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USPTF calls for more data before offering recommendation on CT colonography

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The U.S. Preventive Task Force has updated its recommendations for screening for colorectal cancer. Previously the task force members suggested starting screening at age 50, but did not set an upper age limit. With this iteration of the guidelines, they have now definitively said that for asymptomatic, average-risk patients, screening should stop at age 75. Although in general I think absolute age cut-offs can be foolish, I understand the attempt here — too many older adults getting colonoscopy with likely little anticipated benefit, while there are 50- to 60ish-year-olds who have never been screened. Better to use limited resources more wisely.

Also of interest to me here in Madison, Wis. is the task force's take on CT colonography. We use this a fair amount here at University of Wisconsin, largely because Dr. Perry Pickhardt who was one of the early pioneers of the technology is a faculty member and many of our other faculty now are also interested and experienced in this technology. So, I am biased, and our guys are really experienced, but I really like "virtual colonoscopy." Although the prep is the same, the gas used is different so patients do not get as much shoulder and other gas pains after the procedure. We have the system set up so that if needed the patient can get an immediate optical colonoscopy, so they do not have to do two preps, which I know patients greatly appreciate. And finally, at least for the CT portion, you don't need sedation, which I find useful in patients with cognitive impairment who may need a colon evaluation for some reason.

Besides for screening, I also use virtual CT to complete the colon evaluation in patients with an obstructing lesion. Obviously, your comfort level with this procedure is likely to be directly correlated with your radiologist's experience reading them. Not surprisingly the USPTF is requiring more data before it can recommend either for or against CT colonography, but I think with time and with more data the task force will come around.