Stool-based testing is used for non-invasive colorectal cancer screening. The multi-target stool DNA (mt-sDNA) test has higher completion rates than other stool-based tests; however, data are scarce on mt-sDNA test adherence among Veterans Health Administration (VHA) insurance plan enrollees in the United States. We retrospectively assessed adults aged 45 to 75 years prescribed mt-sDNA testing through a VHA insurance plan, including veterans receiving VHA-authorized care and civilians covered by the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). Study data were obtained from the Abbott database (August 2022-January 2026). The primary outcome was test completion (adherence) within 365 days of kit shipment. Kaplan-Meier and log-rank analyses were used to evaluate time to adherence, and logistic regression was used to evaluate factors associated with mt-sDNA test adherence. Of 8,613 enrollees prescribed mt-sDNA testing, 72.4% (n = 6,234) were adherent; median time to adherence was 16 days. Metropolitan residence was associated with lower adherence (reference: small town; adjusted odds ratio [OR], 0.78; 95% confidence interval [CI], 0.65-0.92; P = .004). Factors associated with higher adherence included median annual household income ≥$125k (reference: <$50k; OR, 1.49; CI, 1.04-2.12; P = .029), test prescription by an obstetrician/gynecologist (reference: nurse practitioner/physician assistant; OR, 1.45; CI, 1.10-1.92; P = .009), and opting in to email and text notifications (reference: no digital notification; OR, 2.02; CI, 1.65-2.46; P < .001). Time to adherence differed significantly by outreach type and prior mt-sDNA return history (both log-rank P < .0001). Adherence to mt-sDNA testing among VHA enrollees was higher than stool-based test adherence rates previously reported among United States veterans or the general population. These findings support broader integration of mt-sDNA testing within VHA colorectal cancer screening programs to help improve screening participation. Future studies could assess follow-up colonoscopy adherence in an effort to optimize colonoscopy utilization.

Longitudinal adherence with stool-based testing for colorectal cancer screening in four US health systems.

Whether collecting one or two fecal samples for immunochemical testing (FIT) optimizes colorectal cancer screening outcomes remains unclear. We systematically searched multiple databases until October 2025 for studies directly comparing 1-FIT and 2-FIT strategies. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for dichotomous outcomes. Five studies (n = 45,888) and three economic evaluations were included. Participation was higher with 1-FIT (RR = 1.05, P < 0.0001), while 2-FIT had a higher positivity rate (RR = 0.65, P < 0.0001). Although 2-FIT detected more CRC (RR = 0.62, P = 0.02), advanced neoplasia and advanced adenoma detection were similar. The 2-FIT strategy had higher sensitivity (RR = 0.64, P = 0.04) but lower specificity (RR = 1.70, P < 0.001) than 1-FIT. A pivotal finding was that the 1-FIT strategy demonstrated a superior positive predictive value (PPV) for both advanced neoplasia (RR = 1.21, P = 0.004) and advanced adenoma (RR = 1.41, P < 0.0001), which translated into a substantially lower demand for colonoscopy (RR = 0.64, P < 0.0001) Economic evaluations consistently favored 1-FIT across different healthcare systems. Although the 2-FIT strategy improves test sensitivity, it fails to enhance advanced neoplasia detection while substantially increasing colonoscopy demand due to its reduced positive predictive value. In contrast, the 1-FIT strategy preserves screening efficacy with superior participation rates, resource utilization, and cost-effectiveness. We recommend 1-FIT as the preferred strategy in settings with constrained colonoscopy resources, while reserving 2-FIT for resource-abundant environments where maximizing sensitivity justifies the additional economic and operational costs (Scheme 1). The research protocol was prospectively registered in the PROSPERO registry, bearing the registration identifier CRD420251153202.

Prevalence and distribution of high-risk HPV in an organized hospital-based cervical cancer screening cohort.

