Colonoscopy: Boldly going ... virtual

A colonoscopy, one of the most dreaded routine medical procedures, is a type of cancer screening where physicians use a flexible tube mounted with a camera to view the interior of the colon for cancerous polyps. Most people are sedated during a colonoscopy; and according to the American Cancer Society, people complain more about the pre-screening preparation than any pain during (because they are sedated) or after the examination. The Center for Disease Control recommends that after the age of 50, everyone receive a colonoscopy every ten years. However, for men and women alike, colonoscopies are a stressful event, and people tend to avoid them until they have some other signs of cancer. Unfortunately for test avoiders, colorectal cancer is the second leading cause of cancer death in the United States and new research is making colonoscopies seem even more important.

The research led by Ann G. Zauber at Memorial Sloan-Kettering Cancer Center looked at the long-term results of over 2,602 patients who had precancerous polyps removed while enrolled in the National Polyp Study. The researchers found that patients who had the precancerous polyps removed had 53 percent less chance of colorectal cancer mortality than people in the general population. Moreover, the same patients retained these lower death rates for up to 10 years.

This research is important because it is the first major study to demonstrate that colonoscopies not only prevent cancer but prevent death.  Researchers in Spain are also trying to determine if there are cheaper alternatives to colonoscopies, but in the first round of testing, the researchers have found that colonoscopies uncovered about twice as many advanced adenomas than a much cheaper stool sample test. So the research suggests that colonoscopies are a useful tool to detect cancer and prevent cancer death with few major complications. The downside is that they are expensive (around $1,000) and invasive.

Of course, people should get screened, but it is not the expense that is keeping most people away. It is the incredibly invasive and embarrassing nature of colonoscopies. No one wants a camera in their rectum -- no one. Luckily, there is an advance in the screening of precancerous polyps that will make it somewhat less invasive – virtual colonoscopies.

Virtual colonoscopies are basically a colonoscopy that is conducted with computed tomography (CT) or magnetic resonance imaging (MRI) scans. Virtual colonoscopies have the benefit of allowing a physician to check your colon without the use of a camera or sedation. Virtual colonoscopies are also faster than traditional colonoscopies, and they allow physicians to view the colons of patients with abnormal growths or inflammation that could prevent or hinder traditional colonoscopy methods.

However, virtual colonoscopies are not the prefect replacement. The patient still needs to conduct the pre-screening ritual diet that so many people hate and the machines generally cannot detect polyps less than 10 millimeters. For most people, health insurance will not cover the cost of a virtual colonoscopy, and the MRI scan can be more expensive. Unfortunately for everyone, a tube will still be inserted into the patient’s rectum to fill the large intestines with air or a contrasting agent -- though the tube is much smaller and does not pass through the entire colon. Also, if the virtual screening finds anything, a traditional colonoscopy will still need to be performed.

Yet with all the downsides, virtual colonoscopy is still faster, cheaper and less invasive. If health insurance would cover the cost of a virtual colonoscopy (which is reportedly cheaper), doctors believe more patients would seek colorectal cancer screening. This would save lives. Another reason for health insurance to cover the cost of virtual colonoscopies is that virtual colonoscopies perform as well as traditional colonoscopies in detecting polyps in both middle aged and older individuals.

Currently, unless you want to pay out of pocket, you will be unable to get a virtual colonoscopy. Yet virtual colonoscopy use is spreading, and more research is proving that it is often a faster and safer alternative to traditional colonoscopies. It should be very soon when all colonoscopies are virtual until polyps are found.