CT Colonography Screening Program Achieves Significant Milestones

A recent comprehensive study spanning over two decades has highlighted significant benchmarks in the implementation of CT colonography (CTC) screening, a non-invasive method for colorectal cancer (CRC) detection. Researchers from the University of Wisconsin School of Medicine and Public Health, led by Dr. Perry Pickhardt, published their findings on July 23, 2025, in the American Journal of Roentgenology, detailing the results of nearly 12,000 patients and over 15,000 screening exams conducted between April 2004 and March 2024.

CT colonography has been recognized for its efficacy in CRC prevention, as it not only detects colorectal polyps but also assesses extracolonic findings. The study reported that of the 15,431 screening examinations, 15.9% identified polyps measuring 6 mm or larger, with a positive predictive value of 91.6%. Furthermore, the examinations revealed a 0.2% detection rate of histologically confirmed adenocarcinoma and identified advanced adenomas in 4% of cases, underscoring the potential of CTC in early cancer intervention. Notably, the screening also detected unexpected extracolonic malignancies in 0.4% of cases and abdominal aortic aneurysms in 0.3%.

The context of these findings is particularly significant as CTC screening has not gained the traction expected since its introduction, with utilization rates declining sharply. The annual volume of CTC procedures for primary evaluation plummeted from a peak of 1,589 in 2005 to just 72 in 2023. This downturn has raised concerns among healthcare professionals regarding the future of CTC in CRC screening protocols.

Dr. Pickhardt and colleagues emphasize the need for standardized procedures and dedicated centers to enhance the consistency and quality of CTC screenings. The research team implemented a range of quality assurance measures, including the use of dedicated software for polyp detection and a comprehensive clinical database to document case results. This structured approach has set a standard for practices aiming to establish effective CTC screening programs.

Despite these advancements, the study authors noted that factors such as the rise of stool DNA testing, particularly Cologuard, and a general lack of awareness and acceptance among gastroenterologists and primary care providers have contributed to the diminished role of CTC in CRC screening. As Dr. Pickhardt stated, 'Through proper technique, CTC screening can provide non-invasive CRC prevention that is lacking with stool-based tests and avoid complications associated with primary optical colonoscopy screening.'

Looking to the future, the recent decision by Medicare to cover CTC screenings starting January 2025 is anticipated to boost CTC utilization rates. However, experts urge that without addressing the systemic barriers and enhancing outreach to healthcare providers, the potential of CTC as a critical tool in colorectal cancer prevention and detection may remain underutilized.

In conclusion, this 20-year programmatic analysis not only establishes benchmarks for CTC screening but also underscores the need for a concerted effort to reinvigorate interest and utilization in this crucial area of preventative health care. As the healthcare landscape continues to evolve, the role of CTC in colorectal cancer screening may become increasingly vital, provided that stakeholders commit to addressing the current challenges and enhancing patient education and provider engagement.