Colorectal cancer (CRC) is the third most common malignancy, but ranks second in cancer-related mortality. CRC screening has been shown to decrease the incidence of CRC. However, screening methods are only effective if they are done. This is an analytical cross-sectional study done via a web-based questionnaire that was distributed in person and online. Convenient sampling methods were used to collect responses from adult males and females willing to participate in this study. The study included 643 participants with female predominance (72.2%). Although 88.5% recognized CRC as a preventable disease and 68.4% knew early detection improves outcomes, only 35.1% were aware of cancer screening tests. The most reported barriers to general screening were absence of symptoms (63.3%) and lack of physician recommendation (57.5%). Emotional and psychological barriers were the most reported barriers for colonoscopy (62.5%), and lack of knowledge about the availability of stool-based tests (50.5%). The study participants demonstrated fair knowledge about risk factors and symptoms of CRC, but there were significant knowledge gaps about the available screening methods. This highlights the need for national awareness campaigns and improved patient-physician communication about CRC screening.

Label-free vibrational spectroscopic techniques (Raman spectroscopy) combined with machine learning (ML) methodologies have huge potential for the development of screening and diagnostic tests in oncology. Traditionally, screening for colorectal cancer (CRC) has relied on immunochemical faecal occult blood (iFOBT) testing; however, this has shown to have low compliance in the Australian setting. The aim of this study was to assess the efficacy of Raman spectroscopy for the detection of CRC and potential screening for CRC. Plasma samples were analysed from a total of 370 participants; 117 CRC patients and 253 iFOBT positive control participants. 8 of the CRC patients were from the iFOBT cohort. The control cohort had either advanced adenomas (n = 81), non-advanced adenomas (n = 76), colitis (n = 2) or no evidence of disease (n = 94). The Raman spectra of these plasma samples were analysed using ML algorithms in separate training (n = 222) and validation (n = 148) cohorts. A sensitivity of 84% and specificity of 93% was achieved for the detection of CRC in the validation cohort. When analysed in subcategories, 95% of people with CRC would receive a colonoscopy and 42% of FIT positive people could potentially be spared a colonoscopy. This exploratory study demonstrated a high level of accuracy for the detection of CRC using a Raman spectroscopy-based ML model and has the potential to be used for CRC screening.

Colorectal cancer (CRC) is a significant cause of mortality globally, with a rising incidence in the Middle East. Understanding CRC screening awareness among the Syrian population is crucial for effective public health interventions. We conducted a cross-sectional study from September 22 to October 15, 2023, with 928 participants. Data were collected via an online questionnaire covering sociodemographic, knowledge, and attitude sections. Descriptive statistics, chi-square tests, and regression were used for analysis with Statistical Package for Social Sciences v28.0. The study revealed a concerning lack of awareness regarding CRC screening among Syrians, with only 52.6% of participants familiar with early cancer screening tests and 48.4% showing adequate knowledge. Knowledge was significantly associated with gender, family history, employment, education, and economic status (P < .05). The logistic regression model was highly significant (P < .001, χ2 = 73.19). Binary regression showed higher odds of insufficient knowledge among participants aged 36 to 40 (P = .049) and those with poor economic status (P = .001). Middle school education was protective (P = .022). Gender and employment showed trends but were not significant. The findings underscore the necessity for public health initiatives to enhance CRC screening knowledge in Syria. Tailored educational programs and increased access to screening facilities are essential for improving early detection and reducing the burden of CRC. Efforts to boost public understanding and engagement in CRC screening are critical for lowering incidence and mortality rates.

