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Updated: Oct 27, 2025
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Evaluation of Colorectal Cancer Risk and Prevalence by Stool DNA Integrity Detection
Published on: June 8, 2020
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Retrospective Review of Multitarget Stool DNA as a Screening Test for Colorectal Cancer.
Thomas K Kleinschmidt1,2,3, Austin Clements1,3,4, Mark A Parker1,2
1Brookwood Baptist Health Systems, Birmingham, AL, USA.
The American Surgeon
|July 19, 2021
Summary
Noninvasive multitarget stool DNA testing shows a low positive predictive value for colorectal cancer screening. This screening method is less effective than colonoscopy in detecting adenomas and cancer.
Area of Science:
- Gastroenterology
- Oncology
- Medical Diagnostics
Background:
- Colorectal cancer (CRC) screening is crucial for early detection and improved outcomes.
- Noninvasive screening methods aim to increase patient compliance.
- Multitarget stool DNA (mt-sDNA) testing is a noninvasive option for CRC screening.
Purpose of the Study:
- To evaluate the effectiveness of noninvasive multitarget stool DNA testing for colorectal cancer screening.
- To determine the positive predictive value (PPV) of mt-sDNA testing in a real-world clinical setting.
Main Methods:
- Retrospective review of patients referred for colonoscopy due to a positive Cologuard test.
- Inclusion criteria: positive Cologuard test, referral for colonoscopy.
- Data collected: colorectal cancer diagnosis, advanced adenoma findings, PPV assessment.
Main Results:
- 1.3% PPV for colorectal cancer and 7.7% PPV for advanced adenomas or cancer.
- Only 1.3% of patients with a positive mt-sDNA test were diagnosed with colorectal cancer.
- A significant majority (89.7%) had normal colonoscopies, hyperplastic polyps, or non-advanced adenomas.
Conclusions:
- Multitarget stool DNA testing has an unacceptably low PPV for colorectal cancer screening.
- The test's detection rate for adenomas and cancer is lower than screening colonoscopy.
- While noninvasive, its low PPV limits its utility as a primary CRC screening tool.
