Next-Generation Noninvasive Colorectal Cancer Screening.

Quantitation of Hemoglobin Improves Fecal Immunochemical Tests for Noninvasive Screening

Optimizing Colorectal Cancer Screening by Getting FIT Right

1University of Dundee, Nethergate, Dundee, DD1 4HN, Scotland, UK *Author for correspondence: r.j.c.steele@dundee.ac.uk The most commonly used strategy in colo­ rectal cancer (CRC) screening pro grams involves the use of stool tests to detect occult blood, and guaiac fecal occult blood tests (gFOBTs) are, to date, the only fecal tests shown to reduce CRC mortality in population­based randomized trials [1]. However, gFOBTs also carry disadvantages. A major concern is that interval cancers account for around 50% of cancers detected in gFOBT screened populations [2] and recent data show that gFOBTs are less sensitive in women than in men, and in both rectal and right­sided cancers when compared with left­sided disease [2,3]. In addition, the test is associated with a high false­positive rate with no neoplasia detected in around half of colonoscopies performed following a positive gFOBT [2,3]. This may be, in part, explained by the fact that gFOBTs are not specific for human hemoglobin (Hb) and are subject to possible dietary interference from, for example, red meat and high­peroxidase fruits and vegetables. As a result, it has been common practice to instruct participants to adhere to dietary restrictions ahead of sample collection, although this may act as a barrier to screening and affect participation rates [4]. However, data from a meta­analysis did not support dietary restrictions with gFOBTs, leading to recommendations that restrictions are abandoned to improve adherence rates [5]. Fecal immunochemical tests (FITs) are now available and are increasingly being used in screening programs. Unlike gFOBTs, FITs are specific for the detection of human Hb, eliminating any potential for dietary interference, and are also more specific than gFOBT for lower gastrointestinal bleeding. In addition, modern FITs generally allow a more convenient method of sample collection, and are associated with better participation rates [6]. Another major advantage of FIT is that automated versions not only eliminate interobserver variability, but also the quantitative nature of these tests allow provision of a measured fecal Hb concentration. Screening program “...the adoption of fecal immunochemical tests in colorectal cancer screening programs has potential to address participation, appropriate positivity rates and the problem of false‐negative results.” EDITORIAL

Is this the end of colonoscopy screening for colorectal cancer? An Asia-Pacific perspective.

Comparing Fecal Immunochemical Tests: Improved Standardization Is Needed

Background & Aims: The fecal immunochemical test (FIT) is used for colorectal cancer (CRC) screening worldwide. However, there are several issues of the false-positive and the false-negative. To overcome these problems, various molecular biological tests have been combined to FIT. In this context, multitarget fecal DNA test was approved by FDA in August 2014. In addition, multitarget fecal microbiota has been recently reported. We have reported the usefulness of fecal miRNA analysis to detect CRC. Here, we investigated the applicability of multitarget fecal miRNA test combined with FIT and fecal miRNA test using fecal RNA extracted from FIT residua. Methods: In this study, 57 patients with invasive CRC, 33 patients with advanced adenoma, and 60 healthy individuals were enrolled. Each participant collected 10 mg fecal samples using the FIT sampling container for 2 days. After FIT was performed, total RNA was extracted from the residuum and miRNA expression was analyzed by using real-time RT-PCR. The sensitivity and specificity of the multitarget fecal miRNA test combined with FIT and fecal miRNA test was analyzed by using the decision tree analysis. Results: Approximately 1μg RNA was extracted from 10 mg fecal sample. The expressions of miR-16, miR-92a, miR-106a, miR-142-3p, miR-223, and miR-451 in fecal samples were significantly higher in the patients with advanced neoplasm (including invasive CRC and advanced adenoma) than in the healthy individuals (P<0.05). The sensitivity and the specificity of the FIT alone were 74.4% (67/90) and 93.3% (56/60), whereas those of the multitarget fecal miRNA test were 93.3% (83/90) and 91.7% (55/60). Moreover the multitarget fecal miRNA test could detect 81.8% of patients with advanced adenoma (27/33). Conclusions: Multitarget fecal miRNA test combined with FIT and fecal miRNA test may be a useful new CRC screening method. Citation Format: Yoshikatsu Koga, Nobuyoshi Yamazaki, Yasuo Kakugawa, Takahisa Matsuda, Masaaki Ito, Yutaka Saito, Hiroshi Saito, Yasuhiro Matsumura. Multitarget fecal miRNA test combined with fecal occult blood test and fecal miRNA test for colorectal cancer screening [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5292. doi:10.1158/1538-7445.AM2017-5292

The Ideal Screening Test Is the Test That Is Done

Guaiac-based faecal occult blood tests versus faecal immunochemical tests for colorectal cancer screening in average-risk individuals.

COVID-19: An Opportunity to Reimagine Colorectal Cancer Diagnostic Testing—A New Paradigm Shift

CN14-06: Screening for colorectal cancer: 2009

Reduced Incidence of Colorectal Cancers With Repeated Screening With Fecal Immunochemical Tests

Screening and Surveillance Colonoscopy and COVID-19: Avoiding More Casualties

doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

Divergent detection rates of fecal immunochemical test and questionnaire-based risk assessment for detecting proximal and distal advanced colorectal adenomas

Uptake of Colorectal Cancer Screening in 45 to 49 Year Olds: An Early-Inning View from the Endoscopy Suite