Noninvasive screening tests for colorectal cancer.

Dig Dis 2012 23;30 Suppl 2:16-26. Epub 2012 Nov 23.

Indiana University School of Medicine, Regenstrief Institute, Inc. and Richard L. Roudebush VA Medical Center, Indianapolis, Indiana 46202, USA.

Background: Identifying an accurate, reliable, affordable, and acceptable noninvasive screening test for colorectal cancer (CRC) would greatly facilitate population screening.

Methods: Published literature from 2000 through February 2012 on noninvasive CRC screening tests was identified, reviewed, and summarized.

Results: The highest quality evidence for noninvasive screening exists for guaiac-based fecal occult blood tests (gFOBTs), for which the CRC-specific incidence and mortality reductions are modest. Fecal immunochemical tests (FITs) offer better sensitivity and comparable specificity. Cross-sectional studies comparing gFOBTs and FITs suggest that FITs provide higher detection of advanced neoplasia. Modeling studies favor FITs over gFOBTs with respect to effectiveness and cost-effectiveness. A myriad of studies report the performance of fecal-based and blood-based genetic and protein-based biomarkers; the studies differ in patient population assembled, marker selection, and assay methods. Several markers and panels of markers are promising, although nearly all studies focus on new markers and/or assay methods on small sets of referred patients rather than validating markers using optimal assays in a screening setting.

Conclusion: In the absence of long-term randomized trials, adoption of the noninvasive tests will require cross-sectional data on test characteristics obtained from the screening setting, where CRC prevalence is low and the full spectrum of colorectal findings exists, along with estimates of cumulative risks, benefits, and cost-effectiveness. Test adoption will ultimately depend on test characteristics, availability, affordability, and user appeal. There is no noninvasive substitute for the currently recommended screening tests. FITs should replace gFOBTs wherever gFOBTs are used for screening.

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http://dx.doi.org/10.1159/000341884DOI Listing
June 2013
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References

(Supplied by CrossRef)

Gutierrez-Ibarluzea I et al.
Int J Technol Assess Health Care 2008

Arditi C et al.
Endoscopy 2009

Levin B et al.
Gastroenterology 2008

Levin B et al.
CA Cancer J Clin 2008

Ann Intern Med 2008

Rex DK et al.
Am J Gastroenterol 2009

Kahi CJ et al.
Clin Gastroenterol Hepatol 2009

Winawer SJ et al.
The National Polyp Study Workgroup. N Engl J Med 1993

Zauber AG et al.
N Engl J Med 2012

Frazier AL et al.
JAMA 2000

Heitman SJ et al.
PLoS Med 2010

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