1
|
Moreno C, Kim DH, Bartel TB, Cash BD, Chang KJ, Feig BW, Fowler KJ, Garcia EM, Kambadakone AR, Lambert DL, Levy AD, Marin D, Peterson CM, Scheirey CD, Smith MP, Weinstein S, Carucci LR. ACR Appropriateness Criteria ® Colorectal Cancer Screening. J Am Coll Radiol 2019; 15:S56-S68. [PMID: 29724427 DOI: 10.1016/j.jacr.2018.03.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/19/2022]
Abstract
This review summarizes the relevant literature regarding colorectal screening with imaging. For individuals at average or moderate risk for colorectal cancer, CT colonography is usually appropriate for colorectal cancer screening. After positive results on a fecal occult blood test or immunohistochemical test, CT colonography is usually appropriate for colorectal cancer detection. For individuals at high risk for colorectal cancer (eg, hereditary nonpolyposis colorectal cancer, ulcerative colitis, or Crohn colitis), optical colonoscopy is preferred because of its ability to obtain biopsies to detect dysplasia. After incomplete colonoscopy, CT colonography is usually appropriate for colorectal cancer screening for individuals at average, moderate, or high risk. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | | | - David H Kim
- Co-author and Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | | | - Brooks D Cash
- University of South Alabama, Mobile, Alabama; American Gastroenterological Association
| | | | - Barry W Feig
- University of Texas MD Anderson Cancer Center, Houston, Texas; American College of Surgeons
| | | | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | | | - Drew L Lambert
- University of Virginia Health System, Charlottesville, Virginia
| | - Angela D Levy
- Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Martin P Smith
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
| |
Collapse
|
2
|
Yee J, Kim DH, Rosen MP, Lalani T, Carucci LR, Cash BD, Feig BW, Fowler KJ, Katz DS, Smith MP, Yaghmai V. ACR Appropriateness Criteria colorectal cancer screening. J Am Coll Radiol 2014; 11:543-51. [PMID: 24793959 DOI: 10.1016/j.jacr.2014.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 02/06/2023]
Abstract
Colorectal cancer is the third leading cause of cancer deaths in the United States. Most colorectal cancers can be prevented by detecting and removing the precursor adenomatous polyp. Individual risk factors for the development of colorectal cancer will influence the particular choice of screening tool. CT colonography (CTC) is the primary imaging test for colorectal cancer screening in average-risk individuals, whereas the double-contrast barium enema (DCBE) is now considered to be a test that may be appropriate, particularly in settings where CTC is unavailable. Single-contrast barium enema has a lower performance profile and is indicated for screening only when CTC and DCBE are not available. CTC is also the preferred test for colon evaluation following an incomplete colonoscopy. Imaging tests including CTC and DCBE are not indicated for colorectal cancer screening in high-risk patients with polyposis syndromes or inflammatory bowel disease. This paper presents the updated colorectal cancer imaging test ratings and is the result of evidence-based consensus by the ACR Appropriateness Criteria Expert Panel on Gastrointestinal Imaging. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
Collapse
Affiliation(s)
- Judy Yee
- University of California, San Francisco, San Francisco, California.
| | - David H Kim
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Max P Rosen
- UMass Memorial Medical Center & UMass School of Medicine, Worcester, Massachusetts
| | - Tasneem Lalani
- Inland Imaging Associates and University of Washington, Seattle, Washington
| | - Laura R Carucci
- Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Brooks D Cash
- University of South Alabama, Mobile, Alabama; American Gastroenterological Association, Bethesda, Maryland
| | - Barry W Feig
- University of Texas MD Anderson Cancer Center, Houston, Texas, American College of Surgeons, Chicago, Illinois
| | | | | | - Martin P Smith
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | |
Collapse
|
3
|
Should barium enema be the next step following an incomplete colonoscopy? Int J Colorectal Dis 2010; 25:1353-7. [PMID: 20652709 DOI: 10.1007/s00384-010-1014-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2010] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Double contrast barium enema (DCBE) is used to screen and diagnose colorectal disease and is often recommended following an incomplete colonoscopy. The purpose of this study was to determine the value of DCBE following an incomplete colonoscopy. MATERIALS AND METHODS A retrospective review was conducted of all patients who had an incomplete colonoscopy at Kaiser Permanente, Los Angeles in a 6-year period. Patient data was extracted from the endoscopy and radiology databases. Variables collected included demographics, indication for colonoscopy, reason for incompletion, findings of DCBE, and findings of repeat colonoscopy if subsequently performed. RESULTS The incomplete colonoscopy rate was 1.6%. The mean age was 62 years with a predominance of females. The most common indication for colonoscopy was screening. The most frequent reason attributed to an incomplete colonoscopy was patient discomfort. Two hundred thirty three patients underwent DCBE and 42 patients underwent a repeat colonoscopy without DCBE; 13.3% of the DCBE were of poor quality and could not be interpreted. A repeat colonoscopy following DCBE was performed in 7% of patients. In 50% of these patients, the repeat colonoscopy revealed significant findings not noted on the DCBE or ruled out positive DCBE findings. In patients who had repeat colonoscopy without DCBE, completion rate was 95%. CONCLUSION The rate of incomplete colonoscopy in a high-volume modern endoscopy unit is extremely low. DCBE following incomplete colonoscopy has limited value. A repeat colonoscopy under deeper sedation and/or better bowel preparation may be the preferred next step.
