Noninvasive screening tests for colorectal cancer

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background: Identifying an accurate, reliable, affordable, and acceptable noninvasive screening test for colorectal cancer (CRC) would greatly facilitate population screening. Methods: Published literature from 2000 through February 2012 on noninvasive CRC screening tests was identified, reviewed, and summarized. Results: The highest quality evidence for noninvasive screening exists for guaiac-based fecal occult blood tests (gFOBTs), for which the CRC-specific incidence and mortality reductions are modest. Fecal immunochemical tests (FITs) offer better sensitivity and comparable specificity. Cross-sectional studies comparing gFOBTs and FITs suggest that FITs provide higher detection of advanced neoplasia. Modeling studies favor FITs over gFOBTs with respect to effectiveness and cost-effectiveness. A myriad of studies report the performance of fecal-based and blood-based genetic and protein-based biomarkers; the studies differ in patient population assembled, marker selection, and assay methods. Several markers and panels of markers are promising, although nearly all studies focus on new markers and/or assay methods on small sets of referred patients rather than validating markers using optimal assays in a screening setting. Conclusion: In the absence of long-term randomized trials, adoption of the noninvasive tests will require cross-sectional data on test characteristics obtained from the screening setting, where CRC prevalence is low and the full spectrum of colorectal findings exists, along with estimates of cumulative risks, benefits, and cost-effectiveness. Test adoption will ultimately depend on test characteristics, availability, affordability, and user appeal. There is no noninvasive substitute for the currently recommended screening tests. FITs should replace gFOBTs wherever gFOBTs are used for screening.

Original languageEnglish
Pages (from-to)16-26
Number of pages11
JournalDigestive Diseases
Volume30
Issue numberSUPPL.2
DOIs
StatePublished - Nov 2012

Fingerprint

Guaiac
Occult Blood
Hematologic Tests
Colorectal Neoplasms
Cost-Benefit Analysis
Early Detection of Cancer
Population
Cross-Sectional Studies
Biomarkers
Sensitivity and Specificity
Mortality
Incidence
Neoplasms
Proteins

Keywords

  • Colorectal cancer
  • Fecal immunochemical testing
  • Fecal occult blood tests

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Noninvasive screening tests for colorectal cancer. / Imperiale, Thomas.

In: Digestive Diseases, Vol. 30, No. SUPPL.2, 11.2012, p. 16-26.

Research output: Contribution to journalArticle

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