients

Study Source: Kim, Pickhardt, Taylor, "CT Colonography versus

Colonoscopy for the Detection of Advanced Neoplasia," The New England

Journal of Medicine, vol. 357:1403-1412 (no. 14), October 4, 2007.

SOURCE National Coalition for Quality Colorectal Cancer Screeningand Care
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