The need for accurate, cost-effective, non-invasive screening tests for colorectal cancer (CRC) persists. Repetitive genomic elements like Long Interspersed Nuclear Element-1 (LINE-1), due to their high copy number and cancer-associated alterations, present a promising but unexplored target in stool DNA for CRC detection. In this cross-sectional study, stool DNA was extracted from 38 patients with histologically confirmed CRC and 39 healthy controls. The concentration of human DNA was quantified via quantitative PCR targeting two short LINE-1 amplicons (55-bp and 60-bp). Diagnostic performance was evaluated using ROC curve analysis to determine sensitivity, specificity, and predictive values. The concentration of stool DNA, measured by LINE-1 qPCR cycle threshold (Ct) values, was significantly higher in CRC patients compared to controls (p < 0.001 for both amplicons). The 60-bp LINE-1 amplicon demonstrated superior diagnostic accuracy with an area under the ROC curve (AUC) of 0.92 (95%CI 0.85-0.98), compared to 0.83 (95%CI 0.73-0.93) for the 55-bp amplicon. At the optimal cut-off (Ct ≤ 24.19), the 60-bp marker achieved a sensitivity of 87.0%, specificity of 78.4%, a positive predictive value (PPV) of 71.4%, and a negative predictive value (NPV) of 90.6%. The 55-bp amplicon showed higher sensitivity (95.7%) but lower specificity (59.5%). Quantitative analysis of LINE-1 repetitive elements in stool DNA, particularly using a 60-bp amplicon, demonstrates excellent diagnostic accuracy for detecting CRC. This single-marker, qPCR-based assay represents a simple and potentially low-cost non-invasive strategy, warranting further validation in large-scale screening populations and assessment of its efficacy for detecting precancerous lesions.

Blood-based circulating tumour DNA (ctDNA) tests for colorectal cancer screening: Systematic review and meta-analysis of diagnostic accuracy.

Two new tests, a cell-free DNA (cfDNA) blood-based test (BBT) and multitarget stool RNA (mt-sRNA) test with in-laboratory fecal immunochemical testing, were recently approved by the US Food and Drug Administration, and a second BBT is under review. These tests have the potential to overcome barriers to screening. This review evaluates the current evidence to better understand their utility for routine screening. The authors searched PubMed, other databases, and gray literature sources through March 30, 2026. Included studies examined the diagnostic accuracy, harms, and the adherence to cfDNA and mt-sRNA screening tests for colorectal cancer (CRC). One investigator abstracted data, and a second confirmed. Two investigators independently assessed the risk of bias and strength of evidence. Discords were resolved through consensus. From 262 titles, 12 studies (17 publications) were included. Three studies provide moderate strength evidence to support the performance characteristics of cfDNA, and one provides low strength evidence for mt-sRNA. For cfDNA, adjusted CRC and advanced precancerous lesions sensitivities ranged from 80.8% to 81.1% and from 12.9% to 13.7%, respectively, and advanced colorectal neoplasia specificity ranged from 89.5% to 90.4%. For mt-sRNA, CRC sensitivities were 93% and 48%, and observed specificity was 90%. No studies reported serious harms, and the evidence comparing adherence was insufficient. We found that cfDNA screening tests for CRC are similar, and although mt-sRNA estimates fall below those demonstrated by mt-sDNA, its in-laboratory fecal immunochemical testing, has the potential to increase adherence. Future research examining adherence is needed, as are data from which to examine their impact on underrepresented populations.

e22565 Background: Uptake of age- and sex-appropriate cancer screening remains suboptimal in the United States. Patients with cardiovascular risk factors have increased direct cancer risk through shared behavioral, environmental, and inflammatory pathways. However, these patients may also have more frequent touchpoints with the health care system for management of their CV conditions, raising opportunities for appropriate cancer screening. Thus, we evaluate whether individuals with CV risk factors have higher rates of guideline-concordant cancer screening compared with those without such risks. Methods: We analyzed pooled 2018–2024 data from the National Health Interview Survey, restricting the sample to adults without a prior history of cancer. CV risk was defined by the presence of one or more of the following conditions: coronary heart disease, high cholesterol, congenital heart disease, diabetes, prior myocardial infarction, hypertension, or other heart disease. Outcomes included receipt of age- and sex-appropriate cancer screening (mammography, prostate-specific antigen (PSA) testing, and colonoscopy), determined according to U.S. Preventive Services Task Force recommendations. Covariates included health insurance status, private insurance, and family cancer history. Sample weights were applied to account for complex survey design. Multivariable logistic regressions were estimated for each sample. Results: Unweighted sample sizes were as follow: mammography (9,390), PSA (3,723), and colonoscopy (16,080). Survey-weighted rates of cardiovascular risk factors for each sample of screening-eligible individuals were as follow: mammography (67.8% [SE: 1.72]), PSA (82.5% [1.97]), and colonoscopy (74.8% [1.20]). In multivariable regression models, having CV risk factors was not significantly associated with increased cancer screening: mammography (OR: 1.09, p: 0.25), PSA (OR: 1.49, p: 0.19), and colonoscopy (OR: 1.03, p: 0.73). Conclusions: In this nationally representative study, cardiovascular risk factors were not associated with higher rates of guideline-concordant mammography, PSA testing, or colonoscopy. These findings suggest that chronic cardiovascular care does not consistently facilitate cancer screening, potentially due to competing clinical priorities and fragmented care. However, given continued shared risk factors, integrating cancer screening into cardiovascular disease management may represent an important opportunity to improve preventive care delivery.

