Colorectal Cancer Awareness Month: Why Radiologists Should Lead on CT Colonography

Kevin J. Chang, MD, FACR, American College of Radiology Colon Cancer Committee Chair, contributed this piece.

Colorectal cancer (CRC) recently re-entered the public spotlight following several high-profile deaths that underscore a sobering reality — CRC, including early-age onset colorectal cancer (EAOCRC), is affecting people younger than ever. The passings of actors James Van Der Beek, 48, and Chadwick Boseman, 43, have put renewed attention on this disease and on the need for earlier detection and broader screening options.

The epidemiology is troubling. Recent analyses show that CRC has become the leading cancer killer for Americans of both sexes under 50. Not only are more younger people being diagnosed, but they are more often presenting with advanced-stage disease (stage 3 and 4). The reasons for this shift are incompletely understood; most cases are not explained by inherited syndromes. Rather, multifactorial, largely modifiable contributors — diet, obesity, sedentary behavior, and other environmental and lifestyle factors — appear to play prominent roles. These trends helped drive the USPSTF decision in 2021 to lower the recommended starting age for average-risk CRC screening from 50 to 45.

The COVID-19 pandemic amplified an existing problem — constrained endoscopy capacity and delayed screening. In response, non-colonoscopy options such as FIT and fecal DNA testing are more widely used. But among nonendoscopic structural tests, CT colonography (CTC) stands out as the single alternative to conventional optical colonoscopy that combines structural visualization with broad acceptance in guidelines and now improved reimbursement. With Medicare’s recent decision to cover screening CTC — and a growing number of private insurers following suit—financial barriers are largely addressed. Yet, despite improved coverage, CTC remains surprisingly underutilized in many communities.

Why? Much of the skepticism and low uptake falls to radiology practices themselves. Many radiologists and administrators view CTC as an extra procedure with marginal value at a time of rising workload and staff shortages. This attitude has a downstream effect: primary care physicians and patients rarely hear about CTC as a practical screening option, so they continue to rely on FIT or pursue colonoscopy only when capacity allows.

Radiologists must change that narrative. CTC is uniquely well-suited to reach the population at greatest risk from EAOCRC: working-age adults who may be hesitant to undergo sedation, who cannot easily take time off for colonoscopy, or who face local endoscopy backlogs. CTC requires no sedation, no driver, and allows immediate return to normal activities — advantages that are especially meaningful for younger patients balancing employment and family responsibilities. It is an evidence-based, structural screening test that detects advanced neoplasia and cancer with high sensitivity when performed with modern techniques.

What radiology departments can do now:

• Offer CTC as an active service and register your practice on the ACR My CT Colonography Screening Locator Tool. Sites that do not provide CTC miss an opportunity to increase screening access and impact population health.
  
• Update technical protocols. Implement low-dose CT techniques and up-to-date bowel prep and fecal fluid-tagging protocols to optimize lesion detection while minimizing radiation and patient discomfort. 
  
• Train and support radiologists. Encourage colleagues to obtain training in CTC interpretation and to adopt reading workflows that are time-efficient without sacrificing quality. Mentorship, peer review, and structured reporting will speed competence and confidence.
  
• Communicate availability. Proactively notify primary care, gastroenterology, and surgery colleagues that your practice offers CTC. Provide clear referral pathways and patient-facing information that explain CTC’s benefits and logistics.
  
• Educate patients. Highlight that CTC is noninvasive, does not require sedation, and supports a rapid return to work—features attractive to a younger demographic that is increasingly affected by EAOCRC.

Colorectal cancer is changing, and so must the ways we screen for it. As imaging specialists, radiologists have the tools and expertise to make a meaningful impact on CRC screening participation and early detection. By expanding access to CT colonography, updating protocols to the latest technical standards, and training more radiologists to read CTC efficiently, we can help close the gap in screening for younger adults and improve outcomes for patients across the country.

This Colorectal Cancer Awareness Month, let’s commit to making CTC an accessible, well-publicized, and high-quality option in every community. The evidence and the need are clear —now is the time for radiology to step forward.