Collapse
|
4
|
Yee J, Rosen MP, Blake MA, Baker ME, Cash BD, Fidler JL, Grant TH, Greene FL, Jones B, Katz DS, Lalani T, Miller FH, Small WC, Sudakoff GS, Warshauer DM. ACR Appropriateness Criteria® on Colorectal Cancer Screening. J Am Coll Radiol 2010; 7:670-8. [DOI: 10.1016/j.jacr.2010.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 05/03/2010] [Indexed: 12/12/2022]
|
5
|
Liang Z, Richards R. Virtual colonoscopy vs optical colonoscopy. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2010; 4:159-169. [PMID: 20473367 PMCID: PMC2869208 DOI: 10.1517/17530051003658736] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
IMPORTANCE OF THE FIELD: The high prevalence of colon carcinoma combined with the low compliance of currently recommended screening guidelines explains the continued high mortality rate of colon cancer. Utilizing a strategy of virtual colonoscopy (VC) in asymptomatic patients over 50, with optical colonoscopy (OC) follow-up for removal of detected adenomatous polyps may result in lowering the colon cancer death rate. However, the screening potential of VC has not yet been widely recognized. Debates and doubts of its potential benefits have been frequently seen in the literature since VC was first reported in 1994. AREAS COVERED IN THIS REVIEW: This article reviews the currently available screening options and discuss their advantages and drawbacks. TAKE HOME MESSAGE: VC has many advantages over the existing screening options and its several drawbacks can be mitigated so that it would become a valuable screening modality. A strategy that utilizes VC for population-based screening over the age of 50 and OC for screening high-risk individuals and those with positive VC findings would result in a significantly reduced rate of colon cancer deaths.
Collapse
Affiliation(s)
- Zhengrong Liang
- IEEE Fellow, Professor of Radiology, Computer Science and Biomedical Engineering, School of Medicine, L4-120, Health Sciences Center, Stony Brook University, Stony Brook, NY 11794-8460, USA, (Tel): +1 631-444-7837, (Fax): +1 631-444-6450
| | - Robert Richards
- Associate Professor, Program Director - GI Fellowship, Department of Medicine/Gastroenterology, Health Science Center, Level 17, Room 060, Stony Brook University, Stony Brook, NY 11794-8173, USA, (Tel): +1 631-444-7623
| |
Collapse
|
6
|
Lindholm E, Brevinge H, Haglind E. Survival benefit in a randomized clinical trial of faecal occult blood screening for colorectal cancer. Br J Surg 2008; 95:1029-36. [PMID: 18563785 DOI: 10.1002/bjs.6136] [Citation(s) in RCA: 216] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Early detection of colorectal cancer could reduce cancer-specific mortality. The aim of this trial was to evaluate the effect of faecal occult blood test (FOBT) screening on colorectal cancer mortality in a Swedish population. METHODS All 68,308 citizens in Göteborg born between 1918 and 1931 were randomized to a screening or a control group at the age of 60-64 years. All were screened two to three times with rehydrated Hemoccult-II. Compliance was 70.0 per cent (23,916 individuals). Those with a positive test result were offered sigmoidoscopy and a double-contrast enema. The primary endpoint was death from colorectal cancer. RESULTS After a mean of 9 years from the last screening, there was a significant reduction in colorectal cancer mortality in the screening group compared with the control group. The overall risk ratio of death from colorectal cancer was 0.84 (95 per cent confidence interval 0.71 to 0.99). The groups did not differ in incidence of colorectal cancer or in overall mortality. CONCLUSION FOBT screening significantly reduces colorectal cancer mortality.
Collapse
Affiliation(s)
- E Lindholm
- Department of Surgery, Institute of Surgical Sciences, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | | |
Collapse
|
7
|
Critical analysis of the performance of double-contrast barium enema for detecting colorectal polyps > or = 6 mm in the era of CT colonography. AJR Am J Roentgenol 2008; 190:374-85. [PMID: 18212223 DOI: 10.2214/ajr.07.2099] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of our study was to perform a meta-analysis comparing the performance of double-contrast barium enema (DCBE) with CT colonography (CTC) for the detection of colorectal polyps > or = 6 mm using endoscopy as the gold standard. MATERIALS AND METHODS Prospective DCBE and CTC studies were identified. Percentages of polyps and of patients with polyps > or = 10 mm and 6-9 mm were abstracted. The performance of DCBE versus CTC was determined by separately evaluating each technique's performance versus that of endoscopy, and contrasting the techniques. The I-squared statistic and Fisher's exact test were used for heterogeneity, the Cochran-Mantel-Haenszel and the Kruskal-Wallis tests for correlation, and the A(z) test for comparing pooled weighted estimates of performance. RESULTS Eleven studies of DCBE (5,995 patients, 1,548 polyps) and 30 studies of CTC (6,573 patients, 2,348 polyps) fulfilled inclusion criteria. For polyps > or = 10 mm, a 0.121-per-patient sensitivity difference favored CTC (p < 0.0001; DCBE, 0.702 [95% CI, 0.687-0.715]; CTC, 0.823 [0.809-0.836]). For polyps > or = 10 mm, a 0.031-per-polyp sensitivity difference favored CTC (p < 0.0001; DCBE, 0.715 [0.703-0.726]; CTC, 0.746 [0.735-0.757]). For polyps > or = 10 mm, a specificity difference of 0.104 favored CTC (p = 0.001; DCBE, 0.850 [0.847-0.855]; CTC, 0.954 [0.952-0.955]). DCBE was also significantly less sensitive for 6- to 9-mm polyps (p < 0.001). CONCLUSION DCBE has statistically lower sensitivity and specificity than CTC for detecting colorectal polyps > or = 6 mm.
