Colon cancer screening: Can awareness & compliance converge?

Colon cancer took the spotlight in March—colon cancer awareness month. This year, the imaging community and the general public witnessed several measures that could signify a changing landscape.

First, the basics: Every year, more than 140,000 U.S. adults are diagnosed with colorectal cancer, and more than 50,000 people die from the disease. Yet, if everyone older than age 50 were screened regularly as many as 60 percent of colon cancer deaths could be prevented, according to the Centers for Disease Control and Prevention. Colon cancer has a 90 percent cure rate if detected early.

However, compliance with colorectal cancer screening is shaky. Approximately 60 percent of U.S. adults age 50 and older get screened, according to the American College of Physicians (ACP).

ACP has attempted to up compliance, issuing a guideline urging adults to begin screening at age 50 in the March 6 issue of Annals of Internal Medicine.  

Unfortunately, the guideline overlooked CT colonography, recommending a stool-based test, flexible sigmoidoscopy or optical colonoscopy as the designated screening measures. Physicians and patients have cited the discomfort resulting from these procedures as a factor in adults’ lukewarm compliance. Now, research seems to confirm these assertions and indicate that CT colonography may overcome some barriers to screening.

CT colonography delivered superior patient acceptability compared with colonoscopy among symptomatic patients randomized to either exam, according to a study published online March 21 in Radiology. The researchers reported overall physical discomfort was rated as significantly worse for patients undergoing colonoscopy than CT colonography (median score of 39 vs. 35).

At the same time, the discomfort of conventional exams is not the nuisance pain associated with screening.

Congressmen Danny K. Davis (D-Ill.) and Ralph M. Hall (R-Texas) are attempting to remove the sting to patients’ wallets that accompanies CT colonography. The pair introduced H.R. 4165, the CT Colonography Screening for Colorectal Cancer Act of 2012, which would require Medicare to reimburse physicians for virtual colonoscopy. (Although more than half of U.S. states mandate insurance coverage for colorectal cancer screening; coverage is not required on a national level.)

Will these measures spur changes in screening compliance? Time will tell.

How has CT colonography impacted your practice and patients? Let us know.  

Lisa Fratt, editor
lfratt@trimedmedia.com