FEATURE
er than 10 years, that’s going to change the results.” Rex believes another recent study
provides a more accurate representation of patient satisfaction with laxative-free CTC. “There’s a study that’s much more useful than this May study, which is a randomized controlled trial that was re- cently published in The Netherlands. In that study, patients were randomized to have either laxative-free CTC or colo- noscopy,” he says. “They were asked a variety of questions about their per- ceptions about what the burden of the test would be beforehand, and then, they were asked afterwards how they perceived the burden of the test to be. What was found was that conventional colonoscopy was usually perceived as something to be pretty onerous and turned out to be, generally, much less onerous than anticipated, whereas CTC was something that was perceived not to be very onerous and was actually found by the patients to be much more onerous than they anticipated.” One final concern with the use of
CTC voiced by both Johnson and Rex is the CT radiation exposure during screening. “It’s recognizing that the radiation exposure puts the patient already on the threshold risk for ab- dominal cancer even with one CT scan,” Johnson says. “The use of re- petitive radiation for screening is one issue because that is cumulative and additive over time. If you then super- impose the use of radiation for diag- nostic testing, such as a CT scan in the future—or, if you have other rea- sons to have ionizing radiation expo- sure—it creates a significant concern about ongoing cumulative radiation exposure, especially when you’re us- ing it for screening.” Taking all of these considerations
into account, Rex does not believe laxative-free CTC has significant value. “The fact that it’s not as good a test, that actually there’s still a fair amount of discomfort with it,
that there are going to be ongoing concerns in the US as there are in other countries about the radiation exposure for asymptomatic people, and that it has to be repeated at five years, I think we’re going to be left in exactly the same situation we are 18 years after the introduction of CTC, which is basically that it has essen- tially no impact on colorectal can- cer screening in the US,” he says. “I think, taking all of these things into account, there’s not much of a role for this test.” Johnson agrees. “My bias is based
on the present data and the current lit- erature, and the studies that were done in screening trials,” he says. “If we talk about screening, then optical colonos- copy is unquestionably the best test.” If a patient refuses to undergo a colonoscopy, however, alternatives are worth considering, he says. “Any colon cancer screening is better than noth- ing, and that would include fecal test- ing for blood fecal immunochemical
test (FIT) sigmoidoscopy and CTC. You lose some of the benefits when you con- sider the issues of sensitivity, specific- ity, costs, reproducibility and expertise required to perform them, but any test as an alternative to no test would be im- portant and beneficial.” Rex advises ASCs to carefully weigh
whether they should invest in the tech- nology needed to perform CTC. “I certainly would think that if
there’s somebody who owns an ASC who is trying to answer the question of whether they should invest in a CT scanner to put into their ASC, they bet- ter be sure they have enough volume from doing CT on symptomatic pa- tients to pay for the scanner rather than trust or be confident that CTC is going to have an impact on screening,” Rex continues. “This study doesn’t change CMS’ decision not to cover this test for colorectal screenings, so Medicare patients would really have to pay out of pocket for it.”
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