Radiology in Global Health by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783319984858
Publisher: Springer International Publishing

CT Colonography for Colorectal Cancer Screening

With more than 1.2 million new cases and 600,000 deaths, colorectal cancer is the second and third most commonly diagnosed cancer in females and males, respectively [22]. The significant higher incidence and mortality in developed countries than in the developing ones have suggested the importance of dietary and environmental exposures [48, 49].

Endoscopic screening with flexible sigmoidoscopy or colonoscopy has been widely regarded as the standard for detection of colorectal tumors [50]. Although it offers some advantages including instant removal of adenomatous polyps—the precursor lesions of colorectal cancer —it does not comply with many of the criteria for a screening test as it is not simple, it is expensive, and it requires highly trained clinicians for its application [51]. In addition, a number of disadvantages such as the need for full bowel cleansing, aggressive nature of the procedure, and possible complications such as bleeding and perforation do exist.

Computed tomography (CT) colonography was introduced partly to overcome some of those limitations [52]. With insufficient evidence to assess the benefits and harms, CT colonography has not been recommended in the United States [50]. However, more supporting evidence has been released, and its use for mass population screening is promising. For instance, Johnson et al. acquired CT colonographic images of 2600 asymptomatic adults and reported 90% sensitivity for detecting a 10-mm lesion [53]. A population-based screening study in the Netherlands reported that both CT colonography and colonoscopy can be used, but participation in CT colonography is better [54]. CT colonography can also be used for evaluation of the colon after an incomplete conventional colonography [55]. This is a very good example of how a feasibility concern from the public health perspective plays relatively more of a role than the technical aspect of a medical intervention.

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