Virtual colonoscopy as effective at colon cancer screening as standard invasive colonoscopy, SFVAMC

By Kevin Boyd

Many older adults dread colon cancer screening, because the most effective
screening tool, colonoscopy, is uncomfortable and invasive.  A new study from
San Francisco Veterans Affairs Medical Center shows that a faster, safer, and
potentially more pleasant technique works just as well.  The so-called virtual
colonoscopy uses a CT scan to search for pre-cancerous polyps. 

The new study compared the virtual technique to standard colonoscopy, which
involves snaking a long tube-shaped camera through the length of the colon. 

“Since this technique requires no anesthesia, has a no risk of complications
from perforation or bleeding, and may be better tolerated by patients we hope
that it will increase the number of people willing to come in for screening,”
said lead author Judy Yee, MD, UCSF assistant professor of radiology and chief
of CT and gastrointestinal radiology at SFVAMC.  The vast majority of colon
cancers are treatable if detected at an early stage, she added.

Although colon cancer is the number two cancer killer in the US, less than 40
percent of the adults who are eligible for screening actually get it, Yee
said.  The American Cancer Society recommends colon cancer screening for anyone
age 50 or older, and for younger people who have a family history of the

Among the 300 patients in Yee’s study, the largest series published so far,
virtual colonoscopy identified 90 percent of the large polyps found using
regular colonoscopy.  Only polyps 10 millimeters in diameter or larger are
considered clinically significant with a greater potential to develop into a

More importantly, virtual colonoscopy identified every patient with clinically
significant polyps, Yee said.

Once a potentially problematic lesion is identified by virtual colonoscopy a
patient must then undergo a standard colonoscopy.  During this exam a biopsy
may be performed to give a clearer picture of whether or not the polyps might
be cancerous, Yee said.

The study was published in the June, 2001 issue of the journal Radiology.

In addition to its effectiveness at discovering colon cancer, virtual
colonoscopy can also detect diseases and problems in other organs.  The CT scan
creates an image of the entire lower abdominal area, so radiologists can find
problems such as kidney cancer, aneurysms in the aorta, and even lung cancers
near the bottom of the lungs.

Virtual colonoscopy is also faster for the patient than traditional screening. 
Whereas standard colonoscopy can take between 30 minutes to one hour, not
including time required to recover from sedatives, the CT scan takes roughly a
minute to perform, Yee said. 

Once collected, the data is transmitted via fiber-optic cable to a workstation
equipped with specialized analysis software, which can create 3D images of the
interior surface of the colon, and highlight some of the parts of the colon
where a polyp is likely to exist.  The radiologist can rotate the images, zoom
in and out, and even create movie loops that look like a trip through the
inside of the colon. 

But the time required for analysis is one of the major drawbacks for virtual
colonoscopy, Yee said.  “Until we have more advanced software that decreases
the analysis time from 30 minutes to about 10 minutes, it’s unlikely that HMO’s
and other health care payors will be willing to add this as a covered expense,”
she said.

Yee is currently working on a three-way comparison of virtual colonoscopy with
barium enema (another popular screening technique), and traditional
colonoscopy, with Duke University that is funded by the National Institutes of

Co-authors on the newly published study included: Geetanjali Akerkar, MD, staff
gastroenterologist at SFVAMC; Kenneth McQuaid, MD, UCSF associate professor of
gastroenterology and SFVAMC gastroenterologist; Raymond Hung, MD, UCSF/SFVAMC
radiology fellow; Andreas Steinauer-Gebauer, MD, UCSF/SFVAMC radiology fellow;
Susan Wall, MD, UCSF professor of radiology and SFVAMC radiologist.

The work was supported by grants from the UCSF Department of Radiology, as well
as vendor grants, which were managed by Northern California Institute for
Research and Education (NCIRE). 

NCIRE is one of the fastest growing medical research groups in the nation. 
Founded in 1988, NCIRE now manages more than $30 million in funding from
organizations such as the National Institutes of Health, the National
Aeronautics and Space Administration, and the National Science Foundation. 
Based at the San Francisco VA Medical Center, NCIRE is the largest of the 80
congressionally authorized VA research corporations.

The San Francisco Veterans Affairs Medical Center has been a primary affiliate
of University of California, San Francisco since 1974.  The UCSF School of
Medicine and the SFVAMC collaborate to provide education and training programs
for medical students and residents at SFVAMC.  SFVAMC maintains full
responsibility for patient care and facility management of the medical center. 
Physicians at SFVAMC are employed by the Department of Veterans Affairs and
also hold UCSF faculty appointments.