Optimization of screening strategies for colorectal cancer based on fecal DNA and occult blood testing

Abstract

Background Fecal DNA and occult blood testing have been gradually developed for colorectal cancer (CRC) screening. Comparison of different testing strategies for these methods in CRC screening is in urgent need. This study aims to examine the efficacy of different testing strategies including multi-target fecal DNA testing, qualitative and quantitative fecal immunoassay tests (FITs). Methods Fecal samples were collected from patients diagnosed by colonoscopy. Tests using fecal DNA, quantitative FIT or qualitative FIT were performed on same fecal samples. Efficiency of different testing strategies within different populations was investigated. Results For high-risk populations (CRC and advanced adenoma), the positive rate of the three methods alone was 74.3–80%; the positive predictive values (PPVs) ranged from 37.3% to 77.8%, and the negative predictive values (NPVs) ranged from 86.3% to 92.2%. For combined testing strategies, the positive rate was 71.4–88.6%, PPVs ranged from 38.3% to 86.2%, and NPVs ranged from 89.6% to 92.9%. Parallel fecal multi-target DNA test and quantitative FIT appears to be superior when using a combined testing strategy. For the normal population, no significant difference was identified in efficacy between these methods when used alone and in combination. Conclusions Single testing strategy among the three methods is more suitable for the general population screening, and the combined testing strategy is more suitable for high-risk populations screening. The use of different combination strategies may have superiority in CRC high-risk population screening, but cannot conclude significant differences which may be attributed to the small sample size, large samples controlled trials are needed.

The Detection of Colorectal Cancer through Machine Learning-Based Breath Sensor Analysis

“…Since CRC lacks specific symptoms in its early stages, early detection becomes a critical factor in preventing metastases, reducing mortality, and improving future life expectancy and quality [3]. In many developed countries, screening programs are considered fundamental public health services aimed at detecting precancerous lesions in the colon and identifying CRC in its early stages [4].…”

Current Status and Emerging Trends in Colorectal Cancer Screening and Diagnostics

“…So far, several standard diagnostic modalities have contributed to the early intervention and improved management of CRC and patient outcomes. These modalities encompass screening tests such as fecal occult blood tests (FOBT), fecal immunochemical tests (FIT), and stool DNA tests, as well as standard diagnoses such as colonoscopy, which directly visualizes a biopsy of abnormal tissue or polyps, or computed tomographic colonography (CTC) as a less invasive alternative [7,8]. Furthermore, blood-based biomarkers, such as carcinoembryonic antigen (CEA) and circulating tumor DNA (ctDNA), have also demonstrated promise as non-invasive screening modalities for CRC.…”