A new study finds that CT colonography (CTC) is the most cost-effective colorectal cancer screening strategy for Black adults when real-world adherence patterns are taken into account. The findings underscore the importance of Centers for Medicare & Medicaid Services (CMS) expanded coverage for CTC that began in January 2025 and are a call to action to increase the use of CTC to reduce colorectal cancer disparities. Seeking commentary, including: Why is CT colonography a better strategy for Black adults?

CT colonography can be a very smart strategy when you factor in real-world adherence. Screening only works if people actually show up, and a lot of adults — especially those who've had bad prior experiences or feel mistrust toward the healthcare system — simply avoid colonoscopy altogether. If you offer a prep-light, quicker, less invasive option that feels more approachable, adherence goes up. And in populations where screening delays translate directly into worse outcomes, that matters. For Black adults, the advantage isn't that CTC replaces colonoscopy — it's that it improves participation. If a center is set up correctly, with proper prep, good radiology oversight, and a clear pathway for follow-up, CTC becomes a gateway instead of a detour. You're lowering the activation barrier. People who would otherwise skip screening entirely are now walking in the door. We still have to be honest about the limitations. A meaningful percentage of patients who undergo CTC will still need a traditional colonoscopy if something is found. So adherence remains essential, and patients need to understand there's no way to sidestep responsibility for their own health. But as part of a layered approach, especially in communities where mistrust or discomfort leads to lower screening rates, CTC can become a go-to option that saves lives simply by increasing participation. —Pouyan Golshani, MD | Interventional Radiologist & Founder, GigHz and Guide.MD | https://gighz.com

CTC appears to be a better and more cost-effective method for colorectal cancer screening for Black adults because it addresses several key barriers that have historically contributed to lower screening rates and higher mortality in this population. Black adults experience disproportionately high incidence and deaths from colorectal cancer, in part because traditional colonoscopy screening is less frequently completed due to its invasiveness, need for sedation, and the logistical challenges it creates. CTC is far less invasive, requires no anesthesia, and can be completed quickly, which makes it more acceptable to individuals who may avoid or delay colonoscopy. This improved acceptability directly translates into higher adherence, which is one of the strongest drivers of cost-effectiveness and improved outcomes in real-world screening programs. Since colonoscopies require an escort, time off work, transportation accommodations, and recovery time, it poses significant practical obstacles, especially for Black adults due to systemic disparities in work flexibility, caregiving responsibilities, and access to transportation. CTC removes many of these barriers, allowing patients to return to normal activities immediately after the exam. This ease of scheduling and completion significantly increases the likelihood that individuals will get screened on time and stay up to date. CTC is also highly sensitive in the detection of clinically significant polyps and cancers, making it a reliable option for individuals who are less likely to seek a colonoscopy. When adherence patterns are included in cost-effectiveness modeling, CTC outperforms colonoscopy among Black adults because it leads to more people actually being screened, which is important for closing gaps in early detection. With CMS expanding coverage for CTC in January 2025, financial barriers were reduced to allow for broader access to this screening method that aligns better with patient preferences and real-life circumstances. Increasing the use of CTC has the potential to significantly improve early detection, reduce late-stage diagnoses, and meaningfully address colorectal cancer disparities in the Black community.

For Black adults, CT colonography (CTC) is a better colorectal cancer screening strategy because it overcomes many barriers that have historically limited screening participation and contributed to higher cancer mortality in this population. Unlike traditional colonoscopy, CTC is less invasive, requires no sedation, and can be completed quickly, making it more acceptable and easier to schedule into daily life. This leads to higher screening adherence, which is a major driver of cost-effectiveness and better long-term outcomes. Colonoscopy often requires time off work, transportation, and an escort to the procedure, which are obstacles that disproportionately affect Black adults due to systemic disparities in access and flexibility. CTC eliminates many of these logistical challenges while still providing high sensitivity for detecting significant polyps and cancers within the colon. With CMS expanding Medicare coverage for CTC in 2025, more individuals can access this screening option that aligns with their needs, potentially improving early detection and reducing colorectal cancer disparities.

