Frequently Asked Questions: For Primary Care Providers
Patients / Primary Care Providers / GI Physicians / Payors
Why Colorectal Cancer screening important for your patients? Colorectal Cancer (CRC) is the second leading cause of cancer deaths
(2007 estimate: 52,000), and the third leading cause of new cancers
(2007 estimate: 154,000) in the US. The American Cancer Society states
that as many as 90% of all CRC cases and deaths are preventable
with early detection through timely screening. Tragically, less than 50%
of the eligible population in the US gets appropriate testing for CRC.
Therefore, tens of thousands of Americans are dying needlessly from
CRC every year.
[top of this page] What is the Mission/Philosophy of Colon Health Centers (CHC) of America? We at CHC America are passionate in our quest to eliminate CRC in Americans.
While it is estimated that as many as 90% of CRC deaths could be avoided
by appropriate screening, tragically, fewer than half of Americans are
getting screened. Tens of thousands of Americans are dying needlessly
from CRC every year in this country. Plainly stated, the American healthcare
system is failing miserably with respect to CRC screening. This reality
is simply unacceptable.
The mission of CHC America is to change this tragic reality by revolutionizing
the way we screen for CRC in this country. Our goal is to screen every
American for CRC and we will not rest until this is accomplished. We
believe that if CRC screening is made simple, convenient, comprehensive,
and noninvasive, many more Americans will get appropriate screening.
The innovative strategy of CHC America, bringing together the two best
Colon Caner screening methods, Virtual Colonoscopy and traditional colonoscopy,
and allowing patients to benefit from the advantages of both, accomplishes
the need to make screening simple, convenient, comprehensive, and noninvasive.
Satisfied patients mean more patients screened, which means more CRCs
prevented. This is the driving philosophy and passion behind CHC America's
strategy.
[top of this page] Who should be screened for Colorectal Cancer (CRC)? The American Cancer Society (ACS) recommends that average-risk adults
should begin CRC screening at the age of 50 years and to continue periodically
throughout life. Among the reasons for an earlier start for screening
include a patient who is at higher than average risk for CRC.
The ACS defines higher than average risk as:
- individuals with a
history of adenomatous polyps;
- individuals with a personal history
of curative-intent resection of colorectal cancer;
- individuals with
a family history of either colorectal cancer or colorectal adenomas
diagnosed in a first-degree relative before age 60 years;
- individuals at significantly
higher risk due to a history of inflammatory bowel disease of significant
duration; or
- individuals at significantly higher risk due to a known
or suspected presence of one of two hereditary syndromes, specifically,
hereditary nonpolyposis colon cancer (HNPCC) or familial adenomatous
polyposis (FAP).
The intervals for subsequent screening depend on the patient's history
and the results of their initial screening.
[top of this page] What are the options available for CRC screening? Current medical guidelines can often lag several years behind medical
research. As of July 2007, there are four officially recommended methods
for CRC screening:
- Fecal occult blood test (FOBT)
- Flexible Sigmoidoscopy (Flex Sig)
- Double-contrast barium enema: (DCBE)
- Traditional (optical) Colonoscopy (OC)
While all four of these tests are "recommended" by the major
medical guidelines, only traditional colonoscopy is highly sensitive
for detecting polyps and cancers (approximately 90% sensitive). The
other recommended tests are significantly less sensitive (50-70% sensitive--meaning
it might miss as many as half of the polyps and cancers that might
be present in the colon). Therefore most physicians currently recommend
traditional colonoscopy for screening.
[top of this page] Why not just get a traditional colonoscopy then? Traditional colonoscopy is a good screening test because it visualizes
the entire colon, is highly sensitive, and enables the physician to remove
polyps and early cancers during the same test.
Traditional colonoscopy has some major drawbacks, however. It is an
invasive test, and can be painful without sedation or anesthesia. Because
anesthesia is usually given during colonoscopy, the patient must spend
time in the recovery room while the anesthesia wears off. Furthermore,
the patient is not allowed to drive for 24 hours following the exam and
will often miss work that day. Therefore, the rest of the day is usually
gone after a traditional colonoscopy.
