Can Virtual Colonoscopies Be a Reality for Population Screening?

Research scientists in Italy, in an attempt to identify the most optimal method for colon cancer screening, compared different screening methods for colorectal cancer. The study found that ease of preparation prior to the screening test is an important determinant of screening uptake.

For the study, more than 16,000 subjects between 54 and 65 years of age were randomly assigned to 1 of 4 different screening methods:

• reduced cathartic preparation CT colonography (r-CTC)
• full cathartic preparation CT colonography (f-CTC)
• fecal immunochemical test (FIT)
• optical colonoscopy (OC)

Patients who tested positive to FIT or CTC were referred to OC work-up. The primary outcomes measured were participation rate (PR) and detection rate (DR) for cancer or advanced melanoma.

The study found that PR were 50.4% for first-round FIT, 28.1% for r-CTC, 25.2% for f-CTC, and 14.8% for OC, with statistically significant differences between the groups. For advanced neoplasia, DRs were 1.7% for first-round FIT, 5.5% for r-CTC, 4.9% for f-CTC, and 7.2% for OC, with statistically significant differences between CTC and FIT groups, but not between r-CTC and f-CTC groups.

Based on these results, the authors concluded that reduced preparation requirements might be the key to increased participation observed with CTC, and that could make the method an ideal tool for population screening for colorectal cancer (CRC).

Commenting on the study in an accompanying editorial in the same issue, Ernst J. Kuipers, MD, PhD, and Manon C. W. Spaander, MD, PhD, Department of Gastroenterology and Hepatology, Erasmus University Medical Center, write that while no single screening method has been proven to be better than the other, follow-up to the screening is essential, which makes the current study important in combatting CRC. Ease of preparation for the CTC screening test might be the answer to improving acceptance by the population, they write.