CT Colonography: Accuracy, Acceptance, and Safety
CT Colonography: Accuracy, Acceptance, and Safety
Colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-related deaths in Europe. The introduction of CRC screening programmes using stool tests and flexible sigmoidoscopy, have been shown to reduce CRC-related mortality substantially. In several European countries, population-based CRC screening programmes are ongoing or being rolled out. Stool tests like faecal occult blood testing are non-invasive and simple to perform, but are primarily designed to detect early invasive cancer. More invasive tests like colonoscopy and CT colonography (CTC) aim at accurately detecting both CRC and cancer precursors, thus providing for cancer prevention. This review focuses on the accuracy, acceptance and safety of CTC as a CRC screening technique and on the current position of CTC in organised population screening. Based on the detection characteristics and acceptability of CTC screening, it might be a viable screening test. The potential disadvantage of radiation exposure is probably overemphasised, especially with newer technology. At this time-point, it is not entirely clear whether the detection of extracolonic findings at CTC is of net benefit and is cost effective, but with responsible handling, this may be the case. Future efforts will seek to further improve the technique, refine appropriate diagnostic algorithms and study cost-effectiveness.
Colorectal cancer (CRC)-related mortality can be reduced by the implementation of CRC screening programmes as has been demonstrated for stool tests (16%) and flexible sigmoidoscopy (FS, 22%–31%). Randomised trials on the effectiveness of colonoscopy are ongoing, and first results will not be available before 2020. Stool tests, like faecal occult blood testing (FOBT), are non-invasive and simple to perform, but are primarily designed to detect early invasive cancer. More invasive tests, like colonoscopy, aim at accurately detecting both CRC and cancer precursors (ie, advanced adenomas) as well, thus providing for cancer prevention. CT colonography (CTC) has been introduced as a full colon examination similar to colonoscopy but is less invasive. For both colonoscopy and CTC—being full colon evaluation techniques with direct visualisation of target lesions—it is highly plausible that both colonoscopy and CTC screening would result in a further decrease of CRC-related mortality compared with stool-based tests and sigmoidoscopy. Many aspects of CTC have been extensively studied. This review focuses on the accuracy, acceptance and safety of CTC as a CRC screening technique and on the current position of CTC in organised population screening.
Abstract and Introduction
Abstract
Colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-related deaths in Europe. The introduction of CRC screening programmes using stool tests and flexible sigmoidoscopy, have been shown to reduce CRC-related mortality substantially. In several European countries, population-based CRC screening programmes are ongoing or being rolled out. Stool tests like faecal occult blood testing are non-invasive and simple to perform, but are primarily designed to detect early invasive cancer. More invasive tests like colonoscopy and CT colonography (CTC) aim at accurately detecting both CRC and cancer precursors, thus providing for cancer prevention. This review focuses on the accuracy, acceptance and safety of CTC as a CRC screening technique and on the current position of CTC in organised population screening. Based on the detection characteristics and acceptability of CTC screening, it might be a viable screening test. The potential disadvantage of radiation exposure is probably overemphasised, especially with newer technology. At this time-point, it is not entirely clear whether the detection of extracolonic findings at CTC is of net benefit and is cost effective, but with responsible handling, this may be the case. Future efforts will seek to further improve the technique, refine appropriate diagnostic algorithms and study cost-effectiveness.
Introduction
Colorectal cancer (CRC)-related mortality can be reduced by the implementation of CRC screening programmes as has been demonstrated for stool tests (16%) and flexible sigmoidoscopy (FS, 22%–31%). Randomised trials on the effectiveness of colonoscopy are ongoing, and first results will not be available before 2020. Stool tests, like faecal occult blood testing (FOBT), are non-invasive and simple to perform, but are primarily designed to detect early invasive cancer. More invasive tests, like colonoscopy, aim at accurately detecting both CRC and cancer precursors (ie, advanced adenomas) as well, thus providing for cancer prevention. CT colonography (CTC) has been introduced as a full colon examination similar to colonoscopy but is less invasive. For both colonoscopy and CTC—being full colon evaluation techniques with direct visualisation of target lesions—it is highly plausible that both colonoscopy and CTC screening would result in a further decrease of CRC-related mortality compared with stool-based tests and sigmoidoscopy. Many aspects of CTC have been extensively studied. This review focuses on the accuracy, acceptance and safety of CTC as a CRC screening technique and on the current position of CTC in organised population screening.
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