Skip to main content

Advertisement

SpringerLink
Log in

Current Trends in Colorectal Cancer Screening

  • Surgery and Surgical Innovations in Colorectal Cancer (S Huerta, Section Editor)
  • Published:
Current Colorectal Cancer Reports

Abstract

Purpose of Review

The following review is to assess the current methods, both non-invasive and invasive, in colorectal cancer screening and discuss novel screening techniques.

Recent Findings

Colorectal cancer continues to affect millions of people across the world. Through increased and widespread adoption of various screening methods, the rates of colon cancer-related deaths are decreasing. However, this decline has not been observed worldwide, possibly due to the lack of widespread screening adoption. Although there are many methods for screening colorectal cancer, colonoscopy remains the gold standard, due to high sensitivity and specificity as well as the ability to immediately sample or remove concerning tissue. Blood-based molecular testing is the most recent advancement in colorectal cancer screening; however, it has a significantly lower sensitivity and specificity when compared to other methods. However, with continued investigation, blood-based molecular testing may change how we screen for colorectal cancer in the near future.

Summary

Several options for colorectal cancer screening exist today. Colorectal cancer screening methods and techniques have improved over the last several decades. These improvements have helped to decrease the rates of colorectal cancer-related deaths, most notably in the USA. Various organizations have provided a list of recommendations and suggested screening agendas, which will be reviewed in this discussion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Haggar FA, Boushey RP. Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors. Clin Colon Rectal Surg. 2009;22(4):191–7.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30.

    Article  PubMed  Google Scholar 

  3. Cronin KA, et al. Annual Report to the Nation on the Status of Cancer, part I: National cancer statistics. Cancer. 2018;124(13):2785–800.

    Article  PubMed  Google Scholar 

  4. Maxim LD, Niebo R, Utell MJ. Screening tests: a review with examples. Inhal Toxicol. 2014;26(13):811–28.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Simkin J, et al. Differences in colorectal cancer screening rates across income strata by levels of urbanization: results from the Canadian Community Health Survey (2013/2014): Can J Public Health; 2018;110(1):62–71.

  6. Rex DK, et al. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104(3):739–50.

    Article  PubMed  Google Scholar 

  7. Shapiro JA, et al. Patterns of colorectal cancer test use, including CT colonography, in the 2010 National Health Interview Survey. Cancer Epidemiol Biomark Prev. 2012;21(6):895–904.

    Article  Google Scholar 

  8. Colorectal Cancer Facts & Figures 2017-2019., A.C. Society, Editor. 2017; Atlanta.

  9. Gupta S, et al. Comparative effectiveness of fecal immunochemical test outreach, colonoscopy outreach, and usual care for boosting colorectal cancer screening among the underserved: a randomized clinical trial. JAMA Intern Med. 2013;173(18):1725–32.

    PubMed  PubMed Central  Google Scholar 

  10. Force, U.S.P.S.T, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2016;315(23):2564–75.

    Article  CAS  Google Scholar 

  11. Qaseem A, et al. Screening for colorectal cancer: a guidance statement from the American College of Physicians. Ann Intern Med. 2012;156(5):378–86.

    Article  PubMed  Google Scholar 

  12. Wolf AMD, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250–81.

    Article  PubMed  Google Scholar 

  13. Andrews JC, et al. GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation’s direction and strength. J Clin Epidemiol. 2013;66(7):726–35.

    Article  PubMed  Google Scholar 

  14. Lin JS, et al. Screening for colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2016;315(23):2576–94.

    Article  CAS  PubMed  Google Scholar 

  15. Huerta S. Recent advances in the molecular diagnosis and prognosis of colorectal cancer. Expert Rev Mol Diagn. 2008;8(3):277–88.

    Article  CAS  PubMed  Google Scholar 

  16. Hill MJ, Morson BC, Bussey HJR. Aetiology of adenoma-carcinoma sequence in large bowel. Lancet. 1978;1(8058):245–7.

    Article  CAS  PubMed  Google Scholar 

  17. Vogelstein B, Fearon ER, Hamilton SR, Kern SE, Preisinger AC, Leppert M, et al. Genetic alterations during colorectal-tumor development. NEJM. 1988;319(9):525–32.

    Article  CAS  PubMed  Google Scholar 

  18. Winawer SJ. The history of colon cancer screening: a personal perspective. Dig Dis Sci. 2015;60(3):596–608.

    Article  PubMed  Google Scholar 

  19. Gervaz P, Usel M, Rapiti E, Chappuis P, Neyroud-Kaspar I, Bouchardy C. Right colon cancer: left behind. Eur J Surg Oncol. 2016;42(9):1343–9.

