Superheroes Save Lives – and So Do Cancer Screenings

Cecelia Brewington, MD, FACR, a professor and board-certified radiologist practicing at UT Southwestern Medical Center in Dallas, Texas, and member of the American College of Radiology® (ACR®) Colon Cancer Committee, contributed this post.

Like so many of us, I was deeply saddened to hear the news of Chadwick Boseman’s passing as a result of stage IV colon cancer. I was also amazed by his strength as he persevered through his illness to bring us so many remarkable films and the Black superhero, King T’Challa, in Marvel’s “Black Panther.” I was deeply moved by the fact that, during his own treatment, he often visited with young cancer patients.

For me, as a Black physician at UT Southwestern Medical Center who serves on the ACR Colon Cancer Committee, the best way I can personally honor his legacy is by working to prevent losing more young Black men like him to colorectal cancer by encouraging screening. Did you know that Black people have the highest rates of colon cancer of any racial ethnic group in the United States, according to the American Cancer Society (ACS)? Black individuals are about 20% more likely to be diagnosed with colorectal cancer and 40% more likely to die. But it doesn’t have to stay that way.

Some have pointed out that Boseman’s death at only 43 makes him even younger than the recommended age at which to begin regular colorectal cancer screening (age 45). That is true, for those at average risk of colorectal cancer. But those with a personal or family history of colorectal cancer or inflammatory bowel disease – or those who are experiencing symptoms like rectal bleeding – might need to start screening before age 45, be screened more often, or get specific tests. That’s why it’s important to talk to your doctor to determine which cancer screenings are right for you.

On average 30% of us who should be screened for colorectal cancer don’t get tested – and that was before the COVID-19 pandemic. Unfortunately, colorectal cancer screening has dropped 86% during the pandemic relative to averages prior to January 20, 2020. If you’re among those who should be screened but have not, I want you to know this is the first step to take that is in your control. See your doctor and get set up for screening!  There are safe, socially distanced options.

Virtual colonoscopy, known medically as CT Colonography, is a highly accurate, safe, and minimally-invasive test that is preferred by many who can’t or won’t get a colonoscopy. It is also recommended by the ACS. Virtual colonoscopy takes about 20 minutes, during which pictures are taken of the inside of the colon using a CT scanner. It does not require being put to sleep, so you can drive yourself to and from the screening and return to your normal daily activities immediately after the test. It can also be performed in a lower risk manner that maintains social distancing in the COVID-19 era. If a pre-cancerous polyp is found, you can have a follow-up colonoscopy to have it removed before it becomes a cancer (it is estimated that only 14 percent need to go on to colonoscopy).

Conventional colonoscopy is another option – which is the only other exam that can reliably detect pre-cancer polyps throughout the entire colon before they turn into cancer. It can also be performed in a low risk manner during the COVID-19 pandemic. You will need to be put to sleep for this exam and have a driver, but if a polyp is found it can be removed during that exam.

I urge you to talk to your doctor about what it might look like for you to #ReturntoCare even amidst the current pandemic and get your PREVENTIVE screening! The best test is the test that gets done. As a physician who provides CT Colonography, I can attest to the fact that this option has the power to save many lives – and one of them just might be yours.

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What Radiologists Need to Know about the Medicare AUC Mandate

Gregory N. Nicola, MD, FACR, ACR Chair Commission on Economics, contributed this post.

Dr. Gregory N. Nicola

The Centers for Medicare and Medicaid Services (CMS) recently announced that the Educational and Operations Testing Period for the appropriate use criteria (AUC)/clinical decision support (CDS) mandate for all advanced diagnostic imaging services will be extended through Dec. 31, 2021. This decision provides additional time for practices to implement clinical decision support systems, as there are no payment consequences associated with the AUC program during calendar year (CY) 2020 and CY2021. How can your practice prepare?

The American College of Radiology® (ACR®) encourages practices to use this time period to learn, test and prepare for the mandatory start of the AUC program. Thousands of facilities nationwide have already implemented CDS as it has the potential to reduce unwarranted imaging and associated radiation exposure, and make more efficient use of healthcare dollars — a benefit to both providers and patients.

