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Colon cancer screening strategies.
1Brigham and Women's Hospital, Boston, Massachusetts, USA.
Current Opinion in Gastroenterology
|February 3, 2005
Summary
Fecal DNA testing shows improved sensitivity for colorectal cancer detection compared to fecal occult blood tests. However, the higher cost requires further study in larger populations to confirm its value in screening.
Area of Science:
- Gastroenterology
- Oncology
- Public Health
Background:
- Colorectal cancer screening is a public health priority.
- Fecal occult blood testing (FOBT) is common but has limitations including low sensitivity and compliance.
- Innovations in stool testing aim to overcome FOBT limitations.
Purpose of the Study:
- To review innovations in stool testing for colorectal cancer.
- To compare the performance of fecal DNA testing with FOBT.
- To assess the cost-effectiveness and clinical utility of new stool tests.
Main Methods:
- Review of recent studies on colorectal cancer screening methods.
- Analysis of performance characteristics (sensitivity, specificity) of fecal DNA tests.
- Comparison of fecal DNA testing with guaiac-based fecal occult blood testing (gFOBT).
Main Results:
- Fecal DNA tests demonstrate higher sensitivity for colorectal cancer (62-91%) and adenomas (26-73%) than gFOBT.
- Specificity of fecal DNA tests is high (93-100%).
- gFOBT has high false-positive/negative rates, impacting cost-effectiveness despite low initial cost.
Conclusions:
- Preliminary fecal DNA tests offer improved performance over FOBT.
- The added sensitivity of fecal DNA tests may not yet justify the increased cost.
- Larger cohort studies are needed to compare fecal DNA tests with established screening methods.