    Article  CAS  PubMed  Google Scholar 

  20. Committee, A.S.o.P, et al. Complications of colonoscopy. Gastrointest Endosc. 2011;74(4):745–52.

    Article  Google Scholar 

  21. CY 2018 Medicare Fee Schedule Changes (National Estimates), C.f.M.a.M. Services, Editor. 2018.

  22. Ahlquist DA, et al. The stool DNA test is more accurate than the plasma septin 9 test in detecting colorectal neoplasia. Clin Gastroenterol Hepatol. 2012;10(3):272–7 e1.

    Article  CAS  PubMed  Google Scholar 

  23. Nguyen MT, Weinberg DS. Biomarkers in colorectal cancer screening. J Natl Compr Cancer Netw. 2016;14(8):1033–40.

    Article  CAS  Google Scholar 

  24. Scholefield JH, et al. Nottingham trial of faecal occult blood testing for colorectal cancer: a 20-year follow-up. Gut. 2012;61(7):1036–40.

    Article  CAS  PubMed  Google Scholar 

  25. Shaukat A, et al. Long-term mortality after screening for colorectal cancer. N Engl J Med. 2013;369(12):1106–14.

    Article  CAS  PubMed  Google Scholar 

  26. Allison JE, et al. Population screening for colorectal cancer means getting FIT: the past, present, and future of colorectal cancer screening using the fecal immunochemical test for hemoglobin (FIT). Gut Liver. 2014;8(2):117–30.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Church TR, Ederer F, Mandel JS. Fecal occult blood screening in the Minnesota study: sensitivity of the screening test. J Natl Cancer Inst. 1997;89(19):1440–8.

    Article  CAS  PubMed  Google Scholar 

  28. Lang CA, Ransohoff DF. Fecal occult blood screening for colorectal cancer. Is mortality reduced by chance selection for screening colonoscopy? JAMA. 1994;271(13):1011–3.

    Article  CAS  PubMed  Google Scholar 

  29. Lee JK, et al. Accuracy of fecal immunochemical tests for colorectal cancer: systematic review and meta-analysis. Ann Intern Med. 2014;160(3):171.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Syngal S, et al. Detection of stool DNA mutations before and after treatment of colorectal neoplasia. Cancer. 2006;106(2):277–83.

    Article  CAS  PubMed  Google Scholar 

  31. Bailey JR, Aggarwal A, Imperiale TF. Colorectal cancer screening: stool DNA and other noninvasive modalities. Gut Liver. 2016;10(2):204–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Imperiale TF, et al. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med. 2014;370(14):1287–97.

    Article  CAS  PubMed  Google Scholar 

  33. Rank KM, Shaukat A. Stool based testing for colorectal cancer: an overview of available evidence. Curr Gastroenterol Rep. 2017;19(8):39.

    Article  PubMed  Google Scholar 

  34. • Prince M, et al. Multitarget stool DNA tests increases colorectal cancer screening among previously noncompliant Medicare patients. World J Gastroenterol. 2017;23(3):464–71 An important cross-sectional study with real-world applications demonstrating how a multitarget stool DNA test can significantly improve colorectal cancer screening.

  35. Christofk HR, et al. The M2 splice isoform of pyruvate kinase is important for cancer metabolism and tumour growth. Nature. 2008;452(7184):230–3.

    Article  CAS  PubMed  Google Scholar 

  36. Tonus C, et al. Faecal pyruvate kinase isoenzyme type M2 for colorectal cancer screening: a meta-analysis. World J Gastroenterol. 2012;18(30):4004–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Kim YC, et al. The usefulness of a novel screening kit for colorectal cancer using the immunochromatographic fecal tumor M2 pyruvate kinase test. Gut Liver. 2015;9(5):641–8.

    CAS  PubMed  Google Scholar 

  38. Uppara M, et al. A systematic review and meta-analysis of the diagnostic accuracy of pyruvate kinase M2 isoenzymatic assay in diagnosing colorectal cancer. World J Surg Oncol. 2015;13:48.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Hoff G, et al. Testing for faecal calprotectin (PhiCal) in the Norwegian Colorectal Cancer Prevention trial on flexible sigmoidoscopy screening: comparison with an immunochemical test for occult blood (FlexSure OBT). Gut. 2004;53(9):1329–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Widlak MM, et al. Diagnostic accuracy of faecal biomarkers in detecting colorectal cancer and adenoma in symptomatic patients. Aliment Pharmacol Ther. 2017;45(2):354–63.

