President Obama’s Recent Medical Exam Reminds Us to Be Vigilant in Selecting the Best Screening Options for Colon Cancer

In early March, President Obama, who is 48 years old, underwent a thorough physical that included a CT Colonography. The good news is that the President did get screened for colon cancer because he falls into a demographic group where the medical guidelines recommend getting screened for colon cancer before age 50. But the not-so-good news is that by selecting to be screened via a “virtual” CT Colonography, he did not receive the recognized gold standard for screening, which is the traditional colonoscopy¹.

As a result, the American College of Gastroenterology (ACG) fired off a letter to the President a few days after his procedure stating that “while a ‘virtual’ exam is better than no exam, for most people, colorectal screening by colonoscopy is the preferred strategy.”² The letter went on to state, “Our 11,000 physician members are concerned that you missed an important opportunity to set an example of the power of prevention by taking the test proven to prevent colorectal cancer by polyp detection and removal,” said the letter signed by ACG president Dr. Philip O. Katz.

Katz and his ACG colleagues are concerned in large part with the high incidence of colorectal cancer in African Americans. “Evidence reveals that African Americans are diagnosed with colorectal cancer at a younger age, and African Americans with colorectal cancer have decreased survival compared with other racial groups,” he said. The type of colorectal cancer screening that the President selects is important due to his high visibility and the fact that he is a key role model for all Americans.

Although CT Colonography screening is beneficial in certain circumstances, the majority of Americans would be better served to be screened via a traditional colonoscopy because it is a more accurate diagnostic tool and can be used therapeutically as well. For example, patients who think they can avoid the discomfort of a colonoscopy by receiving the ‘virtual exam’ are incorrect for several reasons. Patients still need to be prepped for the procedure the same way that you prep for a traditional colonoscopy, and there can be pain associated with the procedure itself. In addition, patients are exposed to radiation (albeit in small amounts) which can lead to cancer. However perhaps most importantly, if a polyp is found there is no way to remove it during the CT Colonography. The patient has to be transferred to a gastroenterologist office or other setting to have the polyp(s) removed. If this is not done on a timely basis, the patient will have to endure the prep procedure for a second time, and perhaps most importantly, clinical research has not documented the ability of CT colonographies to detect smaller polyps.

Yes, a CT Colonography is better than no screening at all (and might offer more benefits as more empirical analysis is done on the efficacy of this procedure down the road). However, many cancer prevention advocates are hoping the President will pick the most proven and effective procedure available to Americans the next time he has a screening – which today is the traditional colonoscopy.

i As defined by Wikipedia, “Colonoscopy is the endoscopic examination of the colon and the distal part of the small bowel with a CCD camera or a fiber optic camera …….. It may provide a visual diagnosis (e.g. ulceration, polyps) and grants the opportunity for biopsy or removal of suspected lesions.” Click here for source document.