CT colonography (virtual colonoscopy) found more than twice the rate of large polyps or cancer in patients 65 and older compared to everyone being screened for colorectal cancer using the radiology-based test.
About one in six older patients was referred for an optical colonoscopy based on findings from the scans.
There were no major complications including colon perforations or bleeding, from either the CT procedure or the follow-up colonoscopy.
Researchers at the University of Wisconsin reviewed results of 577 people from 65 to 79 tested in the university’s CT colonography screening program and found either an advanced adenoma or cancer in 44 (7.6 percent). There were 5 cancers detected.
The rate of advanced neoplasia (advanced adenoma or cancer) for all the patients screened in the program, young and old, was 3.2 percent.
The percentage of older patients who were referred for an optical colonoscopy was about twice that of those under 65 — 15.3 percent of patients 65 and older, 7.6 percent of younger people. Optical colonoscopy confirmed the positive CT findings in all but 4 percent of cases, not verifying 3.6 percent of smaller polyps measuring 6 to 10 mm and 2.1 percent of those larger than 10 mm.
The scans also found potential problems outside the colon in 89 patients, 45 of whom needed additional medical studies. Workups discovered 21 previously undetected abnormalities including a lung cancer and 18 aneurysms.
The authors point out the the study was retrospective, looking back at experience in their program, and that negative findings were not verified by an optical colonoscopy.
Last year, the Centers for Medicare and Medicaid Services (CMS) declined coverage of screening colonoscopy for Medicare beneficiaries, stating lack of evidence for its effectiveness in people 65 and older. CMS was also concerned that CT colonography identifies issues outside the colon which require additional medical follow-up and may not be serious medical problems.
David H. Kim, MD and his colleagues at the University of Wisconsin concluded,
CT colonography is a safe and effective screening modality for the older population.
SOURCE: Kim et al., Radiology, Volume 254, pp 493-500, February 2010.
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