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14 November 2007
Dear Reader,
A friend of mine named Charles (who's nearing his 60th birthday) recently
mentioned that he's planning his second tubing expedition.
"Tubing" is his metaphor for "colonoscopy." When you allow doctors to sedate
you
and insert a camera where no ray of sunshine ever falls, it helps to have a
sense of humour about it.
But according to a new study, Charles may not need to go tubing because a
tube-
free method might work just as well. No tube sounds promising, but is this
alternative screening technique really preferable?
**************************
Double jeopardy
**************************
For more than three decades, optical colonoscopy (OC) has been the primary
method of colon cancer screening. But an alternative method called computed
tomographic
colonography (CTC) has been developed over the past few years. This method
is
also known as "virtual colonoscopy" because it's minimally invasive,
requiring a
catheter to be inserted into the rectum to fill the colon with air, followed
by
noninvasive optical scan.
Obviously neither method is a day at the beach, but is CTC as effective as
OC?
That's the question US researchers at the University of Wisconsin Medical
School set
out to answer with a study that was published earlier this month in the New
England
Journal of Medicine.
STUDY PROFILE
* The UW team compared screening results from 3,163 patients who underwent
traditional colonoscopy to the results from 3,120 patients who were examined
with the CTC technique
* In the CTC screening, 123 advanced tumours were found, compared to 121 in
the OC group
* Total polyps removed in the CTC group: 561
* Total polyps removed in the OC group: 2,434
* Seven perforations of the colon occurred in the OC group compared to none
in the CTC group
Researchers concluded: "These findings support the use of CTC as a primary
screening test before therapeutic OC."
The risk of a perforated colon is a clear drawback for traditional
colonoscopy,
but let's take another look at two of those bullet points regarding the
total polyps
removed. Those numbers are so lopsided because all polyps are routinely
removed
on the spot during OC, but when polyps were detected in the CTC group,
patients
were given the option of leaving very small polyps in place or undergoing an
additional OC procedure to remove the polyps.
Tiny polyps may never become a problem, but with OC there's no question -
the
polyps are removed. And this is a clear advantage of traditional
colonoscopy. In
the UW study, about eight percent of the patients underwent follow-up OC
after
undergoing CTC.
********************************
Balloon animal
********************************
Virtual colonoscopy is generally referred to as "noninvasive." But as noted
above, there's an invasive moment when air is pumped into the colon by
catheter. Given
the choice between air and a tube, most people would probably choose air.
But I know
of at least one patient who wouldn't recommend filling the colon with air.
In an e-Alert I sent you about two years ago, an HSI member shared a
friend's
account of a CTC procedure: "I thought I was going to just have a CT scan.
NO,
NO.
You have to pump yourself up with air so that they can take the pictures.
Filling yourself up with air is undescribable. I thought I was going to blow
off the
bed. It takes 7 minutes all told but it was the longest 7 minutes I have
ever gone
through.
"It has been one week since the test and my stomach is still very large and
hard. I am sure that there is still air in there. God knows how long this
lasts. It also
makes it difficult to eat as you feel full very quickly. So all I can say is
never, never
again would I do this."
Now that I've completely scared everyone away from considering CTC, it
should be
noted that this procedure may have an unexpected benefit that OC doesn't
provide.
According to a HealthDay report about a 2005 study of 500 patients who
underwent
CTC, in more than half the cases doctors discovered other health issues that
were unrelated to the colon - problems such as lesions, masses in solid
organs, and
large aneurysms.
If you're due for a colon screening, talk to your doctor about the pros and
cons
of the CTC and OC techniques.
***************************
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...and another thing
***************************
According to the most comprehensive international scientific study carried
out
to date, more than a third of cancers are caused by simple, preventable
factors including
insufficient exercise and poor diet.
Research indicated that being even slightly overweight was found to increase
the
risk of a range of common cancers including breast, bowel and pancreatic
cancer. The
largest review of links between diet and cancer, incorporating more than
7,000 studies,
concludes that there is convincing evidence that excess body fat can cause
at
least six different types of the disease.
Until tomorrow,
Rachael
UK Editor
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Sources:
"CT Colonography Versus Colonoscopy for the Detection of Advanced Neoplasia"
New
England Journal of Medicine, Vol. 357, No. 14, 10/4/07, content.nejm.org
"Another Battle Won" The Associated Press, 9/15/07, ap.org
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