Despite the availability of multiple screening options, rates of colorectal cancer (CRC) screening remain suboptimal. With recent approval of a blood test for CRC screening, there is an urgent need to understand screening preferences of populations with low screening rates. Between October 2023 and June 2024, we conducted a survey on preferences for CRC screening modalities of stool test, blood test and colonoscopy among adults aged 45-75 at ambulatory primary care clinics across multiple community health centers and federally qualified healthcare centers across the city as well as in community settings regardless of prior screening. A total of 1,014 individuals completed the survey. Respondents were 12.8% Black/African American, 51.6% White, 23.4% Hispanic, 15.8% South Asian, and 4.2% Asian. Overall, the highest test preference was for screening colonoscopy (45.5%) followed by blood test (29.9%). Colonoscopy was preferred by individuals under age 70 (47.5%), while stool-based (20.2%) and blood-based (31.9%) tests were the most preferred among above 70 years (p = 0.0429. Whites (54.6%), Blacks (44.6%), and Hispanics (35.9%, p < 0.001) preferred colonoscopy, while Asians (37.2%) and South Asians (24.4%) favored blood tests. Factors associated with preference for a colonoscopy over other screening tests were younger age: respondents aged below 70years were more likely to prefer colonoscopy, compared to respondents aged above 70years (OR 1.72, 95% CI [1.20-2.47], p = 0.003); Nonsmoker compared to former/current smokers (OR 2.04, 95% CI [1.10-3.94], p = 0.028); Having undergone a prior colonoscopy (OR 6.83, 95% CI [4.52-10.6], p = < 0.001) or not having a prior stool test (OR 1.56, 95% CI [1.52-2.11], p = < 0.001). Factors associated with preference for a blood test over other screening tests were education level: respondents without any college experience were more likely to prefer blood test compared to respondents with college experience (OR 1.46, 95% CI 1.02-2.07, p = 0.038); Nonsmoker compared to former/current smokers (OR 1.73, 95% CI [1.00-2.99], p = 0.048); Never undergone a prior colonoscopy (OR 1.76, 95% CI [1.23-2.51], p = 0.002). Factors associated with preference for a stool test over other screening tests were: age over 80years compared to respondents aged below 80 (OR 3.34, 95% CI 1.67-6.55, p < 0.001); respondents with college experience were more likely to prefer blood test compared to respondents without college experience (OR 1.62, 95% CI 1.02-2.66, p = 0.048). Colonoscopy was the preferred test option, followed by blood test. Preferences for screening test varied by age, race, ethnicity, education and prior screening. The study underscores importance of patient preference in deciding which tests to offer based on the patient characteristics. Nonsmokers, those without any college education and those without prior screening preferred blood test for screening.

