Beyond the scope: an update on colon cancer screening tests

Area of Science:

• Gastroenterology
• Oncology
• Preventive Medicine

Background:

• Colorectal cancer (CRC) incidence is increasing in younger adults.
• Screening uptake remains suboptimal, especially in the 45-49 age group.
• Early detection through screening prevents CRC mortality.

Purpose of the Study:

• Review average-risk CRC screening options.
• Provide a framework for selecting CRC screening tests.
• Discuss established and novel screening modalities.

Main Methods:

• Literature review of CRC screening tests.
• Analysis of test characteristics: sensitivity, accessibility, cost, and setting appropriateness.
• Comparison of organized versus opportunistic screening approaches.

Main Results:

• Optimal CRC screening tests are sensitive for advanced precancerous colorectal lesions (APLs) and early CRC.
• Established tests include fecal immunochemical testing, multitarget stool DNA, and colonoscopy.
• Novel tests include stool-based RNA, next-generation stool DNA, and blood-based DNA tests.
• Blood-based tests show lower sensitivity for APLs, potentially hindering prevention.

Conclusions:

• Test uptake, cost, and efficacy guide CRC screening modality selection.
• Colonoscopy and stool-based tests are generally recommended as first-line CRC screening options.