Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology.

In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer. CRC largely can be prevented by the detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized. In 2006 to 2007, the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average-risk adults. In this update of each organization's guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy. When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that primarily is effective at early cancer detection and a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps. It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening.

Incidental findings in CT colonography: literature review and survey of current research practice.

Incidental findings (IFs) of potential medical significance are seen in approximately 5-8 percent of asymptomatic subjects and 16 percent of symptomatic subjects participating in large computed tomography (CT) colonography (CTC) studies, with the incidence varying further by CT acquisition technique. While most CTC research programs have a well-defined plan to detect and disclose IFs, such plans are largely communicated only verbally. Written consent documents should also inform subjects of how IFs of potential medical significance will be detected and reported in CTC research studies.

Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology.

In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer. CRC largely can be prevented by the detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized. In 2006 to 2007, the American Cancer Society, the US Multi Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average-risk adults. In this update of each organization's guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy. When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps and a screening test that primarily is effective at early cancer detection. It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening.

National and local trends in CT colonography reimbursement: past, present, and future.

Computed tomographic colonography (CTC) was first introduced in the mid-1990s as a minimally invasive technology for colorectal cancer screening. Given its potential to significantly change colorectal cancer screening practices in the United States, it has attracted widespread multidisciplinary interest among radiologists, gastroenterologists, colorectal surgeons, and primary care physicians. Because of its potential for widespread utilization and the potential associated costs, it has also attracted much scrutiny from payers. The authors discuss the coding and reimbursement history of CTC, outline strategies for obtaining local coverage for CTC, and attempt to outline some of the possible future influences on CTC reimbursement.

AGA future trends report: CT colonography.

BACKGROUND & AIMS: Computed tomographic colonography (CTC) was first described more than a decade ago. Recent advances in imaging hardware and software and results of clinical trials based on new methods for performing and interpreting images suggest that CTC may now be assessed as a method for colorectal cancer screening. METHODS: The Research Policy Committee of the American Gastroenterological Association assembled a task force to review the results of recent clinical trials and quantitative mathematical models pertaining to CTC. The goal of the task force was to assess the current knowledge about CTC and to evaluate the issues that will define its impact. RESULTS: Limitations in evaluating the current state of CTC technology include a wide variation in results of clinical trials. There are as yet insufficient data on the use of CTC in routine clinical practice. Limitations in the use of quantitative mathematical models make predictions based on such models of limited value. The cancer risk and therefore clinical importance of small colorectal polyps detected by CTC and/or nonpolypoid neoplasia not detected by CTC remains largely unknown. CONCLUSIONS: CTC is attractive as a colon imaging modality. It is therefore anticipated that CTC will have a significant impact on the practice of gastroenterology. However, the magnitude of the impact is currently unknown. Whether the ongoing implementation of CTC will increase or decrease the number of referrals for colonoscopy or shift the procedure from colorectal cancer screening to therapeutic interventions (e.g., polypectomy) is unknown at the present time. Multidisciplinary collaboration between gastroenterology and radiology to promote effective implementation and ongoing quality assurance will be important.