CT colonography fits Black adults better mainly because it lines up with how people actually follow through on screening. At Health Rising DPC we see this pattern play out all the time. Many patients avoid a traditional colonoscopy because of the prep, the sedation, the time off work, and the anxiety around an invasive procedure. When a test feels like too much, people delay it. That delay is where cancer hides. CTC lowers those barriers. It takes less time, does not require sedation, and usually feels less intimidating. When the process feels manageable, completion rates climb. That matters more than any perfect test on paper. A screening method only protects someone if they actually show up for it. The other piece is that Black adults face a higher risk of colorectal cancer and often get diagnosed later. A test that people are more willing to do on schedule gives earlier detection a real chance. Earlier detection changes outcomes in a way that shows up in survival numbers, not just charts in a study. If you want to walk through which option fits your health history, we can go over it during your next Health Rising DPC visit and map out a screening plan that feels doable.

I'm Dr. Michael Chichak, and as a physician dedicated to providing compassionate primary care and promoting health equity, I feel the study on CT colonography (CTC) really emphasizes the important difference between a treatment working in the lab (efficacy) and actually working for people in their daily lives (real-world effectiveness). To me, CTC looks like a better, more practical strategy for many individuals because it addresses adherence and structural barriers, not because it's clinically better than a colonoscopy itself. Traditional screening, while wonderful at catching cancer, can be quite difficult for people to manage. It involves sedation, time away from jobs, and organizing travel, and these things can, unfortunately, place a greater burden on people facing social or economic challenges, which can lead to fewer people completing the screening. The real advantage of CTC is that it's non-invasive, requires no sedation, and is a much quicker, easier process. The evidence gently suggests that when given a less disruptive choice like CTC, people are simply more willing to take that important step to get screened. By easing those big hurdles related to scheduling and inconvenience, CTC helps more people finish the screening process, which means we find and treat more cancers, ultimately moving us toward reducing health disparities.

The benefit to Black adults of CT colonography is that it is a more streamlined pathway through the screening process than would be the case during the traditional colonoscopy process. A number of Black adults are faced with conflicting demands such as managing work commitments and/or caring for family members; therefore, they are less likely to be able to take time from their busy lives to attend for an appointment to undergo screening. Additionally, CTC will remove some of the barriers to the screening process many people face. The test is shorter in duration compared to colonoscopy and thus there is less risk of complications than colonoscopy and the patient does not need to be sedated before undergoing the test and so can quickly return to their daily routine. Therefore, when a test is an integral part of daily life rather than conflicting with it adherence improves and ultimately, better results are achieved in the long-term. An additional factor supporting the use of CTC is that it can detect the lesions in the colon in which Black adults have more aggressive disease on those areas of the colon that are more difficult to examine using flexible scope technology. The complete picture with close-up images offered by CTC promises to detect earlier on, especially those Black adults that historically have had less opportunity to get screened or have been screened at an older age. Thus, integrating easy access to screening with the full and accurate imaging capabilities of CTC is assisting a screening strategy with the aim of helping to eliminate the significant disparities in outcomes.

CT colonography or CTC emerges as the most cost-effective colorectal cancer screening modality for Black adults when real-world adherence patterns are considered, a finding that validates the Centers for Medicare & Medicaid Services' expanded coverage initiated in January 2025. This advancement represents a crucial opportunity to mitigate the disproportionate colorectal cancer burden borne by Black communities. The superiority of CTC as a screening strategy for Black adults stems from its high acceptability and accessibility compared to traditional colonoscopy and stool-based tests. Unlike colonoscopy, CTC is less invasive and requires no sedation, alleviating patient apprehension and recovery time, which have historically impeded screening adherence in this population. Black adults show higher willingness to undergo CTC, enhancing screening uptake and enabling earlier detection of pre-cancerous lesions. Clinically, CTC provides superior adenoma detection relative to fecal immunochemical testing while maintaining comparable cancer detection rates to colonoscopy. Economically, incorporating real-world screening behavior, models demonstrate that CTC not only improves health outcomes by reducing colorectal cancer incidence and mortality in Black adults but also reduces healthcare expenditures associated with late-stage disease management. The expanded Medicare coverage removes previous financial barriers that limited CTC access, particularly among low-income and underinsured patients who disproportionately represent Black populations. This policy change, coupled with educational and outreach initiatives, could substantially increase screening rates and reduce racial disparities in colorectal cancer outcomes. Ultimately, leveraging CTC's clinical efficacy, patient-friendly profile, and cost-effectiveness offers a strategic pathway to equitable colorectal cancer prevention. Implementation requires coordinated efforts involving healthcare providers, payers, and community stakeholders committed to addressing structural barriers and promoting equitable healthcare access.

