Colon Health Centers the smart way to screen
of America, LLC

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.

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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.

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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:

  1. individuals with a history of adenomatous polyps;
  2. individuals with a personal history of curative-intent resection of colorectal cancer;
  3. individuals with a family history of either colorectal cancer or colorectal adenomas diagnosed in a first-degree relative before age 60 years;
  4. individuals at significantly higher risk due to a history of inflammatory bowel disease of significant duration; or
  5. 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.

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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:

  1. Fecal occult blood test (FOBT)
  2. Flexible Sigmoidoscopy (Flex Sig)
  3. Double-contrast barium enema: (DCBE)
  4. 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.

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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.

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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.

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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.

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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.

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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.

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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?)

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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.

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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.

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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.

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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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