Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

Comparative effectiveness of multidetector computed tomography (MDCT) (CT colonography) vs colonoscopy for screening colorectal neoplasms – polyps, and primary, recurrent and de novo colorectal cancer. How good is the MDCT, an advanced type of CT scan that produces very accurate 3-dimensional images, to diagnose early colon cancer and to predict cancer recurrence (in the colon or rectum) after initial treatment (compared with colonography or colonoscopy)?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Yes. MDCT (CT colonography) vs colonoscopy for screening colorectal neoplasms

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

General population, population at high risk for colorectal cancers, and patients with a history of colorectal cancer

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

population at high risk for colorectal cancers, patients with a history of colorectal cancer or a family history of the cancer.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Improvements in morbidity and mortality of colorectal cancer outcomes from early diagnosis or surveillance of precursor lesions.

Describe any health-related risks, side effects, or harms that you are concerned about.

Increased radiation exposure, harm caused by false positives (such as unnecessary biopsies, increased medical cost, increased stress due to medical diagnoses and treatments), under-diagnosis resulting in failure to achieve early diagnosis and early intervention

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cancer

AHRQ Priority Populations

• Elderly

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

Colon cancer is the third most common cancer in the US, and the second leading cause of cancer mortality. Patients who were diagnosed with early stage of colorectal cancer have a significantly higher survival rate compared with patients in the advanced stages. Therefore, development of techniques to achieve early detection and diagnosis is of paramount importance in patient outcomes.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

This topic was recommended by a diverse panel of stakeholders as a high priority question for an evidence review.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

“Virtual colonoscopy” was first described in 1994. MDCT is used in some colorectal cancer screening programs, but its role as the first line colorectal screening modality is uncertain.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

The answer(s) to this research question will be disseminated by the Effective Health Care Program to clinical providers and policy makers who will be able to use this information to make more informed treatment recommendations and coverage decisions.

Describe the timeframe in which an answer to your question is needed.

As soon as possible, in order to benefit as many patients as possible

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

The risk of colorectal cancer affects a large percentage of the general US population, men and women. It includes many individuals representative of both vulnerable populations and those unequally screened for diagnosis.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

The answer(s) to this research question will be disseminated by the Effective Health Care Program to clinical providers and policy makers who will be able to use this information to make more informed treatment recommendations and coverage decisions.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program