National Naval Medical Center Performs 10,000th Virtual Colonoscopy

By Sarah Fortney, National Naval Medical Center Public Affairs

BETHESDA, Md. (NNS) -- The National Naval Medical Center (NNMC) performed its 10,000th virtual colonoscopy Jan. 20, demonstrating the hospital's well-established colon health services.

For years, NNMC has been leading the way in colon health, promoting early screening to prevent colon cancer – the second leading cause of cancer death in the U.S. – and offering a full range of services to meet the needs of all beneficiaries.

When it comes to the most-cutting edge technology, patients at NNMC can undergo the virtual colonoscopy (VC), a CAT scan technique that uses modeling software to produce realistic 2-D and 3-D images of the colon, said Capt. Brooks Cash, integrated chief of medicine for the future Walter Reed National Military Medical Center Bethesda.

"The virtual colonoscopy test was developed about 15 years ago and has been refined over the last 10 years, primarily here [at NNMC] as well as several other institutions throughout the country," said Cash.

Likely the most established center performing this procedure, NNMC has performed over 10,000 virtual colonoscopies since 2004, he said.

Patients can also opt for an optical colonoscopy (OC), during which the patient is sedated and a scope is used to find and remove polyps, said Cash. A precursor to colon cancer, polyps arise from the wall of the colon.

The OC, considered the "gold standard," involves removing polyps on the spot, said Dr. Duncan Barlow, senior radiologist for the Colon Health Initiative at NNMC. Once a polyp is removed, he added, it will no longer cause cancer.

If a polyp is found during a VC, the patient should then have a colonoscopy to have it removed, he said.

"There have been multiple studies that have shown the virtual colonoscopy is as accurate as colonoscopy for identifying polyps a centimeter [in diameter] or greater, and these are the polyps that are most likely to progress to colon cancer if undetected," said Cash. "Our data from NNMC is even better, showing diagnostic equivalence for even smaller polyps, a testament to the skill of our team and the efforts of our patients to obtain the best results possible."

While the VC normally takes about 15 minutes, the OC can last about an hour.

"Certainly, there are advantages and disadvantages to both [procedures], but we see them both as standard of care and more complimentary than competitive," said Cash.

Compared to the OC, the VC is also less invasive, as it involves inserting a small tube inside the rectum to fill the colon with carbon dioxide during the 2- and 3-D imaging, he said.

"We have this great technology that allows us to build a model of the colon without invading the patient's body," said Barlow.

He also noted that the procedure uses very low levels of radiation.

"People should not be afraid of the radiation associated with it," said Barlow. "It uses about as much as a plane ride to Denver."

SCREENING COMPLIANCE

"Colon cancer is the third most common cancer, but the second most common killer," said Barlow.

To help reverse those numbers, he said, it's important to raise awareness about screening and prevention.

NNMC's Gastroenterology Service has been making strides in getting patients to comply with colon cancer screening. Amongst Americans eligible for colon cancer screening — men and women ages 50 and over, and African Americans ages 45 and over — only about 50 percent actually get some form of screening, said Cash.

"Here at Bethesda, as well as in the Navy, our compliance rates for colon cancer screening are approaching 70 percent among our enrolled population. When you include the virtual colonoscopy here at NNMC, it approaches 90 percent," said Cash. "We have really made some tremendous advances."

Cash and his colleagues recently surveyed their patients to learn what lead them to choose one method of screening over another. While some patients prefer to be sedated during the OC, others do not like to be put under because they'd prefer not to miss work or arrange someone to drive them home, said Barlow. "It's quite clear [patients] appreciate the convenience [of the VC]," said Cash.

"About 30 percent said they would not have undergone screening had it not been for virtual colonoscopy. What that tells us is that we're bringing people off the sidelines. We're finding those polyps that would have otherwise gone undetected and, by removing them, we're preventing colon cancer. We're thrilled about that."

Martin Heller, the 10,000th patient to undergo a VC at NNMC, underwent the procedure Jan. 20 – it was his first colon cancer screening.

The next day, he learned his results were clear. Heller, who retired from the Air Force, said he appreciated the convenience of the VC.

"The procedure itself was pretty painless," said Heller. "There's a little bit of discomfort, but nothing more than the feeling of having done a ton of sit-ups. You truly feel nothing ... It was really a non-event. All I had to do was just lie there."

