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Updated: Jun 25, 2026

Evaluation of Colorectal Cancer Risk and Prevalence by Stool DNA Integrity Detection
Published on: June 8, 2020
Stool test for colorectal cancer screening--it's time to move!
S M Loitsch1, Y Shastri, J Stein
1St. Elisabethen-Krankenhaus, Frankfurt Institute of Preventive Oncology, Germany.
Fecal occult blood testing (FOBT) is crucial for colorectal cancer (CRC) screening. Immunological FOBTs (iFOBTs) offer higher sensitivity and specificity than older methods, making them a cost-effective screening approach.
Area of Science:
- Gastroenterology
- Oncology
- Medical Diagnostics
Background:
- Fecal occult blood testing (FOBT) is a primary screening method for colorectal cancer (CRC).
- Guaiac-based FOBTs (gFOBTs) have limitations including low sensitivity and poor patient compliance.
- Emerging fecal protein and DNA tests show promise but have drawbacks.
Purpose of the Study:
- To evaluate the performance of different FOBT methods for colorectal cancer screening.
- To compare the sensitivity, specificity, and cost-effectiveness of gFOBT, iFOBT, and fecal DNA testing.
- To identify the most suitable non-invasive screening strategy for CRC.
Main Methods:
- Review of existing literature on FOBT, fecal protein detection, and fecal DNA analysis for CRC screening.
- Comparison of diagnostic performance metrics (sensitivity, specificity) of various tests.
- Assessment of cost-effectiveness and practical limitations of each screening method.
Main Results:
- Immunological FOBTs (iFOBTs) demonstrate significantly higher sensitivity and specificity compared to gFOBTs.
- iFOBTs are not affected by dietary or drug restrictions, improving usability.
- Fecal DNA testing shows high specificity (93-100%) and sensitivity (62-91% for CRC) but is currently cost-prohibitive.
Conclusions:
- iFOBTs represent the most cost-effective non-invasive screening method for colorectal cancer currently available.
- While fecal DNA testing shows potential, its high cost limits its widespread adoption for CRC screening.
- Continued research into advanced fecal-based biomarkers is essential for improving early CRC detection.
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