Computed tomography colonography (CTC) use more than doubled in the United Stated during the COVID-10 pandemic with significantly higher utilization in minority populations as well as patients with diseases such as diabetes, cancer, and chronic obstructive pulmonary disease (COPD), according to new research.
For the study, recently published in Clinical Imaging, researchers reviewed data on CTC use from 58,058 adults who participated in the National Health Interview Survey (NHIS) conducted in 2010, 2015, 2018, 2019 and 2021. Ranging in age between 50 to 75, the cohort had no prior history of colorectal cancer (CRC), according to the study.
While the rate of CTC use was relatively low and similar in 2010, 2018 and 2019, the study authors noted a significant spike from 2019 (1.4 percent) to 2021 (3.5 percent). The researchers noted that long wait lists for colonoscopy and limitations with invasive procedures due to COVID-19 concerns led to increased use of CTC as a viable non-invasive option for CRC screening.
“We found higher CTC use coinciding with the COVID-19 pandemic in 2021. … This increase occurred despite radiology backlogs, which were less significant than disruptions experienced by endoscopic services. As a result, despite disruptions caused by the COVID-19 pandemic, CRC screening participation increased to reach 70 % among eligible adults in 2021 (62.8 % via colonoscopy and 10.0 % via (fecal-immunochemical test)),” wrote lead study author Ali Abbas, an MD candidate at the School of Medicine at the University of Texas Southwestern Medical Center in Dallas, and colleagues.
In comparison to 2010 NHIS findings, the researchers found that non-Hispanic Black patients were over 100 percent more likely and Hispanic patients were 73 percent more likely to utilize CTC in 2021. Additionally, those with a household income < 200 percent of the federal poverty level (FPL) were 25 percent more likely to have CTC screening in contrast to people with household income > 400 percent of the FPL, according to the study authors.
“Our results suggest that CTC could serve as an effective approach to increase CRC screening uptake especially among at-risk populations and reduce disparities, as we observed higher CTC utilization among populations who are traditionally less likely to complete CRC screening and disproportionately experience higher CRC burden,” suggested Abbas and colleagues.
Three Key Takeaways
1. Increased CTC use during the COVID-19 pandemic. The use of computed tomography colonography (CTC) more than doubled in the United States during the COVID-19 pandemic, from 1.4 percent in 2019 to 3.5 percent in 2021. The study authors noted this increase may have resulted from long wait lists for colonoscopy and limitations with invasive procedures due to COVID-19 concerns.
2. Higher utilization among minority populations. CTC utilization was significantly higher among minority populations in 2021 compared to 2010. Non-Hispanic Black patients were over 100 percent more likely, and Hispanic patients were 73 percent more likely to use CTC.
3. Increased CTC use among patients with certain conditions. Patients with conditions such as diabetes, cancer, and chronic obstructive pulmonary disease (COPD) showed higher CTC utilization in 2021 compared to 2010. For example, people with COPD were 58% more likely, cancer patients were 29 percent more likely, and those with a history of diabetes were 20 percent more likely to have CTC screening.
People with COPD were 58 percent more likely to opt for CTC screening in 2021 in comparison to 2010. The researchers also noted that people with cancer and those with a history of diabetes were 29 percent and 20 percent more likely, respectively, to have CTC in 2021.
“CTC may offer a less invasive screening alternative that could be particularly suitable for patients who would have to adjust medications (e.g., anticoagulation) prior to colonoscopy and anesthesia, or those at increased risks of procedural complications,” pointed out Abbas and colleagues.
(Editor’s note: For related content, see “A Victory for Radiology: New CMS Proposal Would Provide Coverage of CT Colonography in 2025,” “Study: Deep Learning Reconstruction Reduces Effective Dosing for CT Colonography by 83 Percent” and “Emerging Perspectives on Computed Tomography Colonography.”)
In regard to study limitations, the authors noted the retrospective nature of the study, self-reported data on CTC use and a lack of detail for determining which patients were at higher risk for CRC.
