ACR Bulletin

Covering topics relevant to the practice of radiology

Saving Lives

Colorectal cancer screening has dropped by 86% during the pandemic — but radiologists can help patients return to care.
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December 01, 2020
The impacts of COVID-19 on healthcare continue to evolve. As radiologists, we face unique opportunities — and challenges — as we work to prioritize safe and quality patient care while we navigate this pandemic.
At the start of the COVID-19 outbreak, most non-emergent healthcare was halted — including cancer screening. Unfortunately, cancer incidence does not stop with the pandemic. For some patients, skipping or postponing screening now could mean a delayed diagnosis, an increased cancer burden, and/or worse outcomes in the future.
Like so many of us, I was deeply saddened to hear the news of actor Chadwick Boseman’s passing as a result of stage IV colon cancer. I was also amazed by his
strength as he persevered through his illness to bring us so many remarkable films and the Black superhero, King T’Challa, in Marvel’s Black Panther. I was deeply moved by the fact that, during his own treatment, he often visited with young cancer patients.
For me, as a Black physician at UT Southwestern Medical Center, the best way I can personally honor his legacy is by working to prevent losing more young Black men like him to colorectal cancer by encouraging screening. Black people have the highest rates of colon cancer of any racial ethnic group in the U.S., according to the American Cancer Society (ACS). Black individuals are about 20% more likely to be diagnosed with colorectal cancer and 40% more likely to die.1 But it doesn’t have to stay that way.
Some have pointed out that Boseman’s death at only 43 makes him even younger than the recommended age at which to begin regular colorectal cancer screening (age 45). That is true, for those at average risk of colorectal cancer. But those with a personal or family history of colorectal cancer or inflammatory bowel disease — or those who are experiencing symptoms like rectal bleeding — might need to start screening before age 45, be screened more often, or get specific tests. Virtual colonoscopy, known medically as CT colonography, is a highly accurate, safe, and minimally-invasive test that is preferred by many who can’t or won’t get a colonoscopy. It is also recommended by the ACS. Virtual colonoscopy takes about 20 minutes, during which pictures are taken of the inside of the colon using a CT scanner. It does not require being put to sleep, so patients can drive themselves to and from the screening and return to their normal daily activities immediately after the test. It can also be performed in a lower risk manner that maintains social distancing in the COVID-19 era. If a pre-cancerous polyp is found, patients can have a follow-up colonoscopy to have it removed before it becomes a cancer (it is estimated that only 14% need to go on to colonoscopy).
Conventional colonoscopy is another option — which is the only other exam that can reliably detect pre-cancer polyps throughout the entire colon before they turn into cancer. It can also be performed in a low-risk manner during the COVID-19 pandemic. Patients will need to be put to sleep for this exam and have a driver, but if a polyp is found, it can be removed during that exam. On average, 30% of patients who should be screened for colorectal cancer don’t get tested — and that was before the pandemic. Unfortunately, colorectal cancer screening has dropped by 86% during the pandemic relative to averages prior to Jan. 20, 2020.2
Radiologists have an opportunity to support the lifesaving benefits of colorectal cancer screening. We need more radiologists to become active in performing and interpreting CT colonography. As a less invasive cancer screening test that requires less PPE than the alternative optical colonoscopy, we can provide a safe and more practical option during and after the pandemic. Pick up the gauntlet and start a CT colonography screening exam in your practice. Encourage patients to return to screening. We can act together to help our patients return to care with the opportunity to save lives



1. American Cancer Society. Cancer facts & figures for African Americans 2019-2021. American Cancer Society, Inc. 2019.
2. Shaukata A, Church T. Colorectal cancer screening in the USA in the wake of COVID-19. Lancet Gastroenterol Hepatol. 2020;5(8):726–727.

Author Cecelia C. Brewington, MD, FACR,  professor and radiologist practicing at UT Southwestern Medical Center in Dallas, and a member of the ACR Colon Cancer Committee and the Commission on Patient- and Family-Centered Care’s Population Health Management Committee