What reporters missed at the NIH colon CA screening state-of-the-science conference

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This week the National Institutes of Health convened an “NIH State-of-the-Science Conference on Enhancing Use and Quality of Colorectal Cancer Screening.

The only story I could find on it was in the Columbus Dispatch.

But I’ve seen no news coverage about what a friend who attended the conference reported to me.

I’ve now verified with various attendees that there were clear new signs of the turf war between gastroenterologists – keepers of the traditional colonoscopy approach – and radiologists – who are more inclined to favor the new kid “virtual colonoscopy.”

More than just “inside baseball” about “inside your colon,” this is another war over evidence in health care.

The NIH panel was not charged with judging the relative value of different colon cancer screening methods.

But it sounds like some of the parties who attended had a different expectation and so the conference they got was not the conference they wanted.

I’m told that radiologists were upset – demanding at least more recognition of the benefits of virtual colonoscopy (or CT colonography) if not a downright endorsement. Some stated their disapproval of the U.S. Preventive Services Task Force statement that “the evidence is insufficient to assess the benefits and harms of computed tomographic colonography (ed. note: and fecal DNA testing, for that matter).” And they’re upset about the subsequent decision by the Center for Medicare & Medicaid Services not to cover the newer test.

Radiologists wanted more recognition of the large American College of Radiology Imaging Network trial.

I’m told that there were several radiologists who got up and basically screamed at the panel members for being in the “dark ages”. They cited the American Cancer Society recommendations that conflict with the USPSTF on the virtual colonoscopy and also evoked what they called the “mammography disaster,” referring to the USPSTF mammography recommendations released last November – another time the USPSTF and Cancer Society disagreed.

One of the speakers at the NIH conference said that the Cancer Society does not use a formal process for evaluating the evidence, does not provide details about how they come to their conclusions and includes only sub-specialists on their panel – raising questions about conflict of interest in their recommendations.

So even though that’s not what the meeting was about, there was scuffling over screening method vs. screening method, turf wars, and conflict of interest in the setting of guidelines or recommendations.

So this one isn’t over.

And it’s difficult to understand why this didn’t get news coverage. It sure sounded newsworthy to me.

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February 5, 2010 at 2:08 pm

I agree the information is newsworthy. However, I have some concerns about your unnamed NIH speaker who raised questions about ACS screening guidelines and the process for evaluation the evidence.
You give credence to a baseless statement made by the unnamed NIH speaker re: the evaluation of evidence by the ACS panel. The point about including only sub-specialists also misses the mark.
I encourage you to link to the following URL for more information on the CRC screening guidelines.

Gary Schwitzer

February 5, 2010 at 2:36 pm

Thanks for your comments.
This post, as written, gives no more credence to what one speaker said than it does to what others said about the NIH panel being “in the dark ages” or referring to “the mammography disaster.” Some would say those were baseless, off the mark comments as well.
My point, at the beginning, at the end, and throughout, is to give a sense of the temperature of the room – as told to me my several who were there – and to question why journalists weren’t there to capture it and explore further.
So I’m pleased to see that you agree with me that this was, indeed, newsworthy.


February 8, 2010 at 6:08 pm

I think you got it right. I was there, and the radiologists were on the warpath. Their agenda was not what the meeting was about, though. The criticisms of ACS were fair. It is surprising that there was not more press coverage. Discussing why people may not choose to be screened is less sexy than discussing the latest technology.