Also, since traditional colonoscopy is an invasive test, it carries
risks to the patient. Besides the well-know risks of anesthesia, traditional
colonoscopy also carries the risk of bowel perforation. This serious
potential side effect occurs in approximately 0.2% of colonoscopies,
and often results in the need for emergency surgery, and possibly death.
Since only 20-30% of average risk patients will have abnormalities that
need to be removed by traditional colonoscopy, it would be unfortunate
if the other 70-80% of patients had to endure the risks and inconveniences
of this invasive test.
[top of this page] What is Virtual Colonoscopy/CT Colonography (CTC)? CTC is a revolutionary and technologically-advanced new screening test
for CRC. CTC is an imaging test that is performed by an advanced CT scanner.
Images of the patient's abdomen are taken by the CT scanner. With special
software, these images are put together to create a three-dimensional
image of the colon. This 3-D image of the colon provides the same view
of the inside of the colon that is seen by traditional colonoscopy. In
fact, the views provided by CTC, in many ways, are even better than those
seen by traditional colonoscopy.
[top of this page] Why is Virtual Colonoscopy/CT Colonography such a breakthrough? CTC is a non-invasive test. It does not require the insertion of an
endoscope throughout the colon. It is quick--completed in about 10-15
minutes. Further, it does not require sedation or anesthesia. Therefore
the patient is able to immediately resume all activities, including driving
and work.
Recent studies of CTC show that it is as sensitive for detecting polyps
and cancers as traditional colonoscopy. In fact, in many ways, the images
provided by CTC are even better than those seen by traditional colonoscopy.
This is because CTC can often see polyps behind haustral folds of the
bowel easier and better than traditional colonoscopy.
Furthermore, unlike traditional colonoscopy, which only sees the inside
of the colon, a CTC also provides images of the rest of the abdomen.
While CTC images are not a substitute for a complete abdominal CT scan,
if one is indicated, these CTC images often detect early cancers and
other abnormalities in abdominal organs. Many people have been cured
of asymptomatic abdominal cancers because they were detected early by
CTC.
With CTC, patients not only receive a very sensitive screening test
for CRC, but they also get a chance to detect any other early cancers
that might be present in the abdomen.
[top of this page] What do the research studies show for CTC? The results of the research studies on CTC have shown a wide range of
sensitivity over the years. There are several reasons for this wide range
of sensitivity, including the use different scanning equipment, different
reading protocols, different image processing techniques, and varied
experience of radiologists.
The best studies have been shown in programs with consistent equipment
types, image processing software, reading techniques, and reader training.
Pickhardt, et al. performed a multi-center trial of CTC as a screening
method for CRC in over 1233 asymptomatic, average risk patients. They
maintained a uniformity of training, scanning, and reading techniques.
The study authors used strategy using 3-D endoluminal displays as the
primary reading source, with clarification and problem-solving in 2-D
windows.
This technique resulted in a high sensitivity and specificity (93.9%,
92.2%) for CTC similar to than traditional colonoscopy. Sensitivities
and specificities of CTC have continued in the research done by two of
the large CTC clinical programs across the country, at the University
of Wisconsin, Madison, and the Bethesda National Naval Medical Center.
The ACRIN 6664 study is another large, multi-center trial of the efficacy
of CTC for CRC screening. The results of this study will be released
in Fall 2007 and may have a significant impact on the acceptability of
CTC across the country.
[top of this page] Do payors currently reimburse for CTC? Because of some of the early variability in CTC studies, CTC is still
considered "investigational" by the AMA, CMS, and the major
cancer screening guidelines. Further, CTC is not currently considered
an acceptable CRC screening modality by the NCQA's HEDIS measurement
system.
Ironically, tests that are clearly inferior to CTC, such as FOBT,
Flex Sig, and DCBE are currently "acceptable" and reimbursed
modalities of CRC screening. These tests have a significantly lower
sensitivity and specificity for CRC screening compared with CTC.
A small number of commercial payors do currently reimburse for CTC in
the state of Wisconsin. The AMA will be reviewing the possibility of
creating a full CPT code for CTC. Commercial payors and Medicare will
likely see the benefits of CTC with respect to cost and patient acceptability
and will begin to reimburse for it as a screening test.
