O ptical colonoscopy remains the dominant strategy for colorectal cancer (CRC) screening in the United States and is used for both cancer prevention and detection. However, optical colonoscopy is an invasive and resourceintense primary screening examination. Less invasive CRC screening tests provide an alternative, complementary option for population-based screening; patients with positive results are referred for optical colonoscopy as the de facto therapeutic standard. However, these noninvasive tests may differ in their ability to prevent CRC through the detection of advanced precancerous polyps. Available noninvasive screening examinations that are approved by the U.S. Food and Drug Administration include stool-based tests and CT colonography. Vast previous screening experiences with fecal occult blood and immunochemical testing have been published previously (1), but the data for multitarget stool DNA (mt-sDNA) and CT colonography screening are limited, and these tests were only recently included in the U.S. Preventive Services Task Force guidelines (2). Data are just now emerging on the postapproval clinical screening experience with the Cologuard (Exact Sciences, Madison, Wis) mt-sDNA test (3-5). Nonetheless, nationwide use of this stool-based test has dramatically increased since its simultaneous approval was granted in August 2014 by the U.S. Food and Drug Administration and the Centers for Medicare and Medicaid Services. Since then, millions of screening tests have been performed. Published data on CT colonography screening are mainly limited to trial data and clinical practice at a single center (6-9). Clinical validation trials (8-10) can derive the sensitivity and specificity of these noninvasive tests for key outcomes such as advanced neoplasia and CRC because every patient undergoes the reference standard, optical colonoscopy. However, in actual clinical practice, diagnostic evaluation

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ObjectiveCancer treatment-induced bone loss is a known side effect of cancer therapy. Computed tomography (CT) bone mineral density screening is a novel tool for identifying bone loss. This study aims to use routine CT images to determine long-term bone mineral density changes and osteoporosis risk among women with gynecologic cancers.MethodsBone loss was evaluated in a retrospective cohort of women ≤65 years old with gynecologic cancer who underwent oophorectomy from January 2010 to December 2014. Opportunistic CT-based bone mineral density measurements (Hounsfield units, HU) were performed at baseline and intervals up to 5 years after cancer diagnosis. Osteoporosis risk was categorized by HU. Bivariate and multivariate analyses were performed to compare baseline to follow-up bone mineral density at 1, 3, and 5 years and to identify predictors of bone loss following diagnosis.ResultsA total of 185 patients (median age 53 years, range 23–65 years, 78.1% ovarian cancer) were included. Bone mineral density significantly decreased between baseline and 1 year (p<0.001), 3 years (p<0.001), and 5 years (p<0.001). Half with normal bone mineral density at baseline had risk for osteopenia or osteoporosis at 5 years. Four percent had osteoporosis risk at baseline compared with 1 year (7.4%), 3 years (15.7%), and 5 years (18.0%). Pre-treatment bone mineral density was a significant predictor at 1 and 5 years (1 year: p<0.01; 5 years: p<0.01). History of chemotherapy predicted bone loss at 1 year (p=0.03). More lifetime chemotherapy cycles were associated with increased risk of osteoporosis at 1 year (p=0.03) and 5 years (p=0.01).ConclusionsWomen with gynecologic cancers may experience accelerated cancer treatment-induced bone loss. Routine CT imaging is a convenient screening modality to identify those at highest risk for osteoporosis who warrant further evaluation with dual-energy X-ray absorptiometry. Routine bone mineral density assessments 1 year following oophorectomy for cancer treatment may be warranted in this population.

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