Towards Novel Non-Invasive Colorectal Cancer Screening Methods: A Comprehensive Review

Abstract

Colorectal cancer (CRC) is one of the leading cancer-related causes of death in the world. Since the 70s, many countries have adopted different CRC screening programs which has resulted in a decrease in mortality. However, current screening test options still present downsides. The commercialized stool-based tests present high false-positive rates and low sensitivity, which negatively affects the detection of early stage carcinogenesis. The gold standard colonoscopy has low uptake due to its invasiveness and the perception of discomfort and embarrassment that the procedure may bring.In this review, we collected and described the latest data about alternative CRC screening techniques that can overcome these disadvantages. Web of Science and PubMed were employed as search engines for studies reporting on CRC screening tests and future perspectives. The searches generated 555 articles, of which 93 titles were selected. Finally, a total of 50 studies, describing 14 different CRC alternative tests, were included. Among the investigated techniques the main feature that could have an impact on CRC screening perception and uptake was the ease of sample collection. Urine, exhaled breath and blood-based tests promise to achieve good diagnostic performance (sensitivity of 63-100%, 90-95%, 47-97%, respectively) while minimizing stress and discomfort for the patient.

Short-chain fatty acid concentrations in the incidence and risk-stratification of colorectal cancer: a systematic review and meta-analysis

“…Among the current CRC screening methods, colonoscopy is the gold standard (Davidson et al 2021) however, being invasive it presents some procedural risk (Ferrari et al 2021). The guaiac fecal occult blood test (gFOBT) and fecal immunochemical test (FIT) are other, in practice, non-invasive stool-based methods for CRC screening, which however require improvement, in particular for detection of CRA or early-stage colonic carcinogenesis (Ferrari et al 2021;Imperiale et al 2019;Jodal et al 2019). Fecal SCFA could be considered as a potential non-invasive biomarker to be measured in combination with or as an alternative to the commonly used non-invasive and current CRC screening methods (Anghel et al 2021;Ferrari et al 2021), to improve specificity and sensitivity of current screening, as well as for potential early detection of CRA.…”

“…2021). The guaiac fecal occult blood test (gFOBT) and fecal immunochemical test (FIT) are other, in practice, non-invasive stool-based methods for CRC screening, which however require improvement, in particular for detection of CRA or early-stage colonic carcinogenesis (Ferrari et al . 2021; Imperiale et al .…”

“…Fecal SCFA could be considered as a potential non-invasive biomarker to be measured in combination with or as an alternative to the commonly used non-invasive and current CRC screening methods (Anghel et al . 2021; Ferrari et al . 2021), to improve specificity and sensitivity of current screening, as well as for potential early detection of CRA.…”

“…This study supports further exploration into fecal concentration of SCFAs: acetic, propionic, and butyric acids, as biomarkers for CRC risk. Among the current CRC screening methods, colonoscopy is the gold standard (Davidson et al 2021) however, being invasive it presents some procedural risk (Ferrari et al 2021). The guaiac fecal occult blood test (gFOBT) and fecal immunochemical test (FIT) are other, in practice, non-invasive stool-based methods for CRC screening, which however require improvement, in particular for detection of CRA or early-stage colonic carcinogenesis (Ferrari et al 2021;Imperiale et al 2019;Jodal et al 2019).…”

“…Among the current CRC screening methods, colonoscopy is the gold standard (Davidson et al . 2021) however, being invasive it presents some procedural risk (Ferrari et al . 2021).…”