CT Colonography: Accuracy, Acceptance, and Safety
CT Colonography: Accuracy, Acceptance, and Safety
Attendance to screening is influenced by the expected burden, illustrated by the results of a Dutch population-based screening trial comparing the participation in colonoscopy and CTC screening. Invitees were asked to fill out a questionnaire in which they could indicate the reasons for accepting or declining their invitation. Almost half the non-screenees had adequate knowledge on CRC screening and expressed a positive attitude towards screening, suggesting the existence of additional barriers towards participation. Both in colonoscopy and CTC screening, the most cited reasons to decline screening were the expected unpleasantness of the examination and the expected inconvenience of the preparation. However, the most decisive reason in colonoscopy was 'unpleasantness of the examination' while CTC non-screenees indicated 'no time/too much effort' and 'lack of symptoms' as most decisive reasons. Ho et al found similar results for CTC in the USA: 38% of non-screenees declined screening due to procrastination and 12% because they were too busy.
The adherence in future screening rounds is probably influenced by the experienced burden in previous screening rounds. In 2012, a meta-analysis was published including 23 studies in both average and high-risk subjects who underwent colonoscopy as well as CTC, presenting data on differences in burden and preferences for colonoscopy or CTC after receiving both examinations. Only three studies showed a significant preference for colonoscopy, while 16 studies showed a significant preference for CTC. Studies in screening populations and studies in which the subjects were aware of the a priori probability of the need for a follow-up colonoscopy after CTC, showed a stronger preference for CTC. Four screening studies compared the perceived burden using a tandem design, showing that 46%–95% of screenees preferred CTC the next time. However, a recent population-based screening trial showed that CTC participants experienced their examination as slightly more burdensome than colonoscopy participants. The clinical relevance of this difference is questionable, as the pooled SD of the scores was 0.9, indicating a large within-group variability in scores. Further, the arms were not randomised for evaluating burden and concerned groups that were not identical, thus hampering comparison. Importantly, the intended participation in a next screening round was more than 90% for both procedures among screenees.
Acceptance
Attendance to screening is influenced by the expected burden, illustrated by the results of a Dutch population-based screening trial comparing the participation in colonoscopy and CTC screening. Invitees were asked to fill out a questionnaire in which they could indicate the reasons for accepting or declining their invitation. Almost half the non-screenees had adequate knowledge on CRC screening and expressed a positive attitude towards screening, suggesting the existence of additional barriers towards participation. Both in colonoscopy and CTC screening, the most cited reasons to decline screening were the expected unpleasantness of the examination and the expected inconvenience of the preparation. However, the most decisive reason in colonoscopy was 'unpleasantness of the examination' while CTC non-screenees indicated 'no time/too much effort' and 'lack of symptoms' as most decisive reasons. Ho et al found similar results for CTC in the USA: 38% of non-screenees declined screening due to procrastination and 12% because they were too busy.
The adherence in future screening rounds is probably influenced by the experienced burden in previous screening rounds. In 2012, a meta-analysis was published including 23 studies in both average and high-risk subjects who underwent colonoscopy as well as CTC, presenting data on differences in burden and preferences for colonoscopy or CTC after receiving both examinations. Only three studies showed a significant preference for colonoscopy, while 16 studies showed a significant preference for CTC. Studies in screening populations and studies in which the subjects were aware of the a priori probability of the need for a follow-up colonoscopy after CTC, showed a stronger preference for CTC. Four screening studies compared the perceived burden using a tandem design, showing that 46%–95% of screenees preferred CTC the next time. However, a recent population-based screening trial showed that CTC participants experienced their examination as slightly more burdensome than colonoscopy participants. The clinical relevance of this difference is questionable, as the pooled SD of the scores was 0.9, indicating a large within-group variability in scores. Further, the arms were not randomised for evaluating burden and concerned groups that were not identical, thus hampering comparison. Importantly, the intended participation in a next screening round was more than 90% for both procedures among screenees.
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