Collapse
|
8
|
Colon, Rectum, and Anus. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
9
|
Kung JW, Levine MS, Glick SN, Lakhani P, Rubesin SE, Laufer I. Colorectal Cancer: Screening Double-Contrast Barium Enema Examination in Average-Risk Adults Older Than 50 Years. Radiology 2006; 240:725-35. [PMID: 16837671 DOI: 10.1148/radiol.2403051236] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively determine the diagnostic yield of double-contrast barium enema examinations performed for colorectal cancer screening of neoplasms 1 cm or larger or advanced neoplastic lesions of any size in average-risk adults older than 50 years. MATERIALS AND METHODS The Institutional Review Board at the affiliated Veterans Affairs Medical Center approved this HIPAA-compliant study protocol and did not require informed consent from patients. Computerized databases revealed 276 double-contrast barium enema examinations performed for colorectal cancer screening in average-risk adults older than 50 years. Radiographic and pathologic reports were reviewed to determine the number of patients who had polypoid lesions 1 cm or larger, polyps smaller than 1 cm, or advanced neoplastic lesions of any size. Forty-five (16.3%) of the 276 patients underwent follow-up sigmoidoscopy or colonoscopy. Medical, endoscopic, and pathologic records were reviewed and compared with radiographic findings. RESULTS The results of double-contrast barium enema examination revealed 74 (26.8%) of 276 patients with 104 polypoid lesions in the colon, including 32 patients (11.6%) with 41 polypoid lesions 1 cm or larger, 15 patients (5.4%) with 19 polyps 6-9 mm, and 27 patients (9.8%) with 44 polyps 5 mm or smaller. Endoscopy was performed in 24 (75%) of 32 patients, the results of which confirmed 23 (72%) of 32 radiographically diagnosed lesions 1 cm or larger in 16 (67%) of 24 patients. In two of these individuals, the polyps were hyperplastic. The remaining 14 patients had a total of 21 neoplastic lesions 1 cm or larger, including 11 tubular adenomas, seven tubulovillous adenomas, one villous adenoma with marked dysplasia, and two cancers. The diagnostic yield of screening double-contrast barium enema examination was 5.1% (14 of 276 patients) for neoplastic lesions 1 cm or larger and 6.2% (17 of 276 patients) for advanced neoplastic lesions of any size. CONCLUSION Double-contrast barium enema examinations performed in average-risk adults older than 50 years have a diagnostic yield of 5.1% for neoplastic lesions 1 cm or larger and 6.2% for advanced neoplastic lesions, regardless of size.
Collapse
Affiliation(s)
- Justin W Kung
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | | | | | | | | | | |
Collapse
|
10
|
Haykir R, Karakose S, Karabacakoglu A, Sahin M, Kayacetin E. Three-dimensional MR and axial CT colonography versus conventional colonoscopy for detection of colon pathologies. World J Gastroenterol 2006; 12:2345-50. [PMID: 16688823 PMCID: PMC4088068 DOI: 10.3748/wjg.v12.i15.2345] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the sensitivity and specificity of MR colonography (MRC) and CT performance in detecting colon lesions, and to compare their sensitivity and specificity with that of conventional colonoscopy.
METHODS: Forty-two patients suspected of having colonic lesions, because of rectal bleeding, positive fecal occult blood test results or altered bowel habits, underwent the examinations. After insertion of a rectal tube, the colon was filled with 1000-1500 mL of a mixture of 9 g/L NaCl solution, 15-20 mL of 0.5 mmol/L gadopentetate dimeglumine and 100 mL of iodinized contrast material. Once colonic distension was achieved, three-dimensional gradient-echo (3D-GRE) sequences for MR colonography and complementary MR images were taken in all cases. Immediately after MR colonography, abdominal CT images were taken by spiral CT in the axial and supine position. Then all patients were examined by conventional colonoscopy (CC).
RESULTS: The sensitivity and specificity of MRC for colon pathologies were 96.4% and 100%, respectively. The percentage of correct diagnosis by MRC was 97.6%. The sensitivity and specificity of CT for colon pathologies were 92.8%, 100%, respectively. The percentage of correct diagnosis by CT was 95.2%.
CONCLUSION: In detecting colon lesions, MRC achieved a diagnostic accuracy similar to CC. However, MRC is minimally invasive, with no need for sedation or analgesics during investigation. There is a lower percentage of perforation risk, and all colon segments can be evaluated due to multi-sectional imaging availability; intramural, extra-intestinal components of colonic lesions, metastasis and any additional lesions can be evaluated easily. MRC and CT colonography are new radiological techniques that promise to be highly sensitive in the detection of colorectal mass and inflammatory bowel lesions.
Collapse
Affiliation(s)
- Rahime Haykir
- Department of Radiology, Selcuk University Meram Medical Faculty, Konya 42080, Turkey
| | | | | | | | | |
Collapse
|
11
|
Kitiyakara T, Selby W. Non-small-bowel lesions detected by capsule endoscopy in patients with obscure GI bleeding. Gastrointest Endosc 2005; 62:234-8. [PMID: 16046986 DOI: 10.1016/s0016-5107(05)00292-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Approximately two thirds of patients undergoing capsule endoscopy for obscure GI bleeding will have an abnormality found in the small intestine. This report describes 9 patients (4 men, 5 women) of 140 with obscure bleeding in whom a source of their blood loss was found in the stomach or the colon at capsule endoscopy. METHODS A review was made of a prospective database of 140 consecutive patients undergoing capsule endoscopy for obscure GI bleeding at a single center. Patients with a definite or likely cause of bleeding within reach of conventional upper or lower GI endoscopy were identified. RESULTS Three patients had gastric antral vascular ectasia and another an inflamed pyloric canal polyp. Two patients had actively bleeding cecal carcinoma, missed at previous colonoscopies. Two others had bleeding cecal angiodysplasia. The final patient had severe nonspecific cecal inflammation. The identification of these lesions was aided by the suspected blood indicator. All patients underwent endoscopic therapy or surgery for their non-small-bowel lesions. CONCLUSIONS Like push enteroscopy, capsule endoscopy also can identify lesions within reach of conventional endoscopy and colonoscopy. These subsequently can be treated successfully. The reasons why these lesions have been missed are unclear.