Many Black adults experience inconsistent guidance due to gaps in provider access. CT colonography offers clearer pathways where care coordination breaks down. The scan requires fewer complex arrangements across departments. This keeps scheduling simple for people with work constraints. Simplicity increases follow through across entire communities. Better follow through improves early detection across high risk groups. Imaging provides strong visibility of concerning areas for further review. This leads to timely decisions inside resource strained facilities. People trust the process when steps remain transparent and manageable. Strong trust improves outcomes across Black communities.

CT colonography provides better results for Black adults because it connects people at high risk with a screening method that they tend to follow through with. Black adults develop colorectal cancer at higher rates than other groups while showing lower rates of colonoscopy screening. The noninvasive nature of CT colonography combined with its sedation-free procedure and shorter duration makes it easier for patients to access the test because they need to find less time for the procedure and do not require a driver. The modeling study which used actual participation data by racial groups determined that CTC screening every five years delivered better health outcomes at affordable costs for Black adults compared to colonoscopy and stool-based screening methods. The implementation of CTC as a screening method under CMS coverage will help detect cancers at earlier stages while decreasing the requirement for advanced late-stage medical interventions among this population.

Why CTC is a Better Strategy for Black Adults It comes down to removing structural barriers. While optical colonoscopy is clinically excellent, it imposes logistical hurdles that disproportionately affect Black communities due to socioeconomic factors. The Sedation Barrier Traditional colonoscopy requires sedation. This demands a chaperone to drive the patient home and usually necessitates a full day off work. For many Black adults, particularly those in hourly wage positions or without robust support networks, this "cost" is too high. They simply don't show up. CTC Increases Adherence CTC requires no sedation. Patients can drive themselves to the appointment, get scanned in 15 minutes, and return to work immediately. The study highlights "real-world adherence" because an imperfect test that a patient actually completes is infinitely more effective than a "gold standard" test they skip. The Cost-Effectiveness Equation When adherence drops, late-stage cancer diagnoses rise. Treating late-stage colorectal cancer is astronomically expensive compared to early screening. By lowering the barrier to entry, CTC catches pathology earlier. The CMS coverage expansion in January 2025 is a direct acknowledgement of this math. We aren't just looking for the best image anymore; we are looking for the strategy that gets the most people screened. For Black adults, that strategy is CTC.

CT colonography stands out as a better strategy for Black adults because it aligns more closely with the real-world challenges that have historically driven screening disparities. When I look at the data and think about what actually happens in everyday life—not ideal clinical conditions—CTC simply fits the reality many people face. One of the biggest issues is adherence. Traditional colonoscopy requires bowel prep, sedation, a driver, time off work, and in some cases, navigating fears tied to invasive procedures. Studies consistently show that these barriers disproportionately affect Black adults, who already experience higher colorectal cancer incidence and are often diagnosed at later stages. CTC, by contrast, is quick, minimally invasive, and doesn't require sedation. That alone removes two major hurdles: logistical complications and procedural anxiety. Another advantage is accessibility. Because CTC can be offered in radiology settings and doesn't require the same specialized staffing as colonoscopy, it expands the geographic footprint of screening. For communities that struggle with limited access to gastroenterology services—an issue that affects many predominantly Black neighborhoods—this makes a real difference. What really resonates with me is the impact on early detection. When screening is easier to complete, more people actually complete it. And when adherence goes up, cancer is caught earlier, when treatment is most effective. That's where the cost-effectiveness comes from: fewer late-stage diagnoses, fewer costly interventions, and better outcomes. CMS expanding coverage in 2025 feels like a pivotal moment. To me, it's not just a policy shift—it's an opportunity to finally close a gap that has persisted for far too long.