Prior to the exam, he said, he felt well-instructed on how to prepare.

"The literature is very accurate," he said.

Heller, who normally receives his primary care at Malcolm Grow Medical Center, on Joint Base Andrews Naval Air Facility, said he was impressed by the ease of access.

"I was discussing with my doctor that I was due for a colonoscopy, and so he sent me here to Bethesda. It was time for me to have one, and it was really easy," he said.

Arthur Sewell, who underwent a colonoscopy Jan. 28, echoed the same sentiment. After recently having a polyp removed, his primary care manager referred him to the gastroenterologists at NNMC for a follow up procedure.

"They wanted to take a look and make sure everything was good to go," said Sewell.

Having pre-existing health issues and anemia, he said, his doctor told him a colonoscopy would be the best option for him. During the procedure, three polyps were removed – he will not learn the biopsy results for a few weeks.

Sewell also noted the importance of screening early to prevent colon cancer.

"[The procedure] wasn't bad," he said. "I wouldn't say it's painful, just a little uncomfortable."

THE COLON HEALTH INITIATIVE

Striving to provide the best care, NNMC's Gastrointestinal (GI) Service counsels each patient to determine which screening is best for the individual, taking into account their family history or any pre-existing medical conditions, said Cathy Dykes, senior nurse research coordinator for the Colon Health Initiative at NNMC. Established in 2003, the Colon Health Initiative works to promote the importance of early detection and to create a premier model colon cancer center.

"It's really a programmatic approach. Once we get folks into our system, we assume the responsibility of calling people to come back when it's time for their [next] screening procedure and we send them home with hard copies of their results," said Dykes.

The GI service has also started a new system to allow patients to learn results of their visit. Dialing into a secure system, using a pin number issued to the patient, they can listen to a message from their doctor informing them of the outcome of their visit, be it a colonoscopy or VC.

Using emerging technologies for preventing colon cancer, the Colon Health Initiative also seeks to continue pioneering research in the field. Dykes said the GI service informs patients of research they're conducting that they may be eligible to partake in. Amongst its first leading developments, in the late 1990s, the GI service at NNMC published ground-breaking research on colonoscopies in women.

At the time, said Cash, there was not much supporting data for colonoscopy screening in women. There had been a number of studies on colonoscopies in men; therefore, they chose to look at colonoscopies in women.

"We found that [colonoscopies are] just as important in women as men," he said, adding that the research confirmed men and women are at the same lifetime risk for developing colon cancer, though men tend to develop colon cancer at an earlier age.

Most recently, the clinic has been working on a study examining the findings of VC procedures in patients over the age of 65.

"We hope that our findings will have national implications, in that the Centers for Medicare will re-evaluate the decision regarding coverage of virtual colonoscopy [for patients over 65]," he said.

MAKING STRIDES

While there aren't many service members in the Navy trained to conduct colonoscopies, Cash said the GI service is strategizing to enhance the capabilities amongst smaller military treatment facilities.

"There are only about 20 gastroenterologists in the Navy," said Cash, many of whom are stationed at teaching hospitals, adding, "There's a lot of demand — just about everybody has a colon and is therefore at risk of developing colon cancer."

To increase screening access, NNMC has initiated a teleradiology project over the past few months, whereby other hospitals, such as Naval Hospital Jacksonville, in Florida, can conduct virtual colonoscopies and send the images electronically to NNMC radiologists who will interpret the studies, then send the results back.

"We're looking to try and expand that to other smaller hospitals throughout DoD that might not have gastroenterologists onboard. We're hoping that we'll be able to increase their colon cancer screening compliance, that we'll find more people with polyps that need to come out, and that we'll recruit people who wouldn't have otherwise been screened … That's really the ultimate goal, to increase screening and decrease colon cancer deaths."

Studies have shown that avoiding obesity, smoking and red meat can lower the risks of colon cancer, he said.

"The most important thing people can do to reduce their risk is get screened for colon cancer," he said. "All those lifestyle modifications can reduce their risk very slightly over 20 or 30 years, but getting a good screening examination is worth a lot more."

Patients do not need a referral to come in for screening at NNMC.

"All they have to do is call us," said Dykes.

For more information on the Colon Health Initiative at NNMC, call 301-319-8284.

For more news from National Naval Medical Center, visit www.navy.mil/local/nnmc/.