Collapse
|
12
|
Loffeld RJLF, van der Putten ABMM. The annual yield of diagnostic endoscopy of the lower digestive tract. Eur J Intern Med 2005; 16:37-40. [PMID: 15733820 DOI: 10.1016/j.ejim.2004.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Revised: 06/24/2004] [Accepted: 07/06/2004] [Indexed: 11/17/2022]
Abstract
BACKGROUND: Endoscopy of the colon and rectum has become a standard diagnostic procedure. No data are presented in the literature on the annual yield or on morbidity patterns. A large, cross-sectional, single-center study was done in order to detect the annual yield of endoscopy of the colon and rectum. METHODS: All consecutive endoscopies performed over an 11-year period were included. All files from a random year were taken in order to collect data on the indication for the endoscopy. A standardized endoscopy report was used. RESULTS: Over the 11-year period, 11,550 consecutive endoscopies of the lower digestive tract were performed. Seven hundred and fourteen procedures were excluded because they were done as a direct follow-up after the index procedure. The majority of endoscopies were scheduled as colonoscopy. The most common endoscopic diagnoses made each year remained constant in number. Cancer was diagnosed in 4-6% of cases, inflammation in 9-15%, polyps in 9-16%, and diverticular disease in 21-37%. The percentage of women undergoing the procedure each year ranged from 54% to 59%, that of men from 41% to 46%. CONCLUSION: From this study it can be concluded that the annual yield of endoscopy of the lower digestive tract remains rather constant. No major changes in morbidity are noted.
Collapse
Affiliation(s)
- R J L F Loffeld
- Department of Internal Medicine and Gastroenterology, De Heel Zaans Medical Center, PO Box 210, 1500 EE Zaandam, The Netherlands
| | | |
Collapse
|
13
|
Allen E, Nicolaidis C, Helfand M. The evaluation of rectal bleeding in adults. A cost-effectiveness analysis comparing four diagnostic strategies. J Gen Intern Med 2005; 20:81-90. [PMID: 15693933 PMCID: PMC1490043 DOI: 10.1111/j.1525-1497.2005.40077.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Though primary care patients commonly present with rectal bleeding, the optimal evaluation strategy remains unknown. OBJECTIVE To compare the cost-effectiveness of four diagnostic strategies in the evaluation of rectal bleeding. DESIGN Cost-effectiveness analysis using a Markov decision model. DATA SOURCES Systematic review of the literature, Medicare reimbursement data, Surveillance, Epidemiology, and End Results (SEER) Cancer Registry. TARGET POPULATION Patients over age 40 with otherwise asymptomatic rectal bleeding. TIME HORIZON The patient's lifetime. PERSPECTIVE Modified societal perspective. INTERVENTIONS Watchful waiting, flexible sigmoidoscopy, flexible sigmoidoscopy followed by air contrast barium enema (FS+ACBE), and colonoscopy. OUTCOME MEASURES Incremental cost-effectiveness ratio. RESULTS OF BASE-CASE ANALYSIS The incremental cost-effectiveness ratio for colonoscopy compared with flexible sigmoidoscopy was 5,480 dollars per quality-adjusted year of life saved (QALY). Watchful waiting and FS+ACBE were more expensive and less effective than colonoscopy. RESULTS OF SENSITIVITY ANALYSES The cost of colonoscopy was reduced to 1,686 dollars per QALY when age at entry was changed to 45. Watchful waiting became the least expensive strategy when community procedure charges replaced Medicare costs, when age at entry was maximized to 80, or when the prevalence of polyps was lowered to 7%, but the remaining strategies provided greater life expectancy at relatively low cost. The strategy of FS+ACBE remained more expensive and less effective in all analyses. In the remaining sensitivity analyses, the incremental cost-effectiveness of colonoscopy compared with flexible sigmoidoscopy never rose above 34,000 dollars. CONCLUSIONS Colonoscopy is a cost-effective method to evaluate otherwise asymptomatic rectal bleeding, with a low cost per QALY compared to other strategies.
Collapse
Affiliation(s)
- Elizabeth Allen
- Portland Veterans Affairs Medical Center, Portland, OR 97207, USA.
