CT colonography utilization remains low in US

CT colonography awareness and utilization in the United States are both trending in the wrong direction, according to a new study published by the Journal of the American College of Radiology.

“With increasing health insurance coverage for CT colonography, there are limited national, population-based estimates of CT colonography utilization over time,” wrote lead author Anand K. Narayan, MD, PhD, department of radiology at Massachusetts General Hospital in Boston, and colleagues. “Our purpose was to estimate longitudinal utilization of CT colonography using nationally representative cross sectional survey data.”

The authors explored 2010 and 2015 data from the National Health Interview Survey, tracking patients between the ages of 50 and 75 with no history of colorectal cancer history. This included more than 8,000 survey respondents from 2010 and more than 12,000 respondents from 2015.

Overall, CT colonography utilization dropped from 1.2 percent in 2010 to 0.9 percent five years later. CT colonography awareness dropped from 20.5 percent to 15.9 percent in the same timeframe. The authors also noted that optical colonoscopy utilization increased from 57.9 percent in 2010 to 63.6 percent in 2015.

“Because overall adherence to colonoscopy screening guidelines remains suboptimal, particularly in marginalized patient populations, the results highlight the importance of promoting CT colonography as a viable test for colorectal cancer screening,” the authors wrote.

The research also revealed “statistically significant increases” in utilization of CT colonography among black patients compared to white patients. Black patients are more likely to die from colon cancer, the authors wrote, and CT colonography “may represent a potential pathway by which providers can reduce colorectal cancer disparities.”  

Narayan and colleagues noted that CT colonography has gained more and more attention in recent years—many private insurance providers cover it, and President Obama famously underwent a CT colonography examination in 2017—but Medicare still does not recommend the test for colorectal cancer screening. (The U.S. Preventive Services Task Force recently recommended CT colonography for screening, so Medicare’s coverage could soon change.)

Something else working against increased utilization and awareness, the authors added, is that “many radiology groups are reluctant to actively promote and implement CT colonography screening.”

“Some are concerned about starting turf wars with gastroenterologists,” the authors wrote. “However, introduction of parallel CT colonography screening programs has been associated with increases in both CT colonography and optical colonoscopy rates. With active champions from local radiology practices, radiologists can help to establish high-volume centers of excellence for CT colonography screening.”