Colonoscopy Test for Colon Cancer May Be More Effective
"With colonoscopy, the potential implication for saving lives is
exceptional," says Winawer, who maintains that the overall costs of all
screening techniques are about equal. "With the rising costs of cancer
care, screening is becoming cost-saving."
Several colon cancer experts tell WebMD the study findings are welcome
confirmation of how they already have been practicing.
"To my knowledge this is this the largest, if not the only, comparison
of these two [methods], and the results are impressive. Most people have
already been favoring colonoscopy to barium enema, and this adds credibility to
that behavior," says Neal Meropol, MD, who reviewed the study for WebMD.
Though the findings aren't surprising, he says, the data from earlier studies
were not definitive. Meropol is director of gastroenterology cancer programs at
Fox Chase Cancer Center in Philadelphia.
Meropol also sees a broader application to the findings, noting that the
various medical societies should revisit their recommendations about which
method is preferred for colon cancer screening and follow-up.
David A. Rothenberger, MD, said further study is needed before colonoscopy
becomes the gold standard for colon cancer screening, although he says it is
essential for patients who require follow-up.
"Increasingly, people are demanding the 'Katie Couric approach,' even as
a first-time screening test," says Rothenberger, a clinical professor and
chief of the Division of Colon and Rectal Surgery at the University of
Minnesota, and director of cancer programs there.
But at least one physician isn't convinced that follow-up with colonoscopy
is superior. Seth N. Glick, MD, professor of radiology at MCP Hahnemann
University in Philadelphia, tells WebMD that in the study, there was very
little difference in the size of the polyps detected by either method, and that
the method of measuring the polyps used has been shown to be less than
Glick adds that more studies should be done, focusing on long-term colon
cancer rates among patients who had both methods, to determine whether any
polyps missed by barium enemas ultimately became cancerous. He argues that the
risks and benefits of the two procedures should be weighed for all
Until there are more studies on which method is best, "the public is
going to have to be subjected to some confusion in terms of the message,"
Rothenberger says. But for all the colon cancer experts, including
Rothenberger, another message is crystal clear: Screening saves lives.
"The best thing would be for all Americans over 50 to do something --
get one of those tests," Rothenberger says. "I would certainly rather
have them have a barium enema, or fecal occult test than do nothing. This is
the most preventable cancer we've got, other than smoking-related
- Although the medical community agrees that everyone should be routinely
screened for colon cancer after age 50, there is no agreement on which type of
test should be used for the initial screening or follow-up.
- New research shows that among people who have a history of colon polyps,
which can become cancerous, colonoscopies are superior to barium enemas in
finding polyps in follow-up testing.
- Colonoscopy is more expensive and requires sedation of the patient, but any
polyps that are discovered can be removed immediately during the