| | | | | |
Collapse
|
14
|
Rockey DC, Koch J, Yee J, McQuaid KR, Halvorsen RA. Prospective comparison of air-contrast barium enema and colonoscopy in patients with fecal occult blood: a pilot study. Gastrointest Endosc 2004; 60:953-8. [PMID: 15605011 DOI: 10.1016/s0016-5107(04)02223-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The utility of air-contrast barium enema and colonoscopy for evaluation of the colon has been debated. Air-contrast barium enema is less expensive and invasive than colonoscopy, but it also is less sensitive and specific. Further, although air-contrast barium enema may be less painful than colonoscopy, it often is poorly tolerated by patients. Thus, this study compared the sensitivity and the specificity of air-contrast barium enema and colonoscopy for detection of colonic lesions in patients with fecal occult blood. METHODS Over a 30-month period, patients with fecal occult blood were recruited. Patients underwent standard air-contrast barium enema, followed by colonoscopy 7 to 14 days later. Colonoscopists were blinded to the results of air-contrast barium enema until the colonoscopy was completed, after which the results were disclosed. If the findings were discrepant, colonoscopy was repeated. RESULTS A total of 100 patients were evaluated. Nine air-contrast barium enemas were reported to be inadequate, and the cecum was not intubated at colonoscopy in two patients. In the remaining patients, 5 cancers were identified (1 each cecum, transverse colon, descending colon, sigmoid colon, and rectum) by both studies. Sixty-six polypoid lesions were identified in 30 patients. Diverticula were identified in 42 patients by air-contrast barium enema and in 18 patients by colonoscopy. Air-contrast barium enema detected 3 of 36 polypoid lesions 5 mm or less in diameter, 5 of 15 adenomas 6 to 9 mm in size, and 4 of 15 adenomas 10 mm or greater in diameter (sensitivity 8%, 33%, and 27%, respectively). After excluding patients with diverticula, air-contrast barium enema detected 3 of 7 adenomas 10 mm or greater in size. Overall, 12 polypoid lesions or filling defects were identified by air-contrast barium enema that could not be verified by colonoscopy. The specificity of air-contrast barium enema for lesions 1.0 cm or greater in size was 100%; for those 6 mm or greater, it was 97%. CONCLUSIONS Air-contrast barium enema accurately detects colon cancer and diverticula. Its sensitivity for detection of polypoid lesions or adenomas is poor and was confounded by the presence of diverticula.
Collapse
Affiliation(s)
- Don C Rockey
- Liver Center, Duke University Medical Center, Sands Building Room 334, Research Drive, Durham, NC 27710, USA
| | | | | | | | | |
Collapse
|
15
|
|
16
|
Baig N, Myers RE, Turner BJ, Grana J, Rothermel T, Schlackman N, Weinberg DS. Physician-reported reasons for limited follow-up of patients with a positive fecal occult blood test screening result. Am J Gastroenterol 2003; 98:2078-81. [PMID: 14499791 DOI: 10.1111/j.1572-0241.2003.07575.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Fecal occult blood testing (FOBT) screening can reduce colorectal cancer (CRC) mortality when patients with an abnormal result [FOBT(+)] undergo a complete diagnostic evaluation (colonoscopy or double-contrast barium enema with or without flexible sigmoidoscopy). The aim of this study was to determine common reasons for nonperformance of a complete diagnostic evaluation. METHODS We identified 544 FOBT(+) patients, aged 50 yr or older, who had participated in a managed care organization-sponsored CRC screening program. The performance of a complete diagnostic evaluation was determined from a patient-specific follow-up form and managed care organization claims data. Physicians were asked to report whether patients submitted to a complete diagnostic evaluation. When an evaluation was not done, the physicians were also asked to state the reasons for nonperformance. RESULTS A total of 248 (46%) patients did not undergo a complete diagnostic evaluation. Physicians provided reasons for nonperformance for 50% (123/248). Factors accounting for nonperformance of a complete diagnostic evaluation were classified as follows: primary care physician decision (50%); specialist decision (28%); patient decision (17%); and other (practice-related) (5%). Many failures to complete an appropriate diagnostic evaluation were due to providers deciding to repeat the FOBT, perform a sigmoidoscopy, or not to proceed with any further testing. CONCLUSION Many patients with a positive FOBT do not receive a complete diagnostic evaluation. The reasons for nonperformance most frequently have to do with physician decision making. Many physician-related explanations do not conform to expert recommendations for appropriate follow-up.
Collapse
Affiliation(s)
- Nadeem Baig
- Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
There is good evidence from faecal occult blood testing trials that detection and removal of non-advanced colorectal neoplasms can achieve a reduction in colorectal cancer mortality. Both colonoscopy and barium enema have potential advantages and disadvantages if implemented for population screening. The relative merits of each are discussed.
Collapse
Affiliation(s)
- R M S Mitchell
- Department of Medicine, Division of Gastroenterology, Box 3189, Duke University Medical Center, Durham, NC 27710, USA.
| | | | | |
Collapse
|
18
|
Yarnall KSH, Pollak KI, Østbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? Am J Public Health 2003; 93:635-41. [PMID: 12660210 PMCID: PMC1447803 DOI: 10.2105/ajph.93.4.635] [Citation(s) in RCA: 1083] [Impact Index Per Article: 51.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2002] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to determine the amount of time required for a primary care physician to provide recommended preventive services to an average patient panel. METHODS We used published and estimated times per service to determine the physician time required to provide all services recommended by the US Preventive Services Task Force (USPSTF), at the recommended frequency, to a patient panel of 2500 with an age and sex distribution similar to that of the US population. RESULTS To fully satisfy the USPSTF recommendations, 1773 hours of a physician's annual time, or 7.4 hours per working day, is needed for the provision of preventive services. CONCLUSIONS Time constraints limit the ability of physicians to comply with preventive services recommendations.
Collapse
Affiliation(s)
- Kimberly S H Yarnall
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC 27710, USA.
| | | | | | | | | |
Collapse
|
19
|
|
20
|
Abstract
CT colonography (Virtual Colonoscopy) was first introduced in 1994 as a novel imaging technique for the detection of colorectal polyps and cancer. It is currently proposed as a new screening tool for colorectal carcinoma that may be more acceptable to patients than current methods. There are a growing number of published studies evaluating all aspects of CT colonography, including technique, imaging displays, interpretation methods, patient acceptance, and lesion detection accuracy. While there are multiple studies that have found excellent CT colonography results for the detection of larger polyps in high risk or symptomatic patient cohorts, there are very few published studies evaluating the performance of CT colonography in asymptomatic screening patients. Although we do not have the results of large, randomized, controlled trials documenting the performance of CT colonography in screening-type patients, this technique is currently employed at some sites as a screening tool for colorectal carcinoma. Thus, CT colonography has become a part of the controversy surrounding total body CT screening. In this article, the current techniques for colonic preparation and distention will be discussed, as well as the optimum CT protocol, and the recommended use of image displays for time-efficient interpretation. The results of the larger and newer studies will be presented, as well as some of the current clinical uses of CT colonography. Issues specific to the use of CT colonography as a screening test will also be discussed.
