St. Vincent Healthcare is among the growing number of hospitals offering patients a safe and effective tool used to detect colorectal cancer, one of the nation's leading cancer killers.
Despite not being covered by Medicare, use of computed tomographic colonography (CTC), commonly referred to as virtual colonoscopy, is on the rise, according to the Journal of the American College of Radiology. Researchers found that in 2008, 17 percent of hospitals offered CTC, up from 13 percent in 2005. St. Vincent Healthcare, the only hospital in the region to offer the service, started its program in May 2008 and has since conducted more than 130 procedures.
CTC is a minimally invasive alternative to the conventional optical colonoscopy that is used for colorectal cancer screening and diagnosis.
CTC uses X-ray technology to produce three-dimensional, fly-through images of the colon and rectum. It is endorsed by the American Cancer Society as a recommended colon cancer screening test.
Hospitals have adopted CTC to provide an alternative screening option for frail, elderly patients and patients who failed optical colonoscopy screens. Some also were encouraged that it would eliminate long waits for the standard procedure. In addition to being less invasive than a standard colonoscopy, it does not require sedation. Patients can return to normal daily activities immediately following the procedure.
The most compelling reason to offer the CTC is that it might entice more people to get screened for the deadly disease. Colorectal cancer is the third-most common cancer diagnosed among men and women in the United States and the second leading cause of cancer death, despite having a 90 percent cure rate when detected early, according to the American College of Radiology. This is because fewer than than half of those 50 and older who should be screened for the disease actually get screened. The National Cancer Institute Colorectal Cancer Progress Review Group predicts that wide use of screening could save 20,000 lives annually.
But one of the biggest barriers for patients wanting the CTC is cost, $1,100. Medicare denies coverage of the exam for seniors. Insurance companies in Montana will only reimburse the cost of CTC if a patient has failed a standard colonoscopy.
The American Cancer Society tried without success in 2008 to get the CTC approved as a reimbursable procedure. Optical screenings are routinely covered by insurance. Both procedures are considered excellent techniques for discovering polyps and are not considered competitors.
"The utilization of (CTC) is very small," said Dr. Mitch Gallagher, a radiologist at St. Vincent. "That disappoints me. Absolutely. It's pretty easy to understand why the screening population isn't accessing this technology because it's a pretty expensive technique."
Because of cost and lack of reimbursement, a lower percentage of patients are being screened than should be, Gallagher said. The best way to cure and manage colon cancer is to detect it early, he said.
"There is a need out there to be screened," Gallagher said.
Gallagher said the CTC is being used primarily at St. Vincent as a problem-solving device for those who failed the standard colonoscopy.
Dustin Strandell, manager of radiology at St. Vincent, said CTC technology provides patients who failed a standard colonoscopy some resolution.
"Patients aren't left in limbo when they come here," Strandell said. "We have the technology in place to complete the exam and give the patient answers."
Janice Green, 55, of Sheridan, Wyo., was one of the patients who wanted answers. She had a standard colonoscopy, but the sigmoidoscope -- a long, slender, flexible tube with an attached camera that is inserted through the rectum up into the colon -- couldn't navigate the twists and turns of her colon.
The results of her test were inconclusive. In March, she underwent a virtual colonoscopy, hoping for a complete and accurate test.
"Nothing was found," Green said. "That was the outcome I was looking for, of course."
Jean Jones, 81, of Lewistown, had a polyp removed during her regular colonoscopy, but complications prevented the procedure from being completed. She feared there might be more polyps. She took her physician's advice and scheduled a virtual colonoscopy.
"It gives me peace of mind," Jones said.
"It is far better to detect these malignancies early and treat them early," Gallagher said. "You can offer a cure to these patients with small polyps."
Billings Clinic does not offer virtual colonoscopies because neither patients nor clinicians request them, said Dr. John Sillery, a radiologist at Billings Clinic. "If we had the demand, we could certainly start offering them."