USPSTF: Lack of Evidence for Screening with CT Colonography

Citing a lack of “mature evidence,” CT colonography didn’t make the cut, again, in the USPSTF draft of recommendations on colorectal cancer screening released yesterday, much to the dismay of several radiology and oncology organizations.

The draft recommendation, which is open for public comment until November 2 at 8:15 PM EST, is an update to the 2008 recommendation, which also omitted CT colonography as a recommended screening method. The USPSTF recommends screening with colonoscopy every 10 years, annual fecal immunochemical test (FIT), and annual high-sensitivity guaiac-based fecal occult blood test (gFOBT); and flexible sigmoidoscopy every 10 years combined with FIT annually (in 2008, the recommendation was flexible sigmoidoscopy every five years with FIT every three years).

While the USPSTF noted that the American Cancer Society, American College of Radiology, and the U.S. Multi-Society Task Force (including several gastroenterology organizations) recommend CT colonography as a preferred test, they “found no studies that assessed the impact of screening with CT colonography on cancer incidence, morbidity, quality of life, or mortality.”

The USPSTF cited that extracolonic findings on CT colonography occur in approximately 40%–70% of screening examinations, 5%– 37% of which require diagnostic follow-up, and 3% of which need definitive treatment. The USPSTF cited potential harms include additional diagnostic testing to determine that an abnormality is of no clinical importance, as well as treatment of findings that may never pose a threat to the patient. It also cited radiation-induced cancer as a potential long-term concern with repeated use of CT colonography.

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“It’s disappointing USPSTF disregarded the abundance of evidence showing that CT colonography is a better, more patient-friendly alternative to traditional optical colonoscopy,” Patrick Hope, executive director of MITA, said in a release. “Colon cancer screening is already dramatically underutilized, and we believe greater acceptance of CT colonography would likely increase access to early detection and life-saving treatment.”

A September 2015 article published in Abdominal Imagingclaimed CT colonography is a cost-effective screening option for the Medicare population and would likely reduce Medicare expenditures for colorectal cancer screening.

“The USPSTF draft recommendation could restrict access to a major tool to help achieve the National Colorectal Cancer Roundtable goal of an 80 percent colorectal cancer screening rate by 2018,” Judy Yee, MD, FACR, chair of the American College of Radiology Colon Cancer Committee, said in a release. “As a result, thousands may continue to die each year that could be saved through more widespread screening enabled by CT colonography.”

Let the USPSTF know what you think about their recommendations.