Collapse
Affiliation(s)
- Judy Yee
- UCSF, Veterans Affairs Medical Center (114), San Francisco, CA 94121, USA.
| |
Collapse
|
21
|
Affiliation(s)
- Judy Yee
- Department of Radiology, UCSF Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA 94121, USA.
| |
Collapse
|
22
|
Rex DK. Rationale for colonoscopy screening and estimated effectiveness in clinical practice. Gastrointest Endosc Clin N Am 2002; 12:65-75. [PMID: 11916162 DOI: 10.1016/s1052-5157(03)00058-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Colonoscopy screening has the highest anticipated level of effectiveness of the available colorectal cancer screening techniques. Its long-term cost-effectiveness is also comparable with or superior to other modalities. Evidence for the expected reduction in colorectal cancer incidence and mortality varies with colonoscopy screening from 50% to 90%, for reasons that are not fully understood. Maintaining a high standard of performance is critical with regard to achieving the highest level of effectiveness possible.
Collapse
Affiliation(s)
- Douglas K Rex
- Department of Medicine, Indiana University School of Medicine and Indiana University Hospital, Indianapolis 46202, USA
| |
Collapse
|
23
|
Yee J, Akerkar GA, Hung RK, Steinauer-Gebauer AM, Wall SD, McQuaid KR. Colorectal neoplasia: performance characteristics of CT colonography for detection in 300 patients. Radiology 2001; 219:685-92. [PMID: 11376255 DOI: 10.1148/radiology.219.3.r01jn40685] [Citation(s) in RCA: 307] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To determine the sensitivity and specificity of computed tomographic (CT) colonography for colorectal polyp and cancer detection by using colonoscopy as the reference standard. MATERIALS AND METHODS Three hundred patients underwent CT colonography followed by standard colonoscopy. Bowel preparation consisted of magnesium citrate and polyethylene glycol. After colonic air insufflation, patients underwent scanning in the supine and prone positions with 3-mm collimation during a single breath hold. The transverse CT images, sagittal and coronal reformations, and three-dimensional endoluminal images were interpreted by two radiologists independently, and then a consensus reading was performed. CT colonographic findings were correlated with standard colonoscopic and histologic findings. RESULTS The overall sensitivity and specificity of CT colonography for polyp detection were 90.1% (164 of 182) and 72.0% (85 of 118), respectively. By using direct polyp matching, the overall sensitivity was 69.7% (365 of 524). The sensitivity was 90% (74 of 82) for the detection of polyps 10 mm or larger, 80.1% (113 of 141) for polyps 5.0-9.9 mm, and 59.1% (178 of 301) for polyps smaller than 5 mm. The sensitivity was 94% (64 of 68) for the detection of adenomas 10 mm or larger, 82% (72 of 88) for adenomas 5.0-9.9 mm, and 66.9% (95 of 142) for adenomas smaller than 5 mm. CT colonography was used to identify all eight carcinomas. CONCLUSION CT colonography has excellent sensitivity for the detection of clinically important colorectal polyps and cancer.
Collapse
Affiliation(s)
- J Yee
- Department of Radiology, Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA 94121, USA.
| | | | | | | | | | | |
Collapse
|
24
|
de Zwart IM, Griffioen G, Shaw MP, Lamers CB, de Roos A. Barium enema and endoscopy for the detection of colorectal neoplasia: sensitivity, specificity, complications and its determinants. Clin Radiol 2001; 56:401-9. [PMID: 11384140 DOI: 10.1053/crad.2000.0672] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To analyse sensitivity, specificity and complication rate of endoscopy, and barium enema for the detection of colorectal neoplasia. MATERIALS AND METHODS A MEDLINE search was performed (1980-2000) directed at the endoscopic and radiologic literature on barium enema. Articles were selected based on the type of study, availability of sensitivity and specificity values in sizeable patient groups, and reports on complications. Sixty articles were included in the analysis. RESULTS Endoscopy proved to have superior sensitivity for polyps in patients at high-risk for colorectal neoplasia. The role of endoscopy and radiology in average-risk screening populations is not known. Sensitivity and specificity rates ranged widely, probably due to bias. For the detection of small polyps endoscopy has superior performance, whereas sensitivity is similar for endoscopy and barium enema for the detection of larger (>1 cm) polyps and tumours. Overall, endoscopy is associated with a higher complication rate. CONCLUSION Endoscopy is the preferred detection method in high-risk patients. The role of endoscopy and radiology in a screening setting requires evaluation. This review provides the test characteristics of endoscopy and radiology which are relevant for a cost-effectiveness analysis. Double-contrast barium enema may play an important role for screening purposes, owing to its good sensitivity for detecting larger (>1 cm) polyps and its lack of major complications. de Zwart, I. M.et al. (2001). Clinical Radiology56, 401-409.
