AJR: CT colonography tops optical colonoscopy in largest survey yet

Responses from the first large, multicenter survey of patient attitudes toward CT colonography (CTC) in clinical practice demonstrate the procedure is preferred over traditional optical colonoscopy. The results showcase CTC’s potential for increasing colorectal (CRC) screening adherence, according to a study published in the June issue of the American Journal of Roentgenology.

CRC is the second leading cause of cancer death in the U.S., but early detection and removal of polyps significantly reduces mortality associated with the disease, explained B. Dustin Pooler, MD, of the University of Wisconsin, Madison, School of Medicine and Public Health, and colleagues. Despite the benefit of early detection, only 55 percent of adults age 50 and older are compliant with current screening guidelines, according to the National Institutes of Health.

To test patients’ preferences regarding CTC, Pooler and colleagues administered a 12-question survey to a cohort of adults undergoing CTC in one of three possible settings: a university academic center, military medical center or community practice.

A total of 1,417 patients responded. The top reason patients said they chose CTC for screening was “noninvasiveness” at 68 percent, with “avoidance of sedation/anesthesia,” “ability to drive after the test,” “avoidance of optical colonoscopy risks,” and “identifying abnormalities outside the colon” also figuring prominently in patients’ decisions.

“This study confirms that concerns about the invasive nature of optical colonoscopy and accompanying sedation are common-place among patients who have opted for CTC screening,” wrote Pooler et al.

Only 7.2 percent of patients reported pain and only 2.5 percent reported anything worse than moderate discomfort during the CTC exam, according to the authors. Of the 441 patients who had experienced optical colonoscopy, 77.1 percent preferred CTC. Of all patients, 93 percent indicated they would choose CTC for their next screening.

“Our data further suggest that the availability of CTC as a screening option has the potential to increase CRC screening rates,” wrote the authors. “When asked if they would have undergone optical colonoscopy were CTC not available as a screening test, nearly 30 percent of the respondents in this study answered ‘no’ (8.3 percent) or ‘not sure’ (21.3 percent), suggesting that CTC could impact this sizeable group.”

Pooler noted their results dovetail with previous research on patient preferences for CRC screening in smaller, single center trials. “It has been said that the best CRC screening test is the one that a patient is willing to undergo. Given the need for ongoing screening in older adults, patient experience and satisfaction are very important components of any programmatic screening regimen.”