John C. Fang, MD, chief of the division of gastroenterology at the University of Utah School of Medicine in Salt Lake City, discusses the costs and benefits of CT colonography.
Question: How has the increasing use of CT colonography impacted your practice?
Dr. John C. Fang: I don't think there's been a significant effect yet, since insurers aren't covering it. If they start covering it, it's still hard to say whether the procedure will increase or decrease our patient volumes — it could do either. It's possible that people who are now getting screened with colonoscopy will switch to getting screened by CT colonography, which would decrease our patient volume, but it's also possible that people who aren't getting screened now will begin getting screened with CT colonography, and will come to us if they find out they have polyps. We just don't know how that will balance out.
Q: What do you think about the recent push for CMS to cover CT colonography, in addition to optical colonoscopy?
JF: CT colonography is good, just not as good as optical colonoscopy, which is the gold standard — also, if virtual colonoscopy is positive, it requires colonoscopy referral for the polyp removal. But I think the bottom line is that even though we, as GI docs, may be biased to be against CT colonography, we should probably be for it, because whatever we can do to get more people screened is good, and CT colonography is likely a very effective way to screen for colorectal cancer. However, because it is relatively expensive compared to stool tests, it may not be the most cost-effective. There is also concern about what to do with incidental findings found with CT colonography, and the cost associated with evaluating them.
Q: What do you think the future of colorectal cancer screening will look like?
JF: I think it will hopefully be a menu of options, which will expand to include tests like CT colonography, blood-based tests and additional stool-based tests that are more accurate and accessible. We don't know that there will be one best test. Perhaps, the ideal situation would be a menu of all these options, and whichever one fits the patient best is the one we would do. As has been said with screening: the best test is the one that gets done