CT colonography screening: ready for prime time?

Every year more than one million new patients are diagnosed with colon cancer worldwide. Although multiple prospective randomized trials and observational studies have demonstrated that mortality from colon cancer can be reduced with screening and removal of adenomatous polyps, compliance with screening guidelines remains low. Recent CT colonography (CTC) trials have shown that CTC is capable of demonstrating adenomatous polyps > or =10 mm (and in most cases > or = 6 mm) with sensitivities comparable to those for optical colonoscopy. Based on these results, at least two expert panels have recommended CTC as an option for colorectal cancer screening. Despite these endorsements, the Centers for Medicare and Medicaid Services (CMS) in the United States recently decided to deny coverage of CTC for colorectal cancer screening. This article addresses the reservations raised by CMS and provides a perspective on whether CTC is ready for routine use as a colorectal cancer screening test.