USPSTF Approval of CT Colonography a “Big Win for Patients”

In a decision many advocates say was a long time coming, the United States Preventive Services Task Force (USPSTF or Task Force) has finally recommended CT colonography (CTC) as an acceptable option for colon cancer screening.

In final recommendations published in the June 21 issue of the Journal of the American Medical Association, the USPSTF reaffirmed a 2008 recommendation to screen all adults ages 50 to 75 for colon cancer. In addition, CTC was listed as one of the acceptable options for colorectal cancer screening (in addition to colonoscopy, flexible sigmoidoscopy, guaiac-based fecal occult blood test, fecal immunochemical test and multi-targeted stool DNA test.)

In its recommendation statement, the Task Force stated that screening for colorectal cancer has been a “substantially” underused preventive health strategy in the U.S.

“In addition, there are no empirical data to suggest that any of the strategies provide a greater net benefit,” the Task Force noted. “Accordingly, the best screening test is the one that gets done, and the USPSTF concludes that maximizing the total proportion of the eligible population that receives screening will result in the greatest reduction in colorectal cancer deaths.”

Judy Yee, MD, professor and vice chair of radiology and biomedical imaging at the University of California, San Francisco, and chair of the American College of Radiology’s Colon Cancer Committee, called the recommendations “the culmination of many years of hard work and research demonstrating the effectiveness and safety of CTC as a screening tool for colorectal cancer.

“Although this is a long overdue triumph for CTC advocates, most importantly this is a big win for patients,” said Dr. Yee, a member of RSNA’s Public Information Advisors Network and former chair of the Society’s Public Information Committee. “CTC is a safe and minimally invasive exam that may be more appealing to some patients and will help bring them in to get screened. No sedation is required so that patients can return to normal daily activities immediately after the scan making it a more convenient test for many people.”

Dr. Yee said that the Affordable Care Act requires private insurers to cover all screening tests recognized by the USPSTF and that the Centers for Medicare and Medicaid Services will likely follow the USPSTF lead, resulting in Medicare coverage of CTC.

CTC Results in a “Net Benefit”

The USPSTF decision to recognize CTC as an acceptable colon cancer screening tool was a “pleasant surprise” said Perry Pickhardt, MD, professor of radiology at the University of Wisconsin, Madison, a member of RSNA’s Public Information Advisors Network and a noted CTC expert who has published more than 100 peer reviewed papers on the topic.

“We wondered whether at this point it just wasn’t going to happen,” Dr. Pickhardt said.

Just last year the Task Force issued a draft recommendation stating there was a lack of “mature evidence” showing CTC as a satisfactory option for colon cancer screening, he said.

Dr. Pickhardt believes the USPSTF has been hesitant to greenlight CTC because of concerns related to associated radiation exposure as well as the extracolonic findings that can be a by-product of CTC.

“I think there was just a lack of understanding about the data and confusion surrounding those two factors that are unique to CTC,” he said.

However, he points out that research has shown a possible net benefit in detecting incidental extracolonic findings such as previously undisclosed abdominal aortic aneurysms and osteoporosis.

On the other hand, potential harms associated with extracolonic findings include the possibility of further work-ups and increased patient expense and anxiety for something that may actually be benign, he said.

“But if handled correctly and responsibly — which every radiologist should do for any CT scan he or she reads — on balance CTC will result in a net benefit because of all of that information we gain outside the colon,” he said. “When you take into account all of the advantages of screening with CTC, in my opinion it is the best test — by far.”

With private insurance coverage guaranteed — and possible Medicare coverage down the road — the demand for CTC is likely to increase, Dr. Pickhardt said.

“The big take away for radiologists is that we need to gear up for CTC in terms of training and being able to provide the service,” Dr. Pickhardt said. “Right now, as a community, we are nowhere near the point where we can handle a huge increase in demand. Every radiology group is going to have to figure this out.”