Grant Number:	1R01CA144835-01 Interpret this number
Primary Investigator:	Smith, Maureen
Organization:	University Of Wisconsin-Madison
Project Title:	Virtual Colonoscopy and Colorectal Cancer Screening
Fiscal Year:	2010

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. PUBLIC HEALTH RELEVANCE: New approaches are critical to increasing screening for colorectal cancer because many patients do not get screened. We will examine a less invasive test (virtual colonoscopy) to see if it increases colorectal cancer screening and how it is used in typical clinical practice. The results from our study are important to understanding how to improve screening and optimize the use of this less invasive test.




Natural History of Colorectal Polyps Undergoing Longitudinal in Vivo CT Colonography Surveillance.
Authors: Pooler B.D. , Kim D.H. , Matkowskyj K.A. , Newton M.A. , Halberg R.B. , Grady W.M. , Hassan C. , Pickhardt P.J. .
Source: Radiology, 2024 Jan; 310(1), p. e232078.
PMID: 38289210
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Growth rates and histopathological outcomes of small (6-9 mm) colorectal polyps based on CT colonography surveillance and endoscopic removal.
Authors: Pooler B.D. , Kim D.H. , Matkowskyj K.A. , Newton M.A. , Halberg R.B. , Grady W.M. , Hassan C. , Pickhardt P.J. .
Source: Gut, 2023-07-28 00:00:00.0; , .
EPub date: 2023-07-28 00:00:00.0.
PMID: 37507217
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Noninvasive Detection of Colorectal Carcinomas Using Serum Protein Biomarkers.
Authors: Ivancic M.M. , Megna B.W. , Sverchkov Y. , Craven M. , Reichelderfer M. , Pickhardt P.J. , Sussman M.R. , Kennedy G.D. .
Source: The Journal Of Surgical Research, 2020 02; 246, p. 160-169.
EPub date: 2019-10-03 00:00:00.0.
PMID: 31586890
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Volumetric growth rates of sessile serrated adenomas/polyps observed in situ at longitudinal CT colonography.
Authors: Pickhardt P.J. , Pooler B.D. , Matkowskyj K.A. , Kim D.H. , Grady W.M. , Halberg R.B. .
Source: European Radiology, 2019 Sep; 29(9), p. 5093-5100.
EPub date: 2019-02-11 00:00:00.0.
PMID: 30741343
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Conserved serum protein biomarkers associated with growing early colorectal adenomas.
Authors: Ivancic M.M. , Anson L.W. , Pickhardt P.J. , Megna B. , Pooler B.D. , Clipson L. , Reichelderfer M. , Sussman M.R. , Dove W.F. .
Source: Proceedings Of The National Academy Of Sciences Of The United States Of America, 2019-04-23 00:00:00.0; 116(17), p. 8471-8480.
EPub date: 2019-04-10 00:00:00.0.
PMID: 30971492
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The Natural History of Colorectal Polyps: Overview of Predictive Static and Dynamic Features.
Authors: Pickhardt P.J. , Pooler B.D. , Kim D.H. , Hassan C. , Matkowskyj K.A. , Halberg R.B. .
Source: Gastroenterology Clinics Of North America, 2018 09; 47(3), p. 515-536.
EPub date: 2018-06-29 00:00:00.0.
PMID: 30115435
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Primary care colorectal cancer screening correlates with breast cancer screening: implications for colorectal cancer screening improvement interventions.
Authors: Weiss J.M. , Pandhi N. , Kraft S. , Potvien A. , Carayon P. , Smith M.A. .
Source: Clinical And Translational Gastroenterology, 2018-04-25 00:00:00.0; 9(4), p. 148.
EPub date: 2018-04-25 00:00:00.0.
PMID: 29691364
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Volumetric Textural Analysis of Colorectal Masses at CT Colonography: Differentiating Benign versus Malignant Pathology and Comparison with Human Reader Performance.
Authors: Pooler B.D. , Lubner M.G. , Theis J.R. , Halberg R.B. , Liang Z. , Pickhardt P.J. .
Source: Academic Radiology, 2018-03-19 00:00:00.0; , .
EPub date: 2018-03-19 00:00:00.0.
PMID: 29566994
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CT colonography: over two decades from discovery to practice.
Authors: Pickhardt P.J. , Yee J. , Johnson C.D. .
Source: Abdominal Radiology (new York), 2018 Mar; 43(3), p. 517-522.
