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| |  CT Colonography Effective for Colorectal Cancer Screening in Older Patients RESTON, Va -- January 26, 2010 -- Computed tomography colonography (CTC) remains effective in screening older patients for colorectal cancer (CRC), produces low referral for colonoscopy rates similar to other screening exams now covered by Medicare, and does not result in unreasonable levels of additional testing resulting from extracolonic findings, according to a study published in the February issue of Radiology. Previous CTC trials have demonstrated excellent performance in average risk individuals. However, concerns remained that such results may not be applicable to older Medicare beneficiaries. Researchers at the University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, analysed various CTC performance and program outcome measures for screening individuals aged 65 to 79 years. “These results confirm that CTC is a safe and effective colorectal cancer screening tool for the older individual,” said principal investigator David H. Kim, MD, University of Wisconsin School of Medicine and Public Health. “There is no significant difference in the way CTC performs in older patients as opposed to younger patients.” In the study, for this older screening group, the advanced neoplastic prevalence was 7.6% (44 of 577). There was no difference between older patients and the general screening population in terms of the characteristics of advanced neoplasia -- including mean size, histologic type, and morphology -- indicating similar accuracy to that found in other trials involving younger patients. The overall referral rate to optical colonoscopy of 15.3% (88 of 577) is actually slightly lower than other Medicare covered CRC screening exams such as flexible sigmoidoscopy. Potentially important extracolonic findings were seen in 15.4% (89 of 577), with a work-up rate of 7.8% (45 of 577). The majority of important extracolonic diagnoses were vascular aneurysms (n = 18). No major complications were encountered. “There have been questions raised that factors such as the [colonoscopy] referral rate and extracolonic work up rates would be too high in an older population for CTC to be a cost-effective, frontline CRC screening exam,” said Dr. Kim. “Our results suggest otherwise and that these rates remain in a reasonable range.” “The lack of complications, particularly no perforations, attests to the safety of this procedure even in the older population,” he said. “Given what we know of the increasing risk for complications for optical colonoscopy in older patients, perhaps we should consider CT colonography more strongly in this particular group.”
SOURCE: American College of Radiology/American Roentgen Ray Society
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