Collapse
Affiliation(s)
- I M de Zwart
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA Leiden, The Netherlands.
| | | | | | | | | |
Collapse
|
25
|
|
26
|
Musinski SE. Preventable cancers: the role of obstetrician gynecologists in colorectal cancer screening. PRIMARY CARE UPDATE FOR OB/GYNS 2000; 7:238-243. [PMID: 11077236 DOI: 10.1016/s1068-607x(00)00052-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Colorectal cancer is second only to lung cancer as a cause of cancer deaths in the United States, and is the third most common cause of cancer deaths in U.S. women. Effective screening and intervention programs exist and, if followed, could halve the number of annual deaths from this disease. Detection of early-stage disease and, more important, premalignant polyps, is possible by following the recommendations of several national societies, including the American College of Obstetricians and Gynecologists. Recommended screening consists of identification of special risk factors, annual fecal occult blood testing, and flexible sigmoidoscopy every 5 years. Alternatively, a dual-contrast barium enema every 5 to 10 years or colonoscopy every 10 years are options. This article reviews the evidence underlying current screening guidelines, highlights emerging trends in screening, and analyzes the growing need for women's health care providers to understand and promote colorectal cancer screening as part of an optimal health maintenance program.
Collapse
Affiliation(s)
- SE Musinski
- Boston University School of Medicine, Department of Ob/Gyn, Boston, Massachusetts, USA
| |
Collapse
|
27
|
Ott DJ. Accuracy of double-contrast barium enema in diagnosing colorectal polyps and cancer. Semin Roentgenol 2000; 35:333-41. [PMID: 11060920 DOI: 10.1053/sroe.2000.17754] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
CRC is a common malignancy, and reduced mortality can be achieved through detection and treatment of early cancers and by removal of colonic adenomas. Although current screening recommendations, especially in the average-risk individual, typically promote the use of FOBT and FS, a substantial minority of colonic cancers and many colonic adenomas are not detected by these methods. Modalities that examine the entire colon, such as the barium enema and colonoscopy, can detect most clinically important colorectal neoplasms; however, their additional costs and potential risks have limited their use as initial screening examinations. But recent changes in governmental policies regarding reimbursement for CRC screening and increasing emphasis on total colon examinations have altered these recommendations. This review on the accuracy of the DCBE has emphasized the detection of colonic polyps and cancers and has updated the changing role of this examination in screening patients at variable risk for CRC. The efficacy of the barium enema depends on many factors that radiologists must understand and control to perform accurate examinations. Current recommendations for CRC screening and approved reimbursement of the barium enema for that purpose provide a new impetus to radiologists to maintain and improve their skills in performing and interpreting this radiologic examination. The barium enema may have a future in the new millennium.
Collapse
Affiliation(s)
- D J Ott
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| |
Collapse
|
28
|
Ahmad NA, Hoops TC. The role of colonoscopy for screening of colorectal cancer. Semin Roentgenol 2000; 35:404-8. [PMID: 11060926 DOI: 10.1053/sroe.2000.17758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- N A Ahmad
- Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia 19104, USA
| | | |
Collapse
|
29
|
Glick S. Double-contrast barium enema for colorectal cancer screening: a review of the issues and a comparison with other screening alternatives. AJR Am J Roentgenol 2000; 174:1529-37. [PMID: 10845475 DOI: 10.2214/ajr.174.6.1741529] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- S Glick
- Department of Radiology, MCP-Hahnemann University, Philadelphia, PA 19102, USA
| |
Collapse
|
30
|
Rex DK, Johnson DA, Lieberman DA, Burt RW, Sonnenberg A. Colorectal cancer prevention 2000: screening recommendations of the American College of Gastroenterology. American College of Gastroenterology. Am J Gastroenterol 2000; 95:868-77. [PMID: 10763931 DOI: 10.1111/j.1572-0241.2000.02059.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- D K Rex
- Indiana University Hospital, Indianapolis 46202, USA
| | | | | | | | | |
Collapse
|
31
|
Zuckerman GR, Prakash C, Askin MP, Lewis BS. AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 2000; 118:201-21. [PMID: 10611170 DOI: 10.1016/s0016-5085(00)70430-6] [Citation(s) in RCA: 361] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This literature review and the recommendations therein were prepared for the American Gastroenterological Association Clinical Practice and Practice Economics committee. The paper was approved by the committee on May 16, 1999, and by the AGA governing board on July 18, 1999.
Collapse
Affiliation(s)
- G R Zuckerman
- Division of Gastroenterology Washington University School of Medicine St. Louis, Missouri, USA
| | | | | | | |
Collapse
|
32
|
|
33
|
McMahon LF, Wolfe RA, Huang S, Tedeschi P, Manning W, Edlund MJ. Racial and gender variation in use of diagnostic colonic procedures in the Michigan Medicare population. Med Care 1999; 37:712-7. [PMID: 10424642 DOI: 10.1097/00005650-199907000-00011] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is accumulating evidence that screening programs can alter the natural history of colorectal cancer, a significant cause of mortality and morbidity in the US. Understanding how the technology to diagnose colonic diseases is utilized in the population provides insight into both the access and processes of care. METHOD Using Medicare Part B billing files from the state of Michigan from 1986 to 1989 we identified all procedures used to diagnose colorectal disease. We utilized the Medicare Beneficiary File and the Area Resource File to identify beneficiary-specific and community-sociodemographic characteristics. The beneficiary and sociodemographic characteristics were, then, used in multiple regression analyses to identify their association with procedure utilization. RESULTS Sigmoidoscopic use declined dramatically with the increasing age cohorts of Medicare beneficiaries. Urban areas and communities with higher education levels had more sigmoidoscopic use. Among procedures used to examine the entire colon, isolated barium enema was used more frequently in African Americans, the elderly, and females. The combination of barium enema and sigmoidoscopy was used more frequently among females and the newest technology, colonoscopy, was used most frequently among White males. CONCLUSION The existence of race, gender, and socioeconomic disparities in the use of colorectal technologies in a group of patients with near-universal insurance coverage demonstrates the necessity of understanding the reason(s) for these observed differences to improve access to appropriate technologies to all segments in our society.
