Stool-Based Tests for Colorectal Cancer Screening: Performance Benchmarks Lead to High Expected Efficacy

Area of Science:

• Gastroenterology
• Oncology
• Preventive Medicine

Background:

• Colorectal cancer (CRC) screening participation in the USA remains below target goals.
• Non-invasive screening methods are crucial for improving patient adherence and overall screening rates.
• Advancements in stool-based and blood-based tests offer potential solutions for early CRC detection.

Purpose of the Study:

• To review recent literature on the performance of stool-based colorectal cancer screening tests.
• To discuss the expectations and potential impact of emerging non-invasive screening technologies for CRC.
• To evaluate current strategies for improving CRC screening participation.

Main Methods:

• Literature review of recent studies on stool-based and blood-based colorectal cancer screening tests.
• Comparative analysis of the sensitivity, specificity, and adherence rates of different screening modalities.
• Evaluation of the potential of emerging non-invasive tests to reduce CRC incidence and mortality.

Main Results:

• Stool-based CRC screening tests demonstrate effectiveness in detecting screen-relevant colorectal neoplasia.
• Multi-target stool DNA (MT-sDNA) testing shows higher adherence and superior sensitivity for detecting precancerous lesions compared to fecal immunochemical testing (FIT).
• Emerging blood-based tests require robust performance in detecting CRC and high-risk polyps to achieve clinical significance.

Conclusions:

• Stool-based CRC screening tests are expected to decrease CRC incidence and mortality by enabling early detection.
• Improved adherence and sensitivity of tests like MT-sDNA offer a promising approach to meet CRC screening goals.
• Future non-invasive screening tests, particularly blood-based assays, must demonstrate significant clinical performance to impact CRC outcomes.