Abstract
Simple SummarySince the 70s, a variety of colorectal cancer (CRC) screening programs have been adopted throughout the world with the aim of reducing the mortality rate of one of the leading cancer-related causes of death in the world. However, currently employed techniques present numerous shortcomings that negatively affect early-stage CRC detection, thus urging us to consider new and improved alternatives. Among the cited shortcomings are invasiveness and cultural stigma surrounding certain sample collection techniques, both of which negatively affect screening compliance. For this reason, many of the viable alternatives collected and described in this review aim to achieve good diagnostic performance while minimizing patient stress and discomfort. This text should serve as a guiding light for healthcare providers specialized in preventive medicine in the continuous pursuit of improved patient care.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%, and 47–97%, respectively) while minimizing stress and discomfort for the patient.
Highlights
From its introduction in the 70s, colorectal cancer (CRC) screening has been developing and evolving at a dramatically fast pace, with many new studies revealing potential markers for early diagnosis of CRC
An exception to this point was made in order to illustrate the Food and Drug Administration (FDA)-approved Cologuard® Multitarget Stool DNA (MT-sDNA), seen as this test is still not widely utilised in common practice as other non-invasive tests of the same kind (e.g., Fecal immunochemical tests (FIT)) are, and it is not yet recommended by the official European guidelines as a first line screening test
96.4%, among those with a negative colonoscopy result (p < 0.001). These results show that the MT-sDNA test, in asymptomatic persons at average risk for colorectal cancer, detects significantly more cancers than FIT
Summary
From its introduction in the 70s, colorectal cancer (CRC) screening has been developing and evolving at a dramatically fast pace, with many new studies revealing potential markers for early diagnosis of CRC. Current CRC screening options, suggested by international guidelines, can be classified as either stool-based or imaging tests. For a population between 45–80 years of age, the European guidelines for quality assurance in colorectal cancer screening and diagnosis recommend Immunochemical FOBT (iFOBT or FIT), Guaiac Fecal Occult Blood Test (gFOBT), flexible sigmoidoscopy (FSIG), and colonoscopy as current gold standard tests for screening [2]. Within the considered population (45–80), at least the age group of 60–64 should be included due to highest incidence and mortality. While these guidelines recognize newer screening technologies such as computed tomography (CT) colonography, stool DNA testing, and capsule endoscopy as emerging possibilities, they do not recommend using them for screening the average-risk population.
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