Next-Generation Noninvasive Colorectal Cancer Screening

Area of Science:

• Oncology
• Gastroenterology
• Public Health

Background:

• Colorectal cancer (CRC) screening is crucial for early detection and prevention.
• Current screening methods, including fecal immunochemical testing (FIT), face challenges in participation and sensitivity.
• Expanding screening eligibility to individuals over 45 necessitates improved and accessible screening options.

Purpose of the Study:

• To review the evolution and effectiveness of noninvasive colorectal cancer (CRC) screening tests.
• To compare the performance of novel CRC screening technologies against established methods like FIT.
• To evaluate the potential of new noninvasive tests in addressing CRC screening disparities and limitations.

Main Methods:

• Review of US Food and Drug Administration-approved noninvasive CRC screening tests.
• Analysis of clinical trial data for multitarget stool DNA, stool RNA, and blood-based cell-free DNA tests.
• Comparison of sensitivity and specificity for CRC and advanced adenoma detection against FIT.

Main Results:

• New noninvasive tests demonstrate improved CRC sensitivity compared to FIT, but not specificity.
• Fecal-based multitarget tests show enhanced sensitivity for advanced adenomas versus FIT.
• Blood-based tests show regressed advanced adenoma sensitivity compared to FIT.
• CRC detection sensitivity is comparable across age groups (<50 and >50 years).

Conclusions:

• Novel noninvasive CRC screening tests offer improved sensitivity, potentially increasing screening participation.
• These tests may help overcome barriers associated with colonoscopy and address screening disparities.
• Further evaluation is needed, particularly for advanced adenoma detection in blood-based tests.