"It's good news that the radiation risk is low with CT colonography, but many practical issues need to be addressed before the test can be recommended to patients for routine colorectal cancer screening," said AGA President David A. Peura, MD. "Evaluating issues of standardization and accuracy of test results and addressing disparities in consistent and uniform training of professionals performing the test should be the focus of future studies. In addition, the procedure still requires a great amount of bowel preparation and causes discomfort--both issues largely affect the current state of patient compliance in colorectal cancer screening."
Researchers from the Center for Radiological Research at Columbia University Medical Center estimated the radiation dose to different organs from adult CT colonography scans. Dose-, organ- and gender-specific excess relative risks for cancer incidence in Japanese A-bomb survivors were used as a basis to generate risk estimates for the U.S. population. This study found the estimated lifetime risk of cancer as a result of radiation from CT colonography in a 50-year-old subject is about 0.14 percent and 0.022 percent for a 70-year-old patient. The main organs found to be at risk for cancer are the colon, stomach and bladder.
"Our study shows that radiation risks associated with virtual colonoscopy are relatively small--much smaller, for example, than for CT-based lung cancer screening," said David J. Brenner, PhD, lead study author with the Columbia University Medical Center. "With the potential for low cancer risks and the use of non-cathartic bowel preparation, virtual colonoscopy is a very promising modality which could potentially increase patient compliance with current guidelines for colorectal cancer screening."
A future trends report published by the AGA1 provided a review of clinical trials and quantitative mathematical models to determine the potential role of CT colonography in colorectal cancer screening. Limitations of CT colonography included variation in results of clinical trials and limited data on its use in routine clinical practice. Questions currently being addressed in clinical outcomes studies include:
- Is there a minimum polyp size detectable by CT colonography for which patients should be referred for polyp removal?
- What is the minimum-sized lesion by which CT colonography sensitivity will be judged?
- What polyp size, if any, would physicians and more importantly their patients, allow to remain in place and undergo surveillance rather than immediate removal?
- How will CT colonography screening followed by colonoscopy for patients with polyps impact patients' compliance and health-care costs?
Bowel preparation continues to be a large barrier to patient compliance for colorectal cancer screening. In most current CT colonography protocols, patients must undergo rigorous bowel cleansing preparation similar to that of traditional colonoscopy. However, significant progress is being made in the development of a minimal preparation or "prep-less" CT colonography test - which would potentially have a major impact on patient compliance.
Guidelines of multiple agencies and professional societies underscore the importance of screening for all individuals 50 years of age and older. Currently, there are a number of tests that may be used to screen for colorectal cancer, the second-leading cancer killer in the United States. Approved tests include barium enema, fecal occult blood test, flexible sigmoidoscopy and colonoscopy. Each screening option has advantages and disadvantages, and patients should consult their physician on the most appropriate test.
More information on colorectal cancer screening is available at www.gastro.org.
About the AGA
The American Gastroenterological Association (AGA) is dedicated to the mission of advancing the science and practice of gastroenterology. Founded in 1897, the AGA is the oldest medical-specialty society in the United States. The AGA's 14,500 members include physicians and scientists who research, diagnose and treat disorders of the gastrointestinal tract and liver. On a monthly basis, the AGA publishes two highly respected journals, Gastroenterology and Clinical Gastroenterology and Hepatology. The AGA's annual meeting is Digestive Disease Week, which is held each May and is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.
Gastroenterology, the official journal of the AGA, is the most prominent journal in the subspecialty and is in the top one percent of indexed medical journals internationally. The journal publishes clinical and basic studies of all aspects of the digestive system, including the liver and pancreas, as well as nutrition. The journal is abstracted and indexed in Biological Abstracts, CABS, Chemical Abstracts, Current Contents, Excerpta Medica, Index Medicus, Nutrition Abstracts and Science Citation Index. For more information, visit www.gastrojournal.org.
1 Van Dam J, Cotton P, Johnson CD, McFarland BG, Pineau BC, Provenzale D, Ransohoff D, Rex D, Rockey D and Wootton FT, III. AGA Future Trends Report: CT Colonography. Gastroenterology 2004; 127: 970-984.