Dear Ms. Thompson,
AS YOU are well aware, there are at least two sides to every story. I read your recent article on CT Colonoscopy (Virtual Colonoscopy) and I am happy to see these developments being brought to the attention of the public.
However, here is another side to the story. CT Colonoscopy is not new. The U.S military has been using it. The results are not as favourable as the article would lead one to believe, when compared to standard colonoscopy.
In specialised centres where large volumes of these studies are being performed, the results are much better than those performed by the community-based radiologist. Studies have shown detection rate of 82 per cent in experienced centres compared to 24 per cent detection rate in less experienced centres. I am sure that in the future, this variability may improve, but we are not there yet.
The issue of complication was touched on. It is not true that there are no risk of complication. There is a one in 2,000 chance of perforation.
GOLD STANDARD
Standard colonoscopy has been around for years. Gastroentero-logists and some surgeons have vast experience doing this procedure, and it remains the gold standard (best test) for evaluating the colon.
But here's the meat of the issue. CT colonoscopy is a screening test for a common problem, colon polyps (benign growth), but cannot treat the finding. Standard colonoscopy screen for these polyps and, if found, they are removed. If the CT colonoscopy finds a polyp, the patient has to be referred for the standard colonoscopy to have the polypoid growth removed. In other words, many patients will end up having two procedures performed, when one (standard colonoscopy) would have been adequate.
Secondly, there is false-positive findings on the CT colonoscopy. Stool adherent to the wall of the colon can look like polyp growth, requiring the patient to go through a standard colonoscopy to find out there was actually no growth.
Even worse, imagine you were a patient who had a CT colonoscopy and a large growth was found. Imagine the mental trauma and stress you would endure while waiting to have a standard colonoscopy to remove this lesion and to determine if it is a cancer. Any patient would rather have the lesion removed at the same time the lesion was found. Only with standard colonoscopy can that be done.
ONLY PREVENTABLE CANCER
Despite the above critical look at CT colonoscopy, any test to screen for colon polyp and cancer is better than no test at all.
Colon cancer is an extremely common cancer, occurring equally in men and women, although more women than men die of this cancer. The reason: doctors overlook screening recom-mendations for colon cancer in women, so their disease, if found, is found at later stages.
Colon cancer is the only truly preventable cancer (screening can prevent this cancer). Screening (meaning, checking a person who is healthy and has no symptoms) is recommended at age 50 in both men and women. It should be done earlier if there's a family history of colon cancer or polyps, or in people with certain inflammatory diseases of the colon. If the initial screen is normal, the test should be repeated (surveillance) every 10 years.
Despite the vast benefit of colon cancer screening, people are still not having this test done. In the United States, where the test is widely available and all insurance and the government pay for the test to be done, only about 42 per cent of those who should have the test, have actually been screened. I suspect the numbers are less in Jamaica, and that's unfortunate.
DR. ISAAC A. BARTLEY
ConsultantGastroenterologist
Medical Director
Pasadena Gastroenterology
Medical Group, Inc.
Author of: 'Beyond Fear: A
Physician's Journey With
His Patient's Illness'.
Send questions and comments to our health specialists at Your Health, c/o The Gleaner, 7 North Street, Kingston; email: yourhealth@gleanerjm.com. Unless otherwise indicated, letters and the specialists' responses are usually published.