Community-based human papillomavirus (HPV) self-sampling can expand cervical cancer screening coverage in rural settings, but local programmatic cost evidence is limited. We conducted an activity-based micro-costing study from the healthcare system perspective to estimate start-up (January 2022-February 2023) and implementation (March-December 2023) costs of a community-based HPV self-sampling screen-triage approach in Siem Reap Province, Cambodia. Resource use and unit costs were measured using direct observation, semi-structured interviews with program staff, and review of budgets and financial reports. All costs were converted to 2024 US dollars. Between January 2022 and December 2023, 7524 women were screened; 359 (4.77%) tested HPV-positive and 312 of 359 (86.91%) completed triage during the study period. Total programmatic cost was US$204,507.14, yielding an average cost of US$27.18 per woman screened and US$569.66 per HPV-positive case identified. Laboratory testing was the largest cost component (55.01% of total programmatic cost), followed by the community-based self-sampling activity (31.12%). Estimated incremental unit costs for triage options were US$3.69 for visual inspection of cervix with acetic acid (VIA), US$16.42 for partial HPV genotyping (types 16 and 18), and US$32.92 for colposcopy per woman receiving the respective triage test. Community-based HPV self-sampling can be delivered at moderate programmatic cost in rural Cambodia, with overall costs driven primarily by laboratory testing and community-based screening delivery. These findings provide inputs for budgeting and planning scale-up of HPV screening from a healthcare system perspective in Cambodia.

For patients undergoing colorectal cancer screening with stool-based tests followed by a negative colonoscopy, management can be challenging due to potential concern for upper aerodigestive cancer or extra-colonic cancer. We sought to synthesize contemporary clinical approaches and cancer outcomes following a positive stool test and a negative colonoscopy and to identify areas in need of further research. Because of the heterogeneity of published research and available evidence, we conducted a scoping review of English-language, peer-reviewed, and full-text articles through September 2025. Two independent reviewers screened titles and abstracts followed by full text assessment, and data extraction. Data were synthesized thematically to explore the outcomes and work-up strategies associated with false-positive results in FIT and mt-sDNA tests within the context of extra-colonic cancer screening. Of 3442 studies identified, 49 underwent full text review of which 8 met inclusion criteria. Most patients were female and ≥50 years; however, reporting of demographic information was variable. The brand of stool-test, definition of stool-test positivity, definition of negative colonoscopy, and follow-up time were variably reported and defined. In terms of outcome, ~0.5% of patients had CRC on second colonoscopy. Incidence of non-colorectal aerodigestive or upper GI cancer ranged from 0-4.3%. There is a critical need for a standardized reporting framework among studies evaluating outcomes after positive stool-test and negative colonoscopy to better synthesize across studies and ultimately, improve clinical management.

While eligibility for cancer screening tests varies by age, women aged 45 to 64 years should regularly screen for 3 cancers (breast, cervical, and colorectal). However, utilization of these screening tests varies. To evaluate patterns of screening across 3 cancers in age-eligible women and to identify screening gaps. This cross-sectional study used a retrospective analysis of the Behavioral Risk Factor Surveillance Survey-a population-based survey of the US-collected January to December 2024. Participants were survey respondents who were women aged 45 to 64 years, reflecting the ages in which women are currently recommended to complete screening for all 3 cancers. Differences in screening patterns across sociodemographic characteristics, including age, insurance coverage, educational attainment, income, and past-year health care use, were evaluated. Survey-weighted means and univariable and multivariable regressions were used to evaluate up-to-date (UTD) use of breast, cervical, and colorectal cancer screening. The proportion and total number of US women estimated to be due for each combination of screenings are reported. Factors associated with being UTD with any screening (vs no screening) and with all screenings (vs 1 or 2 screenings) are identified. The final sample was 68 111 women (mean [SD] age 54.8 [5.8] years), of whom 35 047 (weighted percentage, 50.3%) reported being UTD with all 3 cancer screening tests, 19 389 (weighted percentage, 28.8%) were UTD with 2 screenings, 8776 (weighted percentage, 13.2%) were UTD with only 1 screening, and 4899 (weighted percentage, 7.7%) were UTD with no screenings. Together, these reflect an estimated 17.9 million women aged 45 to 64 years who were due for 1 or more screening tests, with nearly half this group (42.2%; 7.6 million women) due for multiple tests. Socioeconomic factors were associated with all (vs 1 or 2) screenings, while access factors (eg, health insurance, having a regular health care practitioner) were associated with use of both any screening and all screenings. In this cross-sectional study of screening patterns, nearly 18 million middle-aged US women were estimated to be overdue for 1 or more cancer screening tests. Access-related policies or bundled clinical interventions that improve screening across multiple tests should be prioritized to most effectively reduce the burden of screen-detectable cancers.