[top of this page] What are the major limitations of CTC? While CTC is a powerful new technology, and a test that most patients
prefer over traditional colonoscopy, there are a few limitations. First,
CTC has no polyp removal capability. If polyps are detected (approximately
20-30% of average risk patients), a traditional colonoscopy needs to
be performed to remove them.
Second, patients who undergo CTC will need to perform a 12 hour, pre-test
colon preparation, exactly like patients who undergo traditional colonoscopy.
The innovative process employed by Colon Health Centers of America greatly
reduces the impact of these two limitations. The CHC America process
allows patients to fully benefit from all the many advantages of CTC,
while greatly reducing the impact of the two limitations. (See What
is so innovative about the Colon Health Centers of America CRC screening
process?)
[top of this page] What is so innovative about the Colon Health Centers of America? The CHC America CRC screening process represents the ultimate in patient
convenience, comprehensiveness, and safety. The patent-pending CHC America
process brings together the best aspects of CTC and traditional colonoscopy,
and minimizes the limitations of both, in a way that cannot be replicated
elsewhere.
The majority of average risk patients (70-80%) who present for screening
will not be found to have colon polyps or other abnormalities that
would need to be removed. It is unfortunate that these patients have
to undergo the additional risk and inconvenience of a traditional colonoscopy,
only to find a "clean" colon. On the other hand, 20-30% of
patients will have polyps and early cancers detected on CTC that will
need to be removed. It is unfortunate that these patients need to undergo
a colon prep for the CTC, and later will be notified that they will
have to schedule an appointment for a traditional colonoscopy to remove
the abnormalities, and undergo a second colon prep all over
again! These patients have every right to be angry!
The CHC America process streamlines and eliminates these problems
by creating a "Colon Health Center"--a CTC imaging center
together with traditional colonoscopy endoscopy center.
Patients arrive at the Colon Health Center after an overnight colon
prep. They receive their CTC, which takes approximately 10-15 minutes.
The CTC images will be immediately sent to the CHC America reading site,
staffed by the most expert CTC readers in the country. Within one hour's
time, the patient's CTC reading will return and the patient will be notified
whether or not they have any abnormalities. If they are one of the lucky
70-80% of average risk individuals, they are done and can immediately
resume all activities.
If they are among the 20-30% of individuals with polyps or other abnormalities,
they will be immediately directed to the co-located endoscopy center
where they will undergo a traditional colonoscopy and remove the abnormalities.
No need for a second prep! No second day off work! Pure convenience
designed around the needs of patients.
[top of this page] Why choose the Colon Health Centers of America screening process over stand-alone radiology/imaging centers? CTC is a test that is also offered at stand-alone radiology and imaging centers. But the vast majority of these centers will have no capability to follow-up with a traditional colonoscopy. Therefore, many patients will be forced to take a second day off work and undergo a second colon prep! Who would want to take that risk?
Furthermore, the CTCs done at stand-alone radiology/imaging centers will likely be read by the local staff radiologist. While they may be fine radiologists, they will typically be generalists who read chest x-rays, MRIs, mammograms, ultrasounds, etc. along with CTCs. The radiologists who read CHC America studies are national experts in CTC. In many cases, CTC is all they read--all day, every day. Studies have clearly shown that experience dramatically improves one's ability to read CTCs. With CHC America, you will only have the best CTC readers in America reading your study.
[top of this page] Is there radiation involved in CTC? Yes, there is radiation exposure with any x-ray or CT scan. Fortunately,
with advances in CT technology the radiation exposure from is minimal
and is similar to the environmental radiation exposure that one encounters
by being out-of-doors for a period of time. Equipment used at CHC America
centers is the latest technology and therefore performs CTC with the
smallest possible radiation exposure.
[top of this page] Where else can your patients receive a similar comprehensive, same-day process The short answer is "nowhere". CHC America has a patent pending
with the US Patent and Trademark Office on their innovative and comprehensive,
same-day screening methodology in the community. Furthermore, CHC America
has a passion for improving patient satisfaction with its CRC screening
process. After all, satisfied patients are more likely to get screened
and therefore prevent colon continues to improve and perfect this patient-centered
approach to CRC screening.
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