One third of over 740 respondents to a Mayo Clinic survey said that the laxative preparation was the most troublesome part of colorectal cancer screening.
Overall, the likelihood of being screened rose when the need for laxative preparation was removed.
People who had already had one screening with a laxative were the group most likely to say that they were “much more likely” to undergo screening in the future if there were a test that didn’t require a laxative. They also regarded the laxative as “a big problem” most often.
Timothy J. Beebe, PhD and his team from the College of Medicine at the Mayo Clinic concluded:
In this prospective survey, laxative preparation appeared to be a major disincentive to CRC screening. Emerging data suggest that performance of laxative-free computed tomographic colonography may represent an attractive option that removes this relatively common disincentive to CRC screening participation.
Computed tomographic colonography (CTC) or so-called virtual colonoscopy can avoid laxatives by tagging stool with contrast agents.
However, in an accompanying editorial, Perry J. Pickhardt, M.D. from the University of Wisconsin Medical School in Madison points out that laxative-free or non-cathartic preparation for virtual colonoscopy are not prepless. Patients still must adhere to dietary restrictions prior to the procedure and must drink contrast agents.
While a laxative-free regimen might increase compliance in those who put off screening because of the laxative preparation, Dr. Pickhardt believes that there are drawbacks to non-cathartic preps including:
- The need for oral contrast agents and dietary restrictions that may extend for 48 hours or more.
- Potential for missed polyps.
- False positive results that would result in unnecessary follow-up optical colonoscopies
- Not being able to have “one-stop” testing where optical colonoscopy could be done on the same day to remove polyps found on CTC.
He also points out that the group that most disliked laxative preps were people who had already been screened, and it was critical to reach those who had never been tested at all.
In conclusion, Dr. Pcikhardt wrote,
Because increased participation in effective screening programs represents the overriding challenge facing CRC prevention, offering both cathartic and noncathartic options for CT colonography may very well be the most prudent approach for our heterogeneous population that expresses divergent preferences and needs. Although it may initially appear counterintuitive, the noncathartic approach to CT colonography may in fact turn out to be more onerous overall than a low-volume preparation that incorporates laxatives, especially for patients with positive findings on examination.
SOURCE: Beebe et. al., Mayo Clinic Proceedings, Volume 82, Number 6, June 2007.
Pickhardt, Mayo Clinic Proceedings, Editorial, Volume 82, Number 6, June 2007.