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Neither this doctor, nor any medical specialty society, nor any national cancer organization recommend virtual colonoscopy (VC) as a screening test for colorectal cancer (CRC). No national consensus panel has ever endorsed screening VC. Screening VC is not covered by insurance, and you will have to pay out-of-pocket. The most recently advertised "limited-time" rate is $695.00. Referrals for VC are not honored by managed care plans, because VC is not an approved screening test. The recent article in The New England Journal of Medicine was widely misinterpreted. The study did not prove that VC is better than real colonoscopy, or even as accurate. VC cannot diagnose polyps less than 5 mm in size, which are unlikely to contain cancer yet, but VC is clearly less accurate in this regard. The same study showed that 51% of patients undergoing VC had polyps of significant size that had to be removed at a subsequent colonoscopy — which would have been discovered and removed at the time of a real colonoscopy — without the need for having both tests done. Preparation for VC is absolutely the same as for real colonoscopy. VC itself is a computed tomographic (CT) scan of the colon after inflation by air pumped up by a rectal tube. Yet, VC entrepreneurs advertise, "Who wants a 6-foot scope stuck up their colon?" With all due respect, don't let advertising claims blow air ... or smoke ... up your colon. Scanning for dollars is scamming for dollars. For every patient supposedly afraid of "the dreaded colonoscopy," how many others say, "Ohmigosh, not a CAT scan! I can't bear being stuck inside that coffin! I'm so claustrophobic." This is about as silly an excuse for not having a CT scan, if one is necessary, as are unfounded fears of real colonoscopy that the VC industry is exploiting at your expense, medically and financially. The fact is that VC is not as good as the real thing. "Why be claustrophobic? Have a real colonoscopy, and take a nap, while your doctor takes the best possible care of you — and your insurance pays for it." Endoscopic colonoscopy has been around for more than 30 years, millions have been done, and many large studies have been published, including in The New England Journal of Medicine, that have proven its value in the prevention and early detection of CRC. That's why real colonoscopy is approved for payment by Medicare, all insurance, and all managed care plans. Is VC safer than real colonoscopy? Complications of colonoscopy are rare, and almost all of them occur as a result of removing polyps, not from the colonoscopy itself. Such complications will not be reduced, avoided, or prevented by VC. There is a role for VC in the few patients who cannot have complete endoscopic colonoscopy for technical reasons, for the same reason barium enemas are done - or to evaluate large polyps that cannot be removed safely by colonoscopy, just as standard CT scans are done before surgery is planned. VC may be better than a barium enema, but VC is not a colonoscopy. Anyone who thinks otherwise is neither getting the best possible medical care, nor a bargain. Don't be fooled by commercial advertising claims, which are indeed "virtual nonsense." Only endoscopic colonoscopy — the real colonoscopy — is the "gold standard" for screening for colorectal cancer.
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