Most of us would rather lie down and pass through a scanner versus having a tube physically pushed through our colons, but if you’re concerned about colon cancer, choosing the scanner is not your best choice.That’s the message that’s been sent to local physicians and just last week also to management of King Edward VII Memorial Hospital (KEMH).Last month KEMH announced it was offering a new service — virtual colonoscopy. Although sounding like something from the video gaming world, virtual colonoscopy is very real. It’s a non-invasive method of looking at the colon and would be conducted with KEMH’s new 128-slice CT scanner.The state-of-the art scanner is the most powerful on the Island but according to local internist Dr Wilbert Warner, is not full proof when screening for colon cancer.In a May 21 letter to local general practitioners, Dr Warner said: “Optical or standard colonoscopy is regarded as the gold standard for polyp detection.”Dr Warner sent the letter to physicians after he received several inquiries about using the virtual method.“For the last several weeks I have had many inquiries as to the appropriate place of the new technology of CT colonoscopy that has recently become available at KEMH,” he said in his letter.Explaining his concern about the virtual method, Dr Warner told Body & Soul: “We don’t want to be doing a screening test that will not detect what it should be detecting.”His view was endorsed by Johns Hopkins’ Associate Professor of Medicine and Chief of Endoscopy, Patrick Okolo. Dr Okolo told Body & Soul that in the US, Medicare and Medicaid do not cover virtual colonoscopy as a principal screening method for colon cancer because it’s not deemed more effective than the traditional optical method.Screening for polyps: Polyps which are protrusions on the wall of the colon, are what doctors are looking for in colon cancer screening. The polyps can be, or become cancerous. They vary in size and can also grow height-wise or lengthwise. The smaller the lesion the less likely it is to be detected by a CT scanner. Similarly flat lesions — those that grow lengthwise, also pose a problem in being detected.The traditional optical colonoscopy sees a flexible tube fitted with a lens and video camera passed through the length of the colon. The tube also has tools that allow the surgeon or endoscopes to sample tissue from the colon and remove polyps.In the optical colonoscopy the surgeon is working with a picture of the actual inside of the colon. Additionally, when polyps are detected, they can be removed with tools on the device.This means that a patient being screened for colon cancer can be effectively treated simultaneously, reducing stress and actual cost.In his letter to local physicians Dr Warner made the case clearly.He said: “The American College of Physicians as well as the American Cancer Society, suggest that CT colonoscopy should not be performed as a screening procedure in patients at either increased risk or high risk of colon or rectal carcinoma. Patients at increased or high risk for colon or rectal carcinoma include:1. People of African descent above the age of 452. Patients with a history of polyps or prior colonoscopy3. Patients with a personal history or first-degree relative (parents, sibling or child) with colon cancer or malignant polyps.4. Patients with a personal or close family history of breast or uterine cancer.5. Diagnosis of familial adenomatous polyposis syndrome.6. Familial non polyposis cancer syndrome7. History of inflammatory bowel disease.8. People with Type 2 diabetes.9. People with obesityIt is recommended that CT colonoscopy NOT be performed on any of the above group of patients as a screening modality, but rather Optical Colonoscopy. It is also not an approved modality for investigation of diarrhoea, bleeding, suspected colitis etc“Dr Warner also listed five scenarios where it would be appropriate to use CT colonoscopies as a primary screening method. He also noted that in CT scans where polyps are detected, an optical colonoscopy will have to be done to remove them.It seems clear that CT colonoscopy for colon cancer screening would only drive up already high local healthcare costs. Body & Soul understands that local health insurers have agreed to the coverage but only Argus Insurance confirmed its clients are covered.