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Colonoscopy or CT colonography for colorectal cancer screening in 2006?

Nature Clinical Practice Gastroenterology & Hepatology volume 3, pages 296–297 (2006)Cite this article

Colorectal cancer (CRC) is the second leading cause of cancer-related death in the US, claiming >50,000 lives there annually. The vast majority of CRCs arise from readily identifiable precursor lesions, namely adenomatous polyps in the colon. Screening for CRC, with the removal of polyps where present, will have a significant impact on the death rate from this largely preventable cancer. Data published in 2000, indicating that screening with flexible sigmoidoscopy misses >50% of proximal neoplastic colonic lesions,1 has led to consensus amongst gastroenterologists that complete colonic examination with colonoscopy is the most effective and desirable screening option. In addition to being the most effective screening modality for CRC, colonoscopy also offers the singular advantage of allowing both the detection and removal of polyps during the same procedure.

The main drawback of colonoscopy is its invasive nature, which carries an inherent risk of complications, albeit a small one. Data indicate that, for the purely diagnostic part of the procedure, the complication rate is very small. Nelson et al. recorded no perforations of the colon or deaths in >3,000 screening colonoscopies, and bleeding was only noted in a small number of patients who underwent polypectomy.2 Another drawback of colonoscopy is the negative perception of the procedure by patients, largely caused by anxiety about possible discomfort related to the procedure, and poor acceptability of the bowel preparation process. The most pressing issue, however, might be the lack of endoscopic capacity at this time to support CRC screening by colonoscopy alone.3 An alternative CRC screening modality that is accurate, safe, cost-effective, and more acceptable to patients is therefore desirable. CT colonography (CTC) is an evolving imaging modality and a promising alternative, but does it meet all of these criteria?

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Authors and Affiliations

  1. Assistant Professor of Medicine and Director of Biliary Endoscopy,

    Subhas Banerjee & Jacques Van Dam

  2. Professor of Medicine, Director of Endoscopy, and Clinical Chief of the Division of Gastroenterology and Hepatology at the Stanford University School of Medicine, Stanford, CA, USA

    Subhas Banerjee & Jacques Van Dam

Authors
  1. Subhas Banerjee
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  2. Jacques Van Dam
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Correspondence to Subhas Banerjee.

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The authors declare no competing financial interests.

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Banerjee, S., Van Dam, J. Colonoscopy or CT colonography for colorectal cancer screening in 2006?. Nat Rev Gastroenterol Hepatol 3, 296–297 (2006). https://doi.org/10.1038/ncpgasthep0502

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