Population-based screening in colorectal cancer - current practice and future developments: faecal biomarkers review

Colorectal cancer (CRC) is the second most common form of malignancy in Europe and North America, and is one of the major causes of cancer death, with a 50.7% 5 year mortality rate. The majority of cases are of a sporadic nature and develop from a pre-cancerous lesion. Screening programmes have been introduced in many countries to detect and treat the condition. These mostly rely on a combination of faecal occult blood tests and endoscopy to guide diagnosis. They are expensive to establish and run, have a potential for false negatives (especially for high risk adenomas and right sided cancers) and they are often unacceptable to a significant percentage of the at-risk population. Consequently many groups have sought sensitive and specific diagnostic biomarkers for CRC and adenomas. These biomarkers form three broad categories: cytogenetic, enzymatic/protein and metabolomic.

Pubmed and Medline databases were searched to identify relevant articles concerning colorectal cancer screening.

Here we provide a review of the current population-based screening possibilities and faecal biomarkers currently under investigation, an assessment of their cost-effectiveness, their efficacy and suggestions for the future of large scale screening in CRC.