IntroductionIn 2014, the Affordable Care Act (ACA) mandated that newly eligible Medicaid expansion beneficiaries receive recommended preventive services at no cost. Yet, evidence regarding the Medicaid expansion population's use of preventive services is limited.MethodsMedicaid claims data from 2011 to 2019. We focused on 12 selected preventive services that received new, revised, or upheld A or B USPSTF ratings since 2010.ResultsWe find that receipt of preventive services among the Medicaid Expansion population increased from 22% in 2014 to 26% in 2019, with 41% of beneficiaries receiving at least one of the 12 examined services from 2014 to 2019. The most received services were screening tests for HIV infection, cervical cancer, chlamydia and gonorrhea, and hepatitis C virus infection. Receipt of at least one preventive service was highest among non-Hispanic Asian, non-Hispanic Black, and Hispanic beneficiaries.ConclusionFuture changes to Medicaid expansion eligibility or preventive services recommendations could potentially disrupt these utilization patterns, with possible disproportionate effects on people from racial and ethnic minority populations.

Prostate-specific antigen (PSA) test for prostate cancer screening.

Evaluating the Performance of Anal Cytology and Human Papillomavirus Testing for Detection of Anal Cancer and Pre-Cancerous Lesions.

ABSTRACT Background Late diagnosis of colorectal cancer (CRC) remains a public health challenge due to limitations in screening programs. This study evaluated the fecal immunochemical test (FIT) as an alternative screening method for CRC detection. Research design and methods Colonoscopy and immunochemical analysis were used as standard diagnostics. A population-based survey in Kazakhstan assessed disease prevalence and screening outcomes. Diagnostic accuracy and prognostic value of haemoccult testing were analyzed, comparing quantitative and qualitative results. Results Among 6,000 participants, 9.76% (n = 586) had positive FIT results. Elevated fecal hemoglobin concentrations (≥100 µg Hb/g stool) were found in 3.6% (n = 217), while 96.4% (n = 5786) had lower values. Of 150 clinically significant positive cases, 55 were confirmed, including 5 CRC cases and precancerous conditions. FIT facilitated large-scale screening. The Positive Predictive Value (PPV) for qualitative FIT was 10.4%, and for quantitative FIT (≥100 µg Hb/g), it was 15.7%. The Negative Predictive Value (NPV) for qualitative FIT was 100%, and for quantitative FIT, 99.5%. Conclusion FIT demonstrates practical value as an efficient screening tool for early CRC detection, with a weak but significant correlation to histological findings (p < 0.01).

Breast and cervical cancer represent a significant disease burden. Health care quality measures captured through electronic clinical data systems could be used to assess follow-up of abnormal breast and cervical cancer screening results. The National Committee for Quality Assurance (NCQA) wanted to explore the feasibility of using health plan electronic clinical data systems to develop quality measures for follow-up of abnormal breast and cervical cancer screening test results. NCQA interviewed quality improvement leaders from ten health plans, recruited through a purposive sample representing varying sizes, geographic regions, and commercial, Medicare, and Medicaid product lines. Health plan leaders identified several barriers, including a lack of standardized data integration as well as opportunities such as supporting provider and health system data aggregation and other support. Findings indicate that improved data governance, particularly around data standardization and information technology infrastructure integration, would increase the feasibility of monitoring follow-up after abnormal breast and cervical cancer screening results.