Racism and Discrimination in Health Care The highly influential New England Journal of Medicine published a series of perspectives on racial bias in health care. Dr. Mary Bassett, New York City's health commissioner, suggested that the medical community should not only do more to improve …Read more. When Is an Older Driver a Danger on the Road? Telling an older person he should no longer drive is difficult. This can be a devastating blow to the patient, who may resist the suggestion vigorously. No longer being able to drive takes away one's independence and increases isolation, depression, …Read more. Priorities in Lowering the Risk of Heart Disease Heart disease is the leading cause of death in the developed world. Although occurring at a later age, heart disease is just as common in women as in men. Despite this fact, fewer than 1 in 5 women believe that heart disease is a significant health …Read more. Being Your Parent's Parent Is Difficult But Potentially Rewarding I truly miss my mother, who died 18 months ago, at age 90. She was the quintessential Jewish mother and an expert at guilt. When I phoned her in South Africa, I didn't just say hello; I also said I'm sorry. I had almost always done something wrong. …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.