Confusion in the Elderly -- a Life Threatening Condition Illness in the elderly is often manifested with a condition called delirium. This is an acute state of confusion presenting with drowsiness, loss of memory, fluctuating levels of consciousness and frequently hallucinations and delusions. Many …Read more. It Is Time to Receive the Influenza Vaccination -- and That Means You! Compared to the, 36,000 deaths from Influenza that occurred in 2013, the nationwide panic about Ebola is drastically overrated. We should be much more concerned by the fact that less than 50 percent of adults receive the influenza vaccine. This is a …Read more. The Role of Mammograms in Improving Breast Cancer Survival Remains Controversial Although a small city, Little Rock Arkansas, where I live, has the second-largest Race For The Cure in the country. On Saturday, thousands of women turned out in support of breast cancer. Many of the women survivors were diagnosed early thanks to …Read more. Drug Costs May Cause Our Health Care System to Implode With the advent of drug plans, fewer patients are refusing to take common medications because of cost. The problem has also declined, as more and more blockbuster drugs are now generic. But as more of these common drugs become generic, fewer …Read more.more articles
CT Scan Versus Colonoscopy: Each Has Disadvantages
Last week I saw a film starring Ricky Gervais portraying a dentist who elected to have a general anesthetic for a colonoscopy because he wanted to be quite sure that he was fully asleep while they "messed down there." Clearly, he is talking about a subject that all adults can relate to.
The process of having a colonoscopy comes with a good amount of trepidation. You have to receive a sedative to reduce discomfort during the procedure. These days a drug called Versed is frequently used. It removes any recollection of the procedure. Unfortunately, the use of sedatives and pain medications can lead to respiratory distress, nausea and throwing up and potentially fatal infections. Additional side effects can be perforation of the bowel and major bleeding.
Ricky Gervais' character and many others may be thrilled to learn that a CT scan of the colon may be as good a screening test as the colonoscopy, without the need for sedation or risks of perforation or bleeding.
In a paper published in the New England Journal of Medicine, researchers directly compared colonoscopies to a CT scan in 2,600 asymptomatic people aged 50 and over. They showed that a virtual colonography using a CT scan is able to detect benign polyps and malignant tumors greater than one centimeter (cm.) in diameter in 90 percent of cases. Based on this information, the authors believe that this test provides a viable alternative to colonoscopy.
With this new information, don't be surprised if many physicians and their patients now elect the CT scan approach to screen for colon cancer. No more humiliating thoughts of a large scope snaking up your rectum, no more risk of adverse effects from sedatives and no risk of perforation.
However, there are some serious concerns. In a companion editorial published in the Journal, Dr. Robert H. Fletcher pointed out that there were a large number of false positives. While 17 percent of patients had polyps larger than 1 centimeter, only one in four were found to have a polyp when a follow-up colonoscopy was done.
Additionally, CT scans may detect an incidental abnormality outside the colon, leading to anxiety that an undetected malignancy or other serious problem may be present. A total of 16 percent of patients in the study had a problem outside the colon that required further investigation. Fletcher points out that with the exception of identifying a large aortic aneurysm, which should ideally be screened for in other ways, there is no evidence that early detection of an asymptomatic lesion by CT scan is of any benefit. Finally, there is risk of radiation. If a CT scan is done every five years to screen for colon cancer, that radiation risk is totally unacceptable and may be unwarranted.
In my view, using a CT scan to detect colon cancer should be limited to those individuals who, for whatever reason, cannot tolerate a colonoscopy. But remember, colorectal cancer is the third most common cancer in the U.S., with more than 154,000 new cases and 52,000 deaths annually. Almost all of these deaths could be prevented if screening was done more compulsively.
So, whether you elect to do a colonoscopy or CT colonography, you must be screened for the first time at age 50. If you are perfectly normal, some believe a repeat colonoscopy should be done every five years, whereas the American Cancer Society and others recommend every 10 years. Screening should be more frequent if you have had polyps or cancer diagnosed in the past, have a strong family history of colon cancer, particularly if it occurs at a younger age, or if you or someone in your family has been diagnosed with chronic inflammatory bowel disease (ulcerative colitis or Crohn's disease). In addition everyone should have their stool screened for microscopic amounts of blood (fecal occult blood test) every year. Follow this approach and you will virtually eliminate your risk of dying from this cancer.
Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.
COPYRIGHT 2008 CREATORS SYNDICATE INC.