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Joint Statement - AMA and The Colorectal Foundation warn against virtual colonoscopy advertising claims

The AMA and The Colorectal Foundation today warned people to be cautious about claims being made in advertising for 'virtual colonoscopy'.

AMA President, Dr Bill Glasson, said there are concerns that people may be led to believe that 'virtual colonoscopy' is either a cure-all for serious colorectal ailments or a superior technique than conventional colonoscopy.

"It is inappropriate to offer people false hope of miracle cures in the absence of medical evidence to support the claims," Dr Glasson said.

"Virtual colonoscopy is a welcome development but, at this stage, its usefulness is confined to certain clinical conditions or as a complement to traditional treatments.

"Body scanning for the purposes of screening is against AMA policy and contrary to current best practice medicine."

Virtual colonoscopy involves the use of a computer scanning technique to image the large intestine.   The procedure represents a localised form of body imaging which concentrates on the large intestine with the intention of finding polyps and bowel cancer.  It has recently been promoted widely as an alternative to colonoscopy because there is 'no anaesthetic' and 'no risk of infection', according to the advertising.

Colonoscopy is the standard method used to assess the large intestine, allowing both accurate identification and immediate removal of any polyps that are present.

Associate Professor Richard Mendelson, consultant radiologist at Royal Perth Hospital, said that research studies show that, even in experienced hands, virtual colonoscopy may miss more than 30 per cent of polyps under a centimetre in diameter and perhaps 10 per cent of those greater than one centimetre, but is very accurate for the diagnosis of colon cancer.

"But there are several situations where virtual colonoscopy is an accepted method of examining the large intestine," Professor Mendelson said.

"These are where a previous colonoscopy has been incomplete or has presented difficulties; where the patient has another disease which would make colonoscopy hazardous or the accompanying sedation risky; where there is a narrowing of the colon which does not allow the passage of a colonoscope; and for frail, elderly or immobile patients as an alternative to a barium enema x-ray or colonoscopy.

"However, currently there is insufficient evidence available to propose that virtual colonoscopy be offered as a first-line method for screening the general population for colonic cancer or polyps - that is, subjects without symptoms.

"The use of virtual colonoscopy for this purpose should be confined to hospital units where there is an active research and development program looking at comparative techniques and results," Professor Mendelson said.

Dr Graham Newstead, Executive Director of the Colorectal Surgical Society of Australasia and Chairman of The Colorectal Foundation, said today that virtual colonoscopy has the potential to give patients a false sense of security, with a significant risk of subsequent cancer.

"If a polyp is identified at virtual colonoscopy, a standard colonoscopy will then be required to remove the polyp," Dr Newstead said.

"Because there is a direct relationship between the size of polyps and the risk of developing cancer, it is important to find the polyps when small so as to avoid subsequent cancer formation.  Both procedures involve preparation of the bowel at home prior to the procedure.

"There are, however, certain indications for a procedure other than colonoscopy to be considered - either barium enema or perhaps, in specialised units, virtual colonoscopy.

"Such indications might include the very infirm or those patients in whom it is not possible to complete colonoscopy due to excessive intestinal length or due to a narrowing of the intestine blocking passage of the colonoscope.

"At this stage, it is not considered safe practice to offer virtual colonoscopy as a mass population screening tool for colonic polyps.  Nor is it safe practice to advertise so-called 'medical breakthroughs' without the evidence," Dr Newstead said.

New technologies are coming along everyday and even the experts at times have to work hard to keep up with the advances.  If you have health concerns, the first step should always be to discuss them with your doctor and request a referral to a specialist if there is any doubt.

It is a poor investment in your healthcare to access expensive and experimental services advertised in the paper.  If the technology is proven, the specialist will know and can advise you on it.  The best way to receive "gold standard" diagnostic and treatment services is by consulting a specialist in the field.

Contacts:

AMA:                                                 John Flannery, 02 6270 5477, or 0419 494 761

The Colorectal Foundation:          Dr Graham Newstead, 02 9650 4222 or 0418 618 800

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