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Colonoscopy Test for Colon Cancer May Be More Effective

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"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 accurate.

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 patients.

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 cancers."

Vital Information:

  • 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 procedure.
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