Colon cancer screening: which non-invasive filter tests?

Area of Science:

• Gastroenterology
• Oncology
• Preventive Medicine

Background:

• Non-invasive stool tests are crucial for colorectal cancer (CRC) screening.
• Guaiac-based fecal occult blood tests (gFOBT) reduce CRC mortality but have low sensitivity for adenomas.
• Immunochemical fecal occult blood tests (iFOBT) offer improved detection of human blood in stool.

Purpose of the Study:

• To compare the efficacy of different non-invasive stool tests for CRC screening.
• To evaluate the potential of iFOBT in reducing CRC incidence and mortality.
• To review emerging stool-based CRC screening technologies.

Main Methods:

• Review of randomized controlled trials and European CRC screening guidelines.
• Comparison of guaiac-based FOBT (gFOBT), immunochemical FOBT (iFOBT), genetic stool tests, and M2-PK.
• Analysis of sensitivity and specificity for detecting colorectal cancers and advanced adenomas.

Main Results:

• iFOBT detected more cancers and advanced adenomas than gFOBT in recent studies.
• European guidelines now recommend iFOBT as the preferred CRC screening test.
• Genetic stool tests and M2-PK show potential but require further validation in screening populations.

Conclusions:

• iFOBT represent a significant advancement in CRC screening, with the potential to reduce both incidence and mortality.
• Further research is needed to determine optimal cut-off values and sample requirements for iFOBT.
• Modified genetic tests and M2-PK warrant further investigation for CRC screening efficacy.