CANCER IS a dreaded word, especially for people age 50 or older. But one form of the disease, the colorectal variety, usually can be beaten with the help of a comprehensive, albeit unpleasant, procedure. A new American Cancer Society report endorses a variant on the test that should make colon cancer screening appealing to many more people.
The procedure with the bad reputation is the colonoscopy, in which a tube is inserted into a patient's colon to search for and remove cancerous or pre-cancerous polyps. No test is perfect, but this one offers excellent prospects for preventing or curing a cancer that kills 49,960 people in this country every year.
The test has grown in popularity over the last decade but lacks full acceptance by the public. One reason is the arduous preparation. People have to fast for a day or more, and purge their systems with laxatives, then undergo the procedure under sedation, which takes another day. Another obstacle is a general ick factor. The idea of the procedure makes some people uneasy.
The new report affirms that even though the colonoscopy is not a perfect cancer detective, it is superior to less intrusive tests such as stool samples. Another report, in the Journal of the American Medical Association, warned last week that physicians have not been watchful enough for a certain type of lesion. But this report doesn't lessen the urgency for everyone 50 and over to get the test.
Millions of Americans don't want to undergo the two-day regimen, and here the American Cancer Society report offers an alternative. The report was done in conjunction with the US Multi-Society Task Force on Colorectal Cancer, composed primarily of gastroenterologists, who do colonoscopies, and the American College of Radiology.
The radiologists have their own procedure - the computed tomographic colonography (CTC), or virtual colonoscopy. It uses X-rays and computers to produce multiple images of the inside of the colon. The virtual colonoscopy requires a day-long fast and colon purge, but the procedure takes only a few minutes without sedation. If a polyp is found, the patient still has to get a regular colonoscopy to have it removed.
"It's safe and cheaper," said Dr. Michael Zalis, director of CT Colonography at Massachusetts General Hospital. But the price hasn't been set yet. Insurance companies generally cover the regular kind, but not the virtual colonoscopy. And while the report is carefully worded to reflect the different perspectives of radiologists and gastroenterologists, regular colonoscopies still seem to have the edge for their comprehensiveness.
But if millions of people continue to shun them, the virtual option is much better than nothing. Both kinds should be covered by insurance to spare older Americans the ordeal of the advanced form of the disease.
