CT Colonography for Population Screening: Ready for Prime Time?

Pickhardt, Perry J.

doi:10.1007/s10620-014-3454-2

Cited by 34 publications

(20 citation statements)

References 128 publications

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“…Same-day follow-up colonoscopy requires integration between radiology and gastroenterology units and is available at some specialized centers in the United States. 53 Although the burden of bowel preparation with CTC was included in the sensitivity analysis, none of the analyses accounted for the harms associated with the small risk of radiation induced cancer from CTC, nor did the analyses account for the harms (or potential benefits) from the follow-up of extracolonic findings detected at CTC. Accounting for these benefits, harms, and burdens might have the potential to alter whether CTC was a model recommendable strategy, but evidence is insufficient to reliably quantify the magnitude of these effects.…”

Section: Discussionmentioning

confidence: 99%

Estimation of Benefits, Burden, and Harms of Colorectal Cancer Screening Strategies

Knudsen

Zauber

Rutter

et al. 2016

JAMA

411

496

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IMPORTANCEThe US Preventive Services Task Force (USPSTF) is updating its 2008 colorectal cancer (CRC) screening recommendations.OBJECTIVE To inform the USPSTF by modeling the benefits, burden, and harms of CRC screening strategies; estimating the optimal ages to begin and end screening; and identifying a set of model-recommendable strategies that provide similar life-years gained (LYG) and a comparable balance between LYG and screening burden. DESIGN, SETTING, AND PARTICIPANTSComparative modeling with 3 microsimulation models of a hypothetical cohort of previously unscreened US 40-year-olds with no prior CRC diagnosis.EXPOSURES Screening with sensitive guaiac-based fecal occult blood testing, fecal immunochemical testing (FIT), multitarget stool DNA testing, flexible sigmoidoscopy with or without stool testing, computed tomographic colonography (CTC), or colonoscopy starting at age 45, 50, or 55 years and ending at age 75, 80, or 85 years. Screening intervals varied by modality. Full adherence for all strategies was assumed. MAIN OUTCOMES AND MEASURESLife-years gained compared with no screening (benefit), lifetime number of colonoscopies required (burden), lifetime number of colonoscopy complications (harms), and ratios of incremental burden and benefit (efficiency ratios) per 1000 40-year-olds. RESULTSThe screening strategies provided LYG in the range of 152 to 313 per 1000 40-year-olds. Lifetime colonoscopy burden per 1000 persons ranged from fewer than 900 (FIT every 3 years from ages 55-75 years) to more than 7500 (colonoscopy screening every 5 years from ages 45-85 years). Harm from screening was at most 23 complications per 1000 persons screened. Strategies with screening beginning at age 50 years generally provided more LYG as well as more additional LYG per additional colonoscopy than strategies with screening beginning at age 55 years. There were limited empirical data to support a start age of 45 years. For persons adequately screened up to age 75 years, additional screening yielded small increases in LYG relative to the increase in colonoscopy burden. With screening from ages 50 to 75 years, 4 strategies yielded a comparable balance of screening burden and similar LYG (median LYG per 1000 across the models): colonoscopy every 10 years (270 LYG); sigmoidoscopy every 10 years with annual FIT (256 LYG); CTC every 5 years (248 LYG); and annual FIT (244 LYG). CONCLUSIONS AND RELEVANCEIn this microsimulation modeling study of a previously unscreened population undergoing CRC screening that assumed 100% adherence, the strategies of colonoscopy every 10 years, annual FIT, sigmoidoscopy every 10 years with annual FIT, and CTC every 5 years performed from ages 50 through 75 years provided similar LYG and a comparable balance of benefit and screening burden.

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Section: Discussionmentioning

confidence: 99%

Estimation of Benefits, Burden, and Harms of Colorectal Cancer Screening Strategies

Knudsen

Zauber

Rutter

et al. 2016

JAMA

411

496

View full text Add to dashboard Cite

show abstract

“…25 Unlike the non-invasive CRC tests that lack cancer prevention at one end of the modality spectrum (including the new DNA tests), and overly invasive, aggressive, and expensive colonoscopy at the other end, CTC is “just right” in terms of balancing invasiveness and prevention. In fact, no other test can claim to be both minimally-invasive and highly preventive for CRC.…”

Section: Discussion and Comparison With Ct Colonographymentioning

confidence: 99%

Emerging stool-based and blood-based non-invasive DNA tests for colorectal cancer screening: the importance of cancer prevention in addition to cancer detection

Pickhardt

2016

Abdom Radiol

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Colorectal cancer (CRC) screening can be undertaken utilizing a variety of distinct approaches, which provides both opportunities and confusion. Traditionally, there has often been a trade-off between the degree of invasiveness of a screening test and its ability to prevent cancer, with fecal occult blood testing (FOBT) and optical colonoscopy (OC) at each end of the spectrum. CT colonography (CTC), although currently underutilized for CRC screening, represents an exception since it is only minimally invasive yet provides accurate evaluation for advanced adenomas. More recently, the FDA approved a multi-target stool DNA test (Cologuard) and a blood-based test (Epi proColon) for average-risk CRC screening. This commentary will provide an overview of these two new non-invasive tests, including the clinical indications, mechanism of action, and diagnostic performance. Relevance to radiology practice, including a comparison with CT colonography, will also be discussed.

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“…They argued extra-colonic findings, radiation exposure, and decreased performance in various polyp subtypes as reasons against use of this modality. Over the past decade, a substantial body of literature has emerged addressing these issues [27]. Many of these areas of perceived deficiency at CTC are nuanced.…”

Section: Discussionmentioning

confidence: 99%

Predictors of primary care provider adoption of CT colonography for colorectal cancer screening

et al. 2016

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Purpose To examine factors influencing primary care provider (PCP) adoption of CT colonography (CTC) for colorectal cancer (CRC) screening. Materials and Methods We performed a retrospective cohort study linking electronic health record (EHR) data with PCP survey data. Patients were eligible for inclusion if they were not up-to-date with CRC screening and if they had CTC insurance coverage in the year prior to survey administration. PCPs were included if they had at least one eligible patient in their panel and completed the survey (final sample N=95 PCPs; N=6,245 patients). Survey data included perceptions of CRC screening by any method, as well as CTC specifically. Multivariate logistic regression estimated odds ratios and 95% confidence intervals for PCP and clinic predictors of CRC screening by any method and screening with CTC. Results Substantial variation in CTC use was seen among PCPs and clinics (range 0–16% of CRC screening). Predictors of higher CTC use were PCP perceptions that CTC is effective in reducing CRC mortality, higher number of perceived advantages to screening with CTC, and Internal Medicine specialty. Factors not associated with CTC use were PCP perceptions of less organizational capacity to meet demand for colonoscopy, number of perceived disadvantages to screening with CTC, PCP age and gender, and clinic factors. Conclusion Significant variation in PCP adoption of CTC exists. PCP perceptions of CTC and specialty practice were related to CTC adoption. Strategies to increase PCP adoption of CTC for CRC screening should include emphasis on the effectiveness and advantages of CTC.

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CT Colonography for Population Screening: Ready for Prime Time?

Cited by 34 publications

References 128 publications

Estimation of Benefits, Burden, and Harms of Colorectal Cancer Screening Strategies

Estimation of Benefits, Burden, and Harms of Colorectal Cancer Screening Strategies

Emerging stool-based and blood-based non-invasive DNA tests for colorectal cancer screening: the importance of cancer prevention in addition to cancer detection

Predictors of primary care provider adoption of CT colonography for colorectal cancer screening

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