Abstract
Colorectal cancer (CRC) screening can be undertaken utilizing a variety of distinct approaches, which provides both opportunities and confusion. Traditionally, there has often been a trade-off between the degree of invasiveness of a screening test and its ability to prevent cancer, with fecal occult blood testing (FOBT) and optical colonoscopy (OC) at each end of the spectrum. CT colonography (CTC), although currently underutilized for CRC screening, represents an exception since it is only minimally invasive, yet provides accurate evaluation for advanced adenomas. More recently, the FDA approved a multi-target stool DNA test (Cologuard) and a blood-based test (Epi proColon) for average-risk CRC screening. This commentary will provide an overview of these two new non-invasive tests, including the clinical indications, mechanism of action, and diagnostic performance. Relevance to radiology practice, including a comparison with CTC, will also be discussed.
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References
Siegel R, DeSantis C, Jemal A (2014) Colorectal cancer statistics, 2014. CA Cancer J Clin 64:104–117
Torre LA, Bray F, Siegel RL, et al. (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108
Levin B, Lieberman DA, McFarland B, et al. (2008) Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 58:130–160
Pickhardt PJ, Kim DH (2009) Colorectal cancer screening with CT colonography: key concepts regarding polyp prevalence, size, histology, morphology, and natural history. Am J Roentgenol 193:40–46
Pickhardt PJ, Kim DH, Meiners RJ, et al. (2010) Colorectal and extracolonic cancers detected at screening CT colonography in 10,286 asymptomatic adults. Radiology 255:83–88
Young GP, Symonds EL, Allison JE, et al. (2015) Advances in fecal occult blood tests: the FIT revolution. Dig Dis Sci 60:609–622
Ahlquist DA (2015) Multi-target stool DNA test: a new high bar for noninvasive screening. Dig Dis Sci 60:623–633
Imperiale TF, Ransohoff DF, Itzkowitz SH, Turnbull BA, Ross ME (2004) Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population. N Engl J Med 351:2704–2714
Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. (2014) Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med 370:1287–1297
Johnson CD, Chen MH, Toledano AY, et al. (2008) Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med 359:1207–1217
Kim DH, Pickhardt PJ, Taylor AJ, et al. (2007) CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med 357:1403–1412
Lieberman DA, Weiss DG, Bond JH, et al. (2000) Use of colonoscopy to screen asymptomatic adults for colorectal cancer. N Engl J Med 343:162–168
Pickhardt PJ, Choi JR, Hwang I, et al. (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349:2191–2200
Regula J, Rupinski M, Kraszewska E, et al. (2006) Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med 355:1863–1872
Church TR, Wandell M, Lofton-Day C, et al. (2014) Prospective evaluation of methylated SEPT9 in plasma for detection of asymptomatic colorectal cancer. Gut 63:317–325
Gruetzmann R, Molnar B, Pilarsky C, et al. (2008) Sensitive detection of colorectal cancer in peripheral blood by septin 9 DNA methylation assay. PLoS One 3:e3759
Lofton-Day C, Model F, DeVos T, et al. (2008) DNA methylation biomarkers for blood-based colorectal cancer screening. Clin Chem 54:414–423
deVos T, Tetzner R, Model F, et al. (2009) Circulating methylated SEPT9 DNA in plasma is a biomarker for colorectal cancer. Clin Chem 55:1337–1346
Osborn NK, Ahlquist DA (2005) Stool screening for colorectal cancer: molecular approaches. Gastroenterology 128:192–206
Ranasinghe I, Parzynski CS, Searfoss R, et al. (2016) Differences in colonoscopy quality among facilities: development of a post-colonoscopy risk-standardized rate of unplanned hospital visits. Gastroenterology 150:103–113
Rosenthal E (2013) The $2.7 trillion medical bill: colonoscopies explain why U.S. leads the world in health expenditures. The New York Times. 1 Jun 2013
Austin GL, Fennimore B, Ahnen DJ (2013) Can colonoscopy remain cost-effective for colorectal cancer screening? The impact of practice patterns and the will Rogers phenomenon on costs. Am J Gastroenterol 108:296–301
Pickhardt PJ, Kim DH, Pooler BD, et al. (2013) Assessment of volumetric growth rates of small colorectal polyps with CT colonography: a longitudinal study of natural history. Lancet Oncol 14:711–720
Pickhardt PJ, Hain KS, Kim DH, Hassan C (2010) Low rates of cancer or high-grade dysplasia in colorectal polyps collected from computed tomography colonography screening. Clin Gastroenterol Hepatol 8:610–615
Pickhardt PJ (2014) CT colonography for population screening: ready for prime time? Dig Dis Sci 60:647–659
Pickhardt PJ (2006) Incidence of colonic perforation at CT colonography: review of existing data and implications for screening of asymptomatic adults. Radiology 239:313–316
Hassan C, Pickhardt PJ, Laghi A, et al. (2008) Computed tomographic colonography to screen for colorectal cancer, extracolonic cancer, and aortic aneurysm: model simulation with cost-effectiveness analysis. Arch Intern Med 168:696–705
Pickhardt PJ, Hassan C, Laghi A, Kim DH (2009) CT colonography to screen for colorectal cancer and aortic aneurysm in the Medicare population: cost-effectiveness analysis. AJR Am J Roentgenol 192:1332–1340
Pickhardt PJ, Lee LJ, del Rio AM, et al. (2011) Simultaneous screening for osteoporosis at CT colonography: bone mineral density assessment using MDCT attenuation techniques compared with the DXA reference standard. J Bone Miner Res 26:2194–2203
Ziemlewicz TJ, Binkley N, Pickhardt PJ (2015) Opportunistic osteoporosis screening: addition of quantitative CT bone mineral density evaluation to CT colonography. J Am Coll Radiol 12:1036–1041
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Co-founder of VirtuoCTC, shareholder in SHINE, Elucent, and Cellectar Biosciences.
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Grant support: NIH 1R01CA155347, 1R01CA169331.
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Pickhardt, P.J. Emerging stool-based and blood-based non-invasive DNA tests for colorectal cancer screening: the importance of cancer prevention in addition to cancer detection. Abdom Radiol 41, 1441–1444 (2016). https://doi.org/10.1007/s00261-016-0798-4
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DOI: https://doi.org/10.1007/s00261-016-0798-4