According to the National Cancer Institute, approximately 143,000 Americans will be diagnosed with colorectal cancer and 51,000 will succumb to the disease this year.

Colorectal cancer is the fourth most diagnosed cancer and the second leading cause of cancer related death. As recommend by the American Cancer Society, colorectal screening begins at age 50 for average risk individuals. The “gold standard” test is optical colonoscopy, which involves colonic preparation, conscious sedation and direct visualization of the colonic mucosa using a colonoscope. Other colorectal screening tests include the fecal occult blood test (FOBT) and a double contrast barium enema. CT colonography, also known as virtual colonoscopy, is an alternative to the gold standard and has recently gained support from many insurers and medical associations as a colorectal screening exam.

CT colonography (CTC) was first introduced in 1994. Over the years, the detection of colonic polyps, the precursor of most colorectal cancer has markedly improved. CTC involves the following: a multislice CT scanner, colonic preparation and cleansing, colon insufflation, a colonography workstation, and an experienced reader. The colonic preparation is similar for optical colonoscopy; however, also includes small aliquots of barium sulfate which “tags” any remaining solid stool in the colon to better depict true lesions. An important difference is anesthesia support is not necessary, reducing overall procedure time and cost. Patients can return to normal activity immediately after completion. Complications are rare and overall less than that of the more invasive alternatives. CTC not only images the colon, but also the remainder of the abdomen and pelvis and could serendipitously detect other serious pathology, such as aortic aneurysms and other cancers.

A disadvantage is the inability to biopsy a detected lesion; however, approximately 70% of the screening population will not have polyps. Optical colonoscopy would be recommended for patients with either polyp size of 10mm or greater, or 3 or more polyps measuring 6 – 9mm. Radiation exposure, currently a hot topic in the media and press, is similar to a barium enema or a standard non-contrasted CT of the abdomen and pelvis.

Currently, nearly all insurers cover CTC for diagnostic purposes, for example, incomplete or failed optical colonoscopy, the inability to tolerate anesthesia, or in patients unable to stop blood thinning medication. Over the past few years, several scientific studies have touted CTC’s benefits for the screening population. Subsequently, support for CTC as an accepted colorectal screening exam has gained momentum and is now recommended by the American Cancer Society, American College of Radiology and the American Gastroenterological Association. This has sparked the interest of several third-party insurers in covering CTC as an accepted colorectal screening exam.

If you are due for your colonoscopy, or have been procrastinating for various reasons, discuss the colorectal screening options available with your doctor and see if CT colonography is right for you. When it comes to colorectal cancer, Benjamin Franklin’s old adage, “An ounce of prevention is worth a pound of cure” has never been more truthful.

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