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Virtual Colonoscopy Gains in Popularity. Is It Right for You?

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2 Star

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Virtual Colonoscopy Gains in Popularity. Is It Right for You?

Our Review Summary

The story attempts to provide information about a recently published survey of hospitals noting that 17% now offer CT colonoscopy, up from 14% 3 years prior. Why is that important? Is that number high or low? The headline suggests that the method is gaining, but up 3% is hardly an overwhelming response.

We also think the story missed an opportunity since it could have provided readers with more information about who is potentially best served by the virtual test. Elderly, frail patients who cannot undergo both the bowel prep and sedation are prime candidates. If you are going to ask readers a question – “Is It Right For You?” –  you should give them enough information to come up with an educated answer.

 

Why This Matters

Colonoscopy is not the only colon cancer screening option.  And the somewhat growing popularity of the virtual colonoscopy approach should not push it to the top of the list of considerations.

When this story ends with “it’s a matter of personal preference – it’s less important how you get screened, just that you do get screened” – it wraps up without giving readers the complete list of choices they should consider.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

No discussion of cost except a vague line about “the relatively low cost of investing in the software and other equipment.” But nothing on the patient charges.  For a story headlined, “Is It Right For You?” this would seem to be important.

And the discussion of Medicare coverage is wrong when it says that the US Preventive Services Task Force concluded the evidence “wasn’t strong enough to justify Medicare coverage.”  The USPSTF concluded  that the evidence is insufficient to assess the benefits and harms of computed tomographic colonography and fecal DNA testing as screening modalities for colorectal cancer.” What Medicare chooses to do is its decision – not that of the USPSTF.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

No quantification of benefit.  And no adequate comparison with other colon cancer screening techniques.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story states that virtual colonoscopy “involves exposure to a small amount of radiation. But according to Dr. Marc Gollub, director of CT and gastrointestinal radiology at Memorial Sloan-Kettering Cancer Center, “the radiation is much lower than a regular CT scan and has not been proven to be of any risk. It’s similar to [the exposure from cosmic radiation] you might get on a long airplane flight.”

The USPSTF states: “Radiation exposure resulting from CT colonography is reported to be 10 mSv per examination. The harms of radiation at this dose are not certain, but the linear no-threshold model predicts that 1 additional individual per 1000 would develop cancer in his or her lifetime at this level of exposure. The lifetime cumulative radiation risk from the use of CT colonography to screen for colorectal cancer should be considered in the context of the growing cumulative radiation exposure from the use of other diagnostic and screening tests that involve radiation exposure. On the other hand, improvements in CT colonography technology and practice are lowering this radiation dose.”

We think that broader context should have been provided to readers.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

Insufficient.  We only get a line about “growing body of data” suggesting that virtual colonoscopy is as sensitive as colonoscopy.  But no details are given.  There are reasons why some experts say the evidence is insufficient.  What are they?

Does the story commit disease-mongering?

Satisfactory

No overt disease mongering.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

Quotes only one expert in the story – a director of a CT center.

While the story discusses what unnamed skeptics say, we should have heard from some directly to balance the story.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story creates a false dichotomy – as if screening is a choice between regular colonoscopy or CT colonoscopy.  And it inaccurately states that “the American Cancer Society, the American College of Physicians and other gastroenterology experts recommend virtual screening every five years.”  That is not, for example, what the American Cancer Society recommends.

On the ACS website, a range of choices are presented – not just virtual colonoscopy – making the story’s statement misleading at best.  The ACS website states:

Beginning at age 50, both men and women should follow one of these testing schedules:

Tests that find polyps and cancer

  • Flexible sigmoidoscopy every 5 years, or
  • Colonoscopy every 10 years, or
  • Double-contrast barium enema every 5 years, or
  • CT colonography (virtual colonoscopy) every 5 years

And it’s odd that the story never mentioned a new statement by the American College of Obstetricians and Gynecologists reminding women that they have a range of screening options including high-sensitivity guaiac fecal occult blood test or fecal immunochemical test.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story is based on estimates of the rising use of virtual colonoscopy and cites one estimate that 17% of US hospials now offer it. The story suggests that the availability of CT colonoscopy is “on the rise.” In reality the study in question actually demonstrated only a 3% increase over a 3 year period.  Is that high or low?

Does the story establish the true novelty of the approach?

Satisfactory

The story adequately frames the growing use of this technology.

Does the story appear to rely solely or largely on a news release?

Satisfactory

Does not appear to rely on a news release.

Total Score: 4 of 10 Satisfactory

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