President Barack Obama is catching flak for having a virtual colonoscopy as part of his physical rather than undergoing a colonoscopy.

American College of Gastroenterology President Philip O. Katz, MD, FACG, called the president's recent CT colonography exam a "missed opportunity." In a letter to President Obama, Dr. Katz scolded the commander-in-chief for failing to undergo a colonoscopy, the test the ACG says is proven to prevent colorectal cancer by polyp detection and removal.

Dr. Katz's letter says there is no evidence that CT colonography - or virtual colonoscopy - prevents the development of colorectal cancer and notes the U.S. Preventive Services Task Force found insufficient evidence to include CTC as a recommended screening test. It also cites a study appearing in the Feb. 14, 2008 New England Journal of Medicine that states "screening for colorectal cancer ... reduce(s) mortality either at low cost or at a cost savings," which Dr. Katz says coincides with President Obama's healthcare reform efforts.

In the March 2009 issue of The American Journal of Gastroenterology, the ACG updated its colorectal cancer screening guidelines and endorsed the use of CTC when patients refuse colonoscopy, but warned that false positives are common and the exam fails to detect polyps smaller than 5mm, which account for 80% of abnormal colorectal growths.

The guidelines also recommend colorectal cancer screening in African-Americans starting at age 45 rather than age 50. In his letter to President Obama, Dr. Katz alludes to the example the President could have set for African-Americans. He writes, "We are particularly concerned about screening in the African-American community, because evidence reveals that African_Americans are diagnosed with colorectal cancer at a younger age and have decreased survival compared with other racial groups."

On the other hand, James H. Thrall, MD, FACR, chair of the American College of Radiology Board of Chancellors, praised the President for "recognizing the importance and benefits of the latest colorectal cancer screening technology." Dr. Thrall notes the American Cancer Society endorses CTC as an effective cancer-screening exam, but Medicare, unlike many private insurers, doesn't reimburse for the test. That denial of coverage, writes Dr. Thrall, creates uneven coverage between patients with private insurance and Medicare beneficiaries.

"Providing Medicare patients with an effective and less invasive screening tool for colorectal cancer can help overcome the disparity in colorectal care that exists in minority and underserved communities," notes Dr. Thrall. "Congress needs to act now to require Medicare coverage of CT colonography and help minority and underserved populations gain access to this potentially lifesaving care."

Daniel Cook