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Grant Details

Grant Number: 5R01CA144835-04 Interpret this number
Primary Investigator: Smith, Maureen
Organization: University Of Wisconsin-Madison
Project Title: Virtual Colonoscopy and Colorectal Cancer Screening
Fiscal Year: 2013
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Abstract

DESCRIPTION (provided by applicant): Colorectal cancer should be almost entirely preventable if identified and removed in the precancerous polyp stage yet almost 50,000 people each year die of this preventable disease. Rates of colorectal cancer screening are low partly because of the invasive nature of traditional optical colonoscopy (OC). Virtual colonoscopy (VC) is a less invasive test that is newly recognized by the American Cancer Society as one of the preferred methods for colorectal cancer screening and prevention. Although the need for additional approaches to improve colorectal cancer screening rates is clear, the role of VC remains controversial. In particular, it is not clear whether widespread VC availability is an important part of strategies to increase overall screening rates or, perhaps more importantly, as a tool to increase screening via cancer prevention (rather than simply cancer detection with a stool test after cancer develops). Addressing this question is increasingly critical given recognition that some areas of the country have extremely long waiting times for OC due to the nationwide shortage of gastroenterologists. The answer is not straightforward; there may be important barriers to VC use as a standard screening test. For example, primary care physicians (PCPs) may limit their use of VC because they wish to avoid the unplanned identification of new findings (e.g., extracolonic findings) that require additional follow-up for diagnosis or therapy. Consequently, individual PCPs likely have an integral role in the use of VC for patients. To inform policies and target interventions to improve practice, it is crucial to determine whether increased availability of VC improves screening and what factors influence the use of VC in typical clinical practice. The University of Wisconsin is the only center in the US with large numbers of patients who have commercial insurance coverage for both VC and OC screening, uniquely positioning us to address these questions. Our specific aims (1) examine whether patients with insurance coverage for VC have an increased likelihood of colorectal cancer screening or screening for cancer prevention versus cancer detection, (2) determine which PCP characteristics and key experiences affect the use of VC over time, and (3) identify if certain perceptions of VC advantages and disadvantages affect the extent to which a PCP uses VC. We will use data from our electronic health record to identify ~38,000 patients eligible for colorectal cancer screening each year from 2003 to 2010, assign patients to one of ~450 PCPs, and track these patients to determine their use of different screening tests. Because four major local insurers cover VC for screening, while other insurers do not, we will have comparison groups of patients who do and do not have coverage for colorectal cancer screening with VC. PCPs practices and experiences will be assessed using aggregated data from the electronic health record, a PCP survey, and data from the American Medical Association. Overall, the results from our investigation will impact strategies to increase colorectal cancer screening, to change the percent of patients screened for cancer prevention vs. detection, and to optimize the use of VC as a screening tool.

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Publications

Visceral fat quantification in asymptomatic adults using abdominal CT: is it predictive of future cardiac events?
Authors: Ryckman EM, Summers RM, Liu J, Del Rio AM, Pickhardt PJ
Source: Abdom Imaging, 2014 Jul 13;null, p. null.
EPub date: 2014 Jul 13.
PMID: 25015400
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CT Colonography Reporting and Data System (C-RADS): benchmark values from a clinical screening program.
Authors: Pooler BD, Kim DH, Lam VP, Burnside ES, Pickhardt PJ
Source: AJR Am J Roentgenol, 2014 Jun;202(6), p. 1232-7.
PMID: 24848819
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Contrast coating for the surface of flat polyps at CT colonography: a marker for detection.
Authors: Kim DH, Hinshaw JL, Lubner MG, Munoz del Rio A, Pooler BD, Pickhardt PJ
Source: Eur Radiol, 2014 Apr;24(4), p. 940-6.
EPub date: 2014 Jan 31.
PMID: 24482303
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Carpet lesions detected at CT colonography: clinical, imaging, and pathologic features.
Authors: Pickhardt PJ, Lam VP, Weiss JM, Kennedy GD, Kim DH
Source: Radiology, 2014 Feb;270(2), p. 435-43.
EPub date: 2013 Oct 28.
PMID: 24029647
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Computed tomographic colonography for colorectal cancer screening: risk factors for the detection of advanced neoplasia.
Authors: Hassan C, Pooler BD, Kim DH, Rinaldi A, Repici A, Pickhardt PJ
Source: Cancer, 2013 Jul 15;119(14), p. 2549-54.
EPub date: 2013 Jun 10.
PMID: 23754679
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Assessment of volumetric growth rates of small colorectal polyps with CT colonography: a longitudinal study of natural history.
Authors: Pickhardt PJ, Kim DH, Pooler BD, Hinshaw JL, Barlow D, Jensen D, Reichelderfer M, Cash BD
Source: Lancet Oncol, 2013 Jul;14(8), p. 711-20.
EPub date: 2013 Jun 7.
PMID: 23746988
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Predictors of colorectal cancer screening variation among primary-care providers and clinics.
Authors: Weiss JM, Smith MA, Pickhardt PJ, Kraft SA, Flood GE, Kim DH, Strutz E, Pfau PR
Source: Am J Gastroenterol, 2013 Jul;108(7), p. 1159-67.
EPub date: 2013 May 14.
PMID: 23670114
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Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications.
Authors: Pickhardt PJ, Pooler BD, Lauder T, del Rio AM, Bruce RJ, Binkley N
Source: Ann Intern Med, 2013 Apr 16;158(8), p. 588-95.
PMID: 23588747
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Variation in diagnostic performance among radiologists at screening CT colonography.
Authors: Pooler BD, Kim DH, Hassan C, Rinaldi A, Burnside ES, Pickhardt PJ
Source: Radiology, 2013 Jul;268(1), p. 127-34.
EPub date: 2013 Feb 28.
PMID: 23449954
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CT colonography: pitfalls in interpretation.
Authors: Pickhardt PJ, Kim DH
Source: Radiol Clin North Am, 2013 Jan;51(1), p. 69-88.
PMID: 23182508
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Computed tomography colonography: emerging evidence to further support clinical effectiveness.
Authors: Pickhardt PJ
Source: Curr Opin Gastroenterol, 2013 Jan;29(1), p. 55-9.
PMID: 23044493
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Screening CT colonography: multicenter survey of patient experience, preference, and potential impact on adherence.
Authors: Pooler BD, Baumel MJ, Cash BD, Moawad FJ, Riddle MS, Patrick AM, Damiano M, Lee MH, Kim DH, Muņoz del Rio A, Pickhardt PJ
Source: AJR Am J Roentgenol, 2012 Jun;198(6), p. 1361-6.
PMID: 22623549
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Five year colorectal cancer outcomes in a large negative CT colonography screening cohort.
Authors: Kim DH, Pooler BD, Weiss JM, Pickhardt PJ
Source: Eur Radiol, 2012 Jul;22(7), p. 1488-94.
EPub date: 2011 Dec 31.
PMID: 22210409
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Simultaneous screening for osteoporosis at CT colonography: bone mineral density assessment using MDCT attenuation techniques compared with the DXA reference standard.
Authors: Pickhardt PJ, Lee LJ, del Rio AM, Lauder T, Bruce RJ, Summers RM, Pooler BD, Binkley N
Source: J Bone Miner Res, 2011 Sep;26(9), p. 2194-203.
PMID: 21590738
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Colorectal cancer: CT colonography and colonoscopy for detection--systematic review and meta-analysis.
Authors: Pickhardt PJ, Hassan C, Halligan S, Marmo R
Source: Radiology, 2011 May;259(2), p. 393-405.
EPub date: 2011 Mar 17.
PMID: 21415247
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