Practices should also know that since the testing period extension was regulated by CMS outside of the rulemaking process, there is no CMS call for comments. However, the ACR will continue to work with CMS and other physician, medical and patient groups regarding CDS implementation, advocating for changing the program to a more streamlined and efficient quality improvement initiative.

By embracing the upcoming AUC/CDS mandate together, we can continue to position radiology as a leader in value-based care. I encourage you to familiarize yourself and your colleagues to take advantage of this extension and become better prepared for, pending no further changes from CMS, implementation in early 2022.

The ACR is committed to keeping members apprised of critical AUC/CDS developments through updates on and in the Advocacy in Action eNews. You can find additional information regarding the AUC mandate on the CMS website.

  • How is your practice preparing for AUC/CDS?

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Kids & COVID-19: Should My Child Go Back to School?

Richard Heller, MD, MBA, a pediatric radiologist in Chicago, IL, contributed this post.

Dr. Richard Heller, MBA

September is here. That means back-to-school season. My wife, who is not in medicine, recently came to me with questions regarding the possibility of our two children returning to in-person classes. Specifically, she read comments online that children don’t really get sick with COVID-19 and are not a significant concern to spread the disease.

I believe that the decision to return a child to in-person schooling (or not) is a family matter. There are unequivocal benefits to in-person learning, but that must be balanced against the risks of infection to children, school workers, families and others. That personal decision should be based on facts. With the understanding that our knowledge continues to evolve as more studies are published, here are the major facts that I discussed with my wife:

  • Children usually get mild (or no) symptoms: The data to date show that most pediatric cases of COVID-19 are relatively mild, and many children may exhibit no noticeable symptoms. Symptoms are often non-specific and include fever and cough but could include abdominal pain and diarrhea. Children also have a much lower hospitalization rate than adults.

  • Some children develop severe illness: Although most children with COVID-19 do not get very sick, some do. A third of children that get hospitalized will require care in the ICU. Earlier in the pandemic, it was noted that some children developed a Kawasaki disease-like illness, which tended to develop a few weeks after infection. As of Aug. 20, nearly 700 cases of this new illness, termed Multisystem Inflammatory Syndrome in Children had been reported to the Centers for Disease Control and Prevention (CDC). This includes 11 pediatric deaths in 42 states and the District of Columbia. Most of these children were Hispanic/Latino or non-Hispanic Black. There seem to be broader racial disparities with severity of COVID-19 infection in children, with higher rates of hospitalization in Hispanic/Latino and non-Hispanic Black children.

    Children are likely silent spreaders: While not proving they are more infectious, a study from Chicago showed that, compared to older kids and adults, young children with mild to moderate COVID-19 have higher amounts of viral RNA in their nasopharynx. In other pediatrics infections, like Respiratory Syncytial Virus, higher viral loads translate to a greater risk of being infectious. A Korean study showed that many children with COVID-19 were asymptomatic and that, of children who became symptomatic, most had symptoms that went unrecognized prior to diagnosis. This means that it is difficult, if not impossible, to recognize all children that are infected and potentially acting as silent spreaders. Thus, as noted in JAMA Pediatrics, a surveillance strategy based exclusively on testing those with symptoms will miss many cases. Of note, in that Korean study, asymptomatic children had detectable virus for an average of 14 days after initially testing positive; children with symptoms were positive even longer.

The bottom line is that children can get sick with COVID-19. They usually will develop only mild symptoms, if any. That good fortune is a double-edged sword when it comes to limiting the disease.

Children with COVID-19 can easily go undiagnosed, potentially spreading disease to others. That’s why children over two years of age should wear masks and why hand-washing is so important.

The American Academy of Pediatrics and the CDC, among others, have placed useful data online. As for sending kids back to school — that is a family issue. As I told my wife, this is a personal decision, but hopefully one that is grounded in science.

  • How has COVID-19 impacted radiology private practices and families? Attend the Parenting and Radiology Practice in the COVID-19 Era webinar on Sept. 9 at 7pm ET, hosted by the American Association for Women in Radiology and the American College of Radiology® Commissions on Diversity and Human Resources, as we continue this discussion on childcare, academics and economics.

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