CRC screening must be optimized to reach the golden target of reducing incidence of the disease and eventually mortality. Most importantly we need to achieve high rates of participation and adherence in different screening programs by seeking correction of all the confounding factors.
Benefiting from all the available screening tools in the correct settings of each population will increase the compliance of different populations.
Consistent with this goal, adoption of cost-effective non-invasive methodologies designed to reduce complications, reduce anxiety over CRC screening, and improve overall acceptance of the screening process would be highly desirable. Despite the current limitations and caveats, blood based markers may have a solid future. Screening with a relatively inexpensive serum or plasma marker or marker panel could increase screening compliance and be cost-saving if participation and performance were both elevated.
Such a marker has the potential to replace more cumbersome stool based test in programs that employ a 2-stage paradigm.
All the initial enthusiasm raised by the new blood marker have now faded as the rather disappointing results from the prospective trials were published. At this point due to the significant variability in sensitivity and specificity between various trials, it is very difficult to recommend it for mass screening. Other potential options include the noninvasive stool tests and in that regard the FIT seems to still be the most appropriate due to the present prohibitive cost of the multi-strain stool DNA test and the lack of significant difference in their performance.
Colonoscopy is still the most appropriate test in high risk individuals or as second procedure following a positive first test. Future studies should not only focus on the statistical performance of different tests but also on the characterization of complete screening programs, from the invitation to screening to the completion of colonoscopy for patients with a positive test.
Manuscript source: Invited manuscript. Specialty type: Gastroenterology and hepatology. Country of origin: Lebanon. Peer-review report classification. Grade A Excellent : 0.
Conflict-of-interest statement: No potential conflicts of interest. Peer-review started: April 10, First decision: April 21, Article in press: June 19, National Center for Biotechnology Information , U. Journal List World J Gastroenterol v. World J Gastroenterol. Published online Jul Iyad A Issa and Malak Noureddine. Author information Article notes Copyright and License information Disclaimer.
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version. Published by Baishideng Publishing Group Inc. All rights reserved. This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers.
This article has been cited by other articles in PMC. Abstract Colorectal cancer CRC is a significant cause of morbidity and mortality worldwide. Table 1 Updated guidelines of the various societies regarding colorectal cancer screening. Open in a separate window. CTC CTC or virtual colonoscopy is a rapid radiographic non-invasive imaging test that requires no sedation with lower procedural risks compared to colonoscopy[ 63 - 65 ].
Methylated SEPT9 Septins are a group of scaffolding proteins that provide structural support during cell division[ 76 ]. Figure 1. Figure 2. References 1. Global cancer statistics, CA Cancer J Clin. Int J Cancer. Colorectal cancer statistics, Bond JH. Fecal occult blood test screening for colorectal cancer. Gastrointest Endosc Clin N Am. Global cancer statistics.
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Screening for colorectal cancer: a guidance statement from the American College of Physicians. Ann Intern Med. Colorectal Cancer Screening, Version 1. J Natl Compr Canc Netw. Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison. Surveillance, Epidemiology, and End Results Program. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. Long-term colorectal-cancer incidence and mortality after lower endoscopy.
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Colonoscopy screening markedly reduces the occurrence of colon carcinomas and carcinoma-related death: a closed cohort study. Gastrointest Endosc. Association of colonoscopy and death from colorectal cancer. Ransohoff DF. How much does colonoscopy reduce colon cancer mortality? The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer.
Sandler RS. Editorial: colonoscopy and colorectal cancer mortality: strong beliefs or strong facts? Am J Gastroenterol. Neugut AI, Lebwohl B. Colonoscopy vs sigmoidoscopy screening: getting it right. Influence of long-term colonoscopic surveillance on incidence of colorectal cancer and death from the disease in patients with precursors adenomas Acta Oncol. Protection from colorectal cancer after colonoscopy: a population-based, case-control study.
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Quality indicators for colonoscopy and the risk of interval cancer. Wide variation in adenoma detection rates at screening flexible sigmoidoscopy. Endoscopist specialty is associated with incident colorectal cancer after a negative colonoscopy.
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Population screening for colorectal cancer means getting FIT: the past, present, and future of colorectal cancer screening using the fecal immunochemical test for hemoglobin FIT Gut Liver. Screening for colorectal neoplasms with new fecal occult blood tests: update on performance characteristics. Allison JE, Lawson M. Colorectal cancer screening has never been easier. Accurate colorectal screening. InSure ONE qualitatively detects human hemoglobin from blood in fecal samples, 5 which may be an indication of lower gastrointestinal bleeding associated with disorders such as diverticulitis, ulcerative colitis, polyps, colorectal cancers, or large adenomas that bleed.
The assay uses monoclonal antibodies to capture human hemoglobin on a test strip. Patient reminder program improves kit return rates. As a leader in colorectal cancer screening, we know that every kit returned could save a life by early detection. Our InSure ONE integrated reminder program helps encourage test compliance by sending reminder messages to patients to complete and return their collection kits.
Patient-friendly collection. There are no dietary or medicinal restrictions. Patients collect 2 water-based samples from a single bowel movement. Patient instructions - English. Patient instructions - Spanish. Please contact your Quest Diagnostics representative for instructions in additional languages.
How to get started. If you would prefer to order kits over the phone, please call 1. This article has been cited by other articles in PMC. Associated Data Supplementary Materials Web supplement. Abstract Objective In primary care, assessing which patients with bowel symptoms harbour significant disease cancer, higher-risk adenoma or IBD is difficult. Design From October to March , general practitioners were prompted to request FHb and FC when referring patients with bowel symptoms to secondary care.
Results patients returned samples. Significance of this study. What is already known on this subject? What are the new findings?
FHb and FC can be measured from a single sample of faeces collected at home. How might it impact on clinical practice in the foreseeable future? Introduction Patients presenting to general practitioners GPs describing new bowel symptoms can be difficult to assess.
Methods This prospective study gained the full support of GPs and was conducted following the STAndards for the Reporting of Diagnostic accuracy studies guidelines. Results In total, patients were referred for investigation. Open in a separate window. Figure 1. Figure 2. Figure 3. Faecal test performance The advantage of using quantitative assays is that cut-off concentrations that trigger a positive test result can be altered to regulate positivity rates and diagnostic accuracy table 2.
NPV, negative predictive value. Discussion This study demonstrates that patients presenting to primary care with bowel symptoms can be assessed with faecal tests and the results can help determine whether further investigation is required. Supplementary Material Web supplement: Click here to view. References 1. NICE clinical guideline 27; Referral guidelines for suspected cancer. NICE guideline; Suspected cancer: recognition and management of suspected cancer in children, young people and adults.
Value of symptoms and additional diagnostic tests for colorectal cancer in primary care; systematic review and meta-analysis. BMJ ; :c Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on colorectal cancer.
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