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Insurance Coverage for CT Colonography Screening: Impact on Overall Colorectal Cancer Screening Rates.
Authors: Smith M.A. , Weiss J.M. , Potvien A. , Schumacher J.R. , Gangnon R.E. , Kim D.H. , Weeth-Feinstein L.A. , Pickhardt P.J. .
Source: Radiology, 2017 Sep; 284(3), p. 717-724.
EPub date: 2017-07-11 00:00:00.0.
PMID: 28696184
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Predictors of primary care provider adoption of CT colonography for colorectal cancer screening.
Authors: Weiss J.M. , Kim D.H. , Smith M.A. , Potvien A. , Schumacher J.R. , Gangnon R.E. , Pooler B.D. , Pfau P.R. , Pickhardt P.J. .
Source: Abdominal Radiology (new York), 2017 Apr; 42(4), p. 1268-1275.
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CT Colonographic Screening of Patients With a Family History of Colorectal Cancer: Comparison With Adults at Average Risk and Implications for Guidelines.
Authors: Pickhardt P.J. , Mbah I. , Pooler B.D. , Chen O.T. , Hinshaw J.L. , Weiss J.M. , Kim D.H. .
Source: Ajr. American Journal Of Roentgenology, 2017 Apr; 208(4), p. 794-800.
EPub date: 2017-01-26 00:00:00.0.
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Colorectal Findings At Repeat Ct Colonography Screening After Initial Ct Colonography Screening Negative For Polyps Larger Than 5 Mm
Authors: Pickhardt P.J. , Pooler B.D. , Mbah I. , Weiss J.M. , Kim D.H. .
Source: Radiology, 2017 Jan; 282(1), p. 139-148.
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Primary Care Provider Perceptions Of Colorectal Cancer Screening Barriers: Implications For Designing Quality Improvement Interventions
Authors: Weiss J.M. , Pickhardt P.J. , Schumacher J.R. , Potvien A. , Kim D.H. , Pfau P.R. , Jacobs E.A. , Smith M.A. .
Source: Gastroenterology Research And Practice, 2017; 2017, p. 1619747.
PMID: 28163715
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Indeterminate but Likely Unimportant Extracolonic Findings at Screening CT Colonography (C-RADS Category E3): Incidence and Outcomes Data From a Clinical Screening Program.
Authors: Pooler B.D. , Kim D.H. , Pickhardt P.J. .
Source: Ajr. American Journal Of Roentgenology, 2016 Nov; 207(5), p. 996-1001.
EPub date: 2016-08-09 00:00:00.0.
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Serrated Polyps at CT Colonography: Prevalence and Characteristics of the Serrated Polyp Spectrum.
Authors: Kim D.H. , Matkowskyj K.A. , Lubner M.G. , Hinshaw J.L. , Munoz Del Rio A. , Pooler B.D. , Weiss J.M. , Pickhardt P.J. .
Source: Radiology, 2016 Aug; 280(2), p. 455-63.
EPub date: 2016-02-15 00:00:00.0.
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Emerging stool-based and blood-based non-invasive DNA tests for colorectal cancer screening: the importance of cancer prevention in addition to cancer detection.
Authors: Pickhardt P.J. .
Source: Abdominal Radiology (new York), 2016 Aug; 41(8), p. 1441-4.
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Prospective evaluation of the ability of clinical scoring systems and physician-determined likelihood of appendicitis to obviate the need for CT.
Authors: Golden S.K. , Harringa J.B. , Pickhardt P.J. , Ebinger A. , Svenson J.E. , Zhao Y.Q. , Li Z. , Westergaard R.P. , Ehlenbach W.J. , Repplinger M.D. .
Source: Emergency Medicine Journal : Emj, 2016 Jul; 33(7), p. 458-64.
EPub date: 2016-03-02 00:00:00.0.
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Objective and Subjective Intrapatient Comparison of Iohexol Versus Diatrizoate for Bowel Preparation Quality at CT Colonography.
Authors: Johnson B. , Hinshaw J.L. , Robbins J.B. , Pickhardt P.J. .
Source: Ajr. American Journal Of Roentgenology, 2016 Jun; 206(6), p. 1202-7.
EPub date: 2016-03-24 00:00:00.0.
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Colorectal Polyps Missed With Optical Colonoscopy Despite Previous Detection And Localization With Ct Colonography
Authors: Pooler B.D. , Kim D.H. , Weiss J.M. , Matkowskyj K.A. , Pickhardt P.J. .
