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CT Colonography Update
by Duncan S. Barlow, MD

Duncan Barlow
Senior Radiologist

In June of 2016 the United States Preventive Services Task Force (USPSTF) updated its 2008 recommendation for colorectal cancer screening (CRC). The USPSTF issued a grade of “A” to CRC screening of adults between the ages of 50 and 75. CT Colonography (CTC) was included as one of the 7 recognized screening exams for colon cancer screening in the expert panel’s final recommendations. The other CRC screening exams include optical colonoscopy, flexible sigmoidoscopy, the guaiac-based fecal occult blood test, the fecal immunochemical test, the multi-targeted stool DNA test, and the methylated SEPT9 DNA test. These recommendations were published in the most recent Journal of the American Medical Association. (JAMA. 2016;315(23):2564-2575.)

This caps an 8 year push for establishing CTC as a legitimate screening exam for CRC screening. Beginning back in 2008, the American Cancer Society, the American College of Radiology and the Multi-Society Task Force on Colorectal Cancer endorsed CTC as a primary screening tool for colorectal cancer screening. In 2013 an FDA advisory panel, made up of members of the FDA’S Gastroenterology-Urology panel and the Radiological Devices Panel, both subsets of the agencies Medical Devices Advisory Committee, endorsed CTC as a primary screening tool for colon cancer.

Since 2008 multiple large center clinical trials and research studies, both here and abroad have demonstrated CTC to be as accurate as colonoscopy in screening patients 50 years and older for significant polyps. Studies have also shown that CTC is the people’s choice over Optical Colonoscopy for initial screening of CRC. A recent study also demonstrated screening Medicare patients with CT Colonography would reduce CRC screening costs by 29% and save Medicare up to $1.7 billion per screening cycle. (Pyenson B, Pickhardt PJ, Sawhney TG, Berrios M. Medicare cost of colorectal cancer screening: CT colonography vs. optical colonoscopy. Abdominal Imaging. 2015;40(8):2966-2976).

The immediate effect of this updated recommendation by the USPSTF is that under Section 2713 of the Affordable Care Act, all private health plans must now provide coverage without cost-sharing (i.e. copayments, deductibles or co-insurance requirements) to patients undergoing CRC screening by any of the 7 recognized screening exams. These requirements apply to all private plans including individual, small group, large group and self-insured plans in which employers contract administrative services to a third-party payer. It is expected that the Centers for Medicare and Medicaid services will soon follow suit endorsing CTC as a recognized screening exam for CRC screening.

CRC is the second leading cause of cancer death in the United States. According to the American Cancer Society, more than 134,000 people will develop colorectal cancer in 2016. Approximately 49,000 individuals will die of the disease. EagleEye Radiology has been providing quality CTC screening services via a teleradiology network for the last six years. EagleEye Radiology will continue to provide these services in the soon to be expanding CRC screening arena.

Dr. Barlow brings to EagleEye 29 years of skilled radiology expertise and training from the nation's most prestigious military medical institutions. He is presently a member of the Colon Cancer Committee of the American College of Radiology.