OBJECTIVE. Extracolonic findings at screening CT colonography (CTC) represent imaging findings incidentally detected outside the colon and rectum. Confusion regarding rates reported in the literature fuels controversy over the relative benefits versus harms of extracolonic findings. CONCLUSION. From an evidence-based approach, this article reviews the prevalence and benefits of and challenges raised by extracolonic findings, as well as opportunities to further leverage the effect of screening CTC. The role of the radiologist in handling these lesions responsibly is emphasized.