Source: Radiology, 2016 Feb; 278(2), p. 422-9.
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Potentially Important Extracolonic Findings At Screening Ct Colonography: Incidence And Outcomes Data From A Clinical Screening Program
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Source: Ajr. American Journal Of Roentgenology, 2016 Feb; 206(2), p. 313-8.
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CT colonography after incomplete optical colonoscopy: bowel preparation quality at same-day vs. deferred examination.
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Authors: Bannas P. , Li Y. , Motosugi U. , Li K. , Lubner M. , Chen G.H. , Pickhardt P.J. .
Source: European Radiology, 2015-10-31 00:00:00.0; , .
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Opportunistic Osteoporosis Screening: Addition of Quantitative CT Bone Mineral Density Evaluation to CT Colonography.
Authors: Ziemlewicz T.J. , Binkley N. , Pickhardt P.J. .
Source: Journal Of The American College Of Radiology : Jacr, 2015 Oct; 12(10), p. 1036-41.
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Colorectal carcinoma: what should the oncologist recommend for screening?
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CT colonography for population screening: ready for prime time?
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Objective Volumetric Comparison Of Room Air Versus Carbon Dioxide For Colonic Distention At Screening Ct Colonography
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Source: Abdominal Imaging, 2015 Feb; 40(2), p. 231-6.
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Visceral Fat Quantification In Asymptomatic Adults Using Abdominal Ct: Is It Predictive Of Future Cardiac Events?
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Source: Abdominal Imaging, 2015 Jan; 40(1), p. 222-6.
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Recent developments in colorectal imaging.
Authors: Pickhardt P.J. .
Source: Current Opinion In Gastroenterology, 2015 Jan; 31(1), p. 76-80.
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Volumetric analysis of colonic distention according to patient position at CT colonography: diagnostic value of the right lateral decubitus series.
Authors: Pickhardt P.J. , Bakke J. , Kuo J. , Robbins J.B. , Lubner M.G. , del Rio A.M. , Kim D.H. .
Source: Ajr. American Journal Of Roentgenology, 2014 Dec; 203(6), p. W623-8.
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Volumetric texture features from higher-order images for diagnosis of colon lesions via CT colonography.
Authors: Song B. , Zhang G. , Lu H. , Wang H. , Zhu W. , J Pickhardt P. , Liang Z. .
Source: International Journal Of Computer Assisted Radiology And Surgery, 2014 Nov; 9(6), p. 1021-31.
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Intra-individual Comparison Of Magnesium Citrate And Sodium Phosphate For Bowel Preparation At Ct Colonography: Automated Volumetric Analysis Of Residual Fluid For Quality Assessment
Authors: Bannas P. , Bakke J. , Munoz del Rio A. , Pickhardt P.J. .
Source: Clinical Radiology, 2014 Nov; 69(11), p. 1171-7.
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Ct Colonography Reporting And Data System (c-rads): Benchmark Values From A Clinical Screening Program
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Source: The Lancet. Oncology, 2013 Jul; 14(8), p. 711-20.
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Opportunistic Screening For Osteoporosis Using Abdominal Computed Tomography Scans Obtained For Other Indications
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Source: Annals Of Internal Medicine, 2013-04-16 00:00:00.0; 158(8), p. 588-95.
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Cost-effectiveness of CT colonography.
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Optical Colonoscopy And Virtual Colonoscopy Numbers After Initiation Of A Ct Colonography Program: Long Term Data
Authors: Benson M. , Pier J. , Kraft S. , Kim D. , Pickhardt P. , Weiss J. , Gopal D. , Reichelderfer M. , Pfau P. .
Source: Journal Of Gastrointestinal And Liver Diseases : Jgld, 2012 Dec; 21(4), p. 391-5.
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Five Year Colorectal Cancer Outcomes In A Large Negative Ct Colonography Screening Cohort
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Screening Ct Colonography: Multicenter Survey Of Patient Experience, Preference, And Potential Impact On Adherence
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Source: Ajr. American Journal Of Roentgenology, 2012 Jun; 198(6), p. 1361-6.
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Performing An Additional Decubitus Series At Ct Colonography
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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,P.J. , Lee,L.J. , del Rio,A.M. , Lauder,T. , Bruce,R.J. , Summers,R.M. , Pooler,B.D. , Binkley,N. .
Source: Journal Of Bone And Mineral Research : The Official Journal Of The American Society For Bone And Mineral Research, 2011 Sep; 26(9), p. 2194-203.
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