Collapse
Affiliation(s)
- L F McMahon
- Department of Internal Medicine, the University of Michigan, Ann Arbor 48109-0376, USA.
| | | | | | | | | | | |
Collapse
|
34
|
Affiliation(s)
- D C Rockey
- Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, USA.
| |
Collapse
|
35
|
Anwar S, Hall C, Elder JB. Screening for colorectal cancer: present, past and future. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1998; 24:477-86. [PMID: 9870720 DOI: 10.1016/s0748-7983(98)93176-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Colorectal cancer results in 18,000 deaths annually in England and Wales, with 24,000 new cases diagnosed each year. Despite a better understanding of the genetics, and advancement in surgical and anaesthetic techniques, there has been little reduction in mortality and morbidity from this disease over the past 25 years. Colorectal cancer fits recognized criteria for a disease that should be screened in asymptomatic individuals. The putative duration of the adenoma to carcinoma sequence gives an ample window of opportunity to detect and treat colorectal cancer. In this article we have reviewed the strategies involved in screening for colorectal cancer in an asymptomatic population. We have presented trials and arguments for and against the different screening methods and discussed cost effectiveness of screening. In the USA and Canada, major professional organizations and societies now endorse screening; in the UK it is still far from being accepted. We feel that the available evidence shows that colorectal cancer screening has the potential to reduce the morbidity and mortality from this disease and that funding for a mass screening and public education programme should be sought.
Collapse
Affiliation(s)
- S Anwar
- Department of Surgery, Keele University, North Staffordshire, UK
| | | | | |
Collapse
|
36
|
Bond JH. Effectiveness and cost-effectiveness of colorectal cancer screening: Selecting the ideal strategy. J Gastroenterol Hepatol 1998; 13:S252-S256. [PMID: 28976679 DOI: 10.1111/j.1440-1746.1998.tb01887.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Colorectal cancer is the second most common cancer killer of Americans. Recently developed and tested methods of screening and surveillance can effectively diagnose and treat the disease in most patients before symptoms develop when the chance of cure is high. It is also possible to prevent colorectal cancer by detecting and resecting premalignant adenomatous polyps. Evidence-based guidelines recommend that the average-risk population greater than age 50 be screened with annual faecal occult blood tests plus periodic flexible sigmoidoscopy. This approach is feasible, efficacious, affordable and cost-effective in a high-risk country such as the US. Widespread compliance with these recommendations could reduce the mortality from this malignancy by more than 50%.
Collapse
Affiliation(s)
- John H Bond
- Gastroenterology Section, Minneapolis VA Medical Center and University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
37
|
Abstract
Computed tomography (CT) and magnetic resonance (MR) colography (virtual colonoscopy) are new techniques being developed for the purpose of imaging colorectal polyps and cancer. Limited data are available regarding the performance characteristics of either technique, particularly MR. Initial reports suggest that the sensitivity of CT and MR colography for patients with adenomas > or = 1 cm ranges from 75-90%, and decreases precipitously for smaller polyps. Very early data suggest that the specificity for patient with large adenomas is around 90%, but for patients with adenomas in the 5-9 mm range has been as low as 65%. This review discusses currently available published and abstracted data on CT and MR colography and discusses the real and potential advantages and disadvantages of CT and MR colography compared to current colonic imaging methods. The review discusses problems that must be overcome in order for CT or MR colography to be demonstrated as practical tests, and suggests guidelines for the performance of clinical trials testing the performance characteristics of these methods.
Collapse
Affiliation(s)
- D K Rex
- Indiana University School of Medicine and Indiana University Hospital, Indianapolis 46202, USA
| |
Collapse
|
38
|
Mendelson RM. The role of the barium enema in the diagnosis of colorectal neoplasia. AUSTRALASIAN RADIOLOGY 1998; 42:191-6. [PMID: 9727239 DOI: 10.1111/j.1440-1673.1998.tb00490.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The recent interest in guidelines for colorectal cancer diagnosis, management and in screening has important implications for radiologists. The present article reviews the role of the barium enema in colorectal neoplasia diagnosis in symptomatic patients, and in the context of screening programmes.
Collapse
Affiliation(s)
- R M Mendelson
- Department of Radiology, Royal Perth Hospital, Australia.
| |
Collapse
|
39
|
Abstract
Randomized, controlled trials have shown with certainty that screening for colorectal cancer reduces morbidity and is cost-effective. Factors that increase the risk of colorectal cancer include a personal or family history of adenomatous polyps or colorectal cancer, certain genetic syndromes and chronic inflammatory bowel disease.
Collapse
Affiliation(s)
- M A Jednak
- Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0362, USA
| | | |
Collapse
|
40
|
Affiliation(s)
- A Melville
- NHS Centre for Reviews and Dissemination, University of York, UK
| | | | | | | |
Collapse
|
41
|
Rex DK. American Cancer Society guidelines--are we truly improving all aspects of effectiveness? Am J Gastroenterol 1998; 93:475-7. [PMID: 9517666 DOI: 10.1111/j.1572-0241.1998.475_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- D K Rex
- Gastroenterology Division, Indiana University School of Medicine, Indianapolis, USA
| |
Collapse
|
42
|
Abstract
Screening and surveillance examinations are effective in lowering colorectal cancer risk. Screening tests have been demonstrated to reduce colorectal cancer mortality. Colonoscopic removal of adenomatous polyps has been determined to reduce colorectal cancer incidence. High-risk individuals and their family members should be identified and offered more aggressive recommendations for appropriate screening and surveillance guidelines. Colorectal cancer screening strategies are in an acceptable range of cost effectiveness.
Collapse
Affiliation(s)
- A J Markowitz
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | | |
Collapse
|