Closing in on colon cancer

March 31 brought the official close to National Colorectal Cancer Awareness month, which was peppered with a slew of public service announcements encouraging U.S. adults ages 50 and older to participate in screening. We also saw the introduction of the SCREEN Act, which would close a loophole in coverage that leaves Medicare recipients with polyps detected during screening on the cost-sharing hook for their procedures.

Still, convincing adults to participate in colon cancer screening represents an uphill climb of gargantuan proportions. Medicare claims indicate only 55 to 58 percent of beneficiaries have had a colonoscopy or any colorectal cancer test. Meanwhile, colorectal cancer screening has been demonstrated to save Medicare long-term costs; the direct annual costs of treating colon cancer of $4 billion may be reduced with proper screening, according to the American College of Gastroenterologists.

However, conventional colonoscopy is downright distasteful.

CT colonography (CTC) offers a more palatable alternative. (It may not eliminate the awful prep, but it substitutes a noninvasive imaging study for an awfully invasive procedure.)

But key decision makers, specifically the U.S. Preventive Services Task Force and Center for Medicare & Medicaid Services, have refused to endorse CTC. Both have cited concerns about increasing radiation exposure via multiple screening studies as reasons, despite the fact that CTC is a relatively low-dose exam performed on older adults who are at less risk from radiation exposure.

The recent study conducted by Michael Ginsburg, MD, from the department of radiology at The University of Chicago Medical Center, and colleagues may go a long way toward alleviating these concerns.

The researchers demonstrated that a BMI-adjusted dose reduction approach cut effective radiation dose CTC to 1.41 mSv at 15 mAs and 2.81 mSv at 30 mAs for normal BMI and overweight patients while maintaining adequate diagnostic image quality. Ginsburg et al also pointed out that techniques such as reconstruction algorithms and iterative reconstruction may further drop dose.

It’s important work and a terrific model. What important work did your practice perform during colon cancer awareness month?

Please email and let us know.

Lisa Fratt, editor