    Article  CAS  PubMed  Google Scholar 

  41. Patel PM, Harris K, Huerta S. Clinical and molecular diagnosis of pathologic complete response in rectal cancer. Expert Rev Mol Diagn. 2015;15(11):1505–16.

    Article  CAS  PubMed  Google Scholar 

  42. Ramzan Z, Nassri AB, Huerta S. Genotypic characteristics of resistant tumors to pre-operative ionizing radiation in rectal cancer. World J Gastrointest Oncol. 2014;6(7):194–210.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Timmerman C, Taveras LR, Huerta S. Clinical and molecular diagnosis of pathologic complete response in rectal cancer: an update. Expert Rev Mol Diagn. 2018;18(10):887–96.

    Article  CAS  PubMed  Google Scholar 

  44. Gupta S, et al. Challenges and possible solutions to colorectal cancer screening for the underserved. J Natl Cancer Inst. 2014;106(4):dju032.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Ladabaum U, et al. Colorectal cancer screening with blood-based biomarkers: cost-effectiveness of methylated septin 9 DNA versus current strategies. Cancer Epidemiol Biomark Prev. 2013;22(9):1567–76.

    Article  Google Scholar 

  46. deVos T, et al. Circulating methylated SEPT9 DNA in plasma is a biomarker for colorectal cancer. Clin Chem. 2009;55(7):1337–46.

    Article  CAS  PubMed  Google Scholar 

  47. Grutzmann R, et al. Sensitive detection of colorectal cancer in peripheral blood by septin 9 DNA methylation assay. PLoS One. 2008;3(11):e3759.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Warren JD, et al. Septin 9 methylated DNA is a sensitive and specific blood test for colorectal cancer. BMC Med. 2011;9:133.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Church TR, et al. Prospective evaluation of methylated SEPT9 in plasma for detection of asymptomatic colorectal cancer. Gut. 2014;63(2):317–25.

    Article  CAS  PubMed  Google Scholar 

  50. Chen CH, Yan SL, Yang TH, Chen SF, Yeh YH, Ou JJ, et al. The relationship between the methylated septin-9 DNA blood test and stool occult blood test for diagnosing colorectal cancer in Taiwanese people. J Clin Lab Anal. 2017;31(1). https://doi.org/10.1002/jcla.22013

  51. Jin P, et al. Performance of a second-generation methylated SEPT9 test in detecting colorectal neoplasm. J Gastroenterol Hepatol. 2015;30(5):830–3.

    Article  CAS  PubMed  Google Scholar 

  52. Nicoloso MS, et al. MicroRNAs—the micro steering wheel of tumour metastases. Nat Rev Cancer. 2009;9(4):293–302.

    Article  CAS  PubMed  Google Scholar 

  53. Marshall KW, et al. A blood-based biomarker panel for stratifying current risk for colorectal cancer. Int J Cancer. 2010;126(5):1177–86.

    CAS  PubMed  Google Scholar 

  54. • Bray C, et al. Colorectal cancer screening. WMJ. 2017;116(1):27–33 The development of a risk-stratification tool using molecular testing with exciting implications for streamlined colorectal cancer screening.

  55. Ganepola GA, et al. Use of blood-based biomarkers for early diagnosis and surveillance of colorectal cancer. World J Gastrointest Oncol. 2014;6(4):83–97.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Wang S, et al. A plasma microRNA panel for early detection of colorectal cancer. Int J Cancer. 2015;136(1):152–61.

    Article  CAS  PubMed  Google Scholar 

  57. Yiu AJ, Yiu CY. Biomarkers in colorectal cancer. Anticancer Res. 2016;36(3):1093–102.

    CAS  PubMed  Google Scholar 

  58. Fan C, Lei X, Wu FX. Prediction of CircRNA-disease associations using KATZ model based on heterogeneous networks. Int J Biol Sci. 2018;14(14):1950–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Chen H, et al. Head-to-head comparison and evaluation of 92 plasma protein biomarkers for early detection of colorectal cancer in a true screening setting. Clin Cancer Res. 2015;21(14):3318–26.

    Article  CAS  PubMed  Google Scholar 

  60. Chen H, et al. Prospective evaluation of 64 serum autoantibodies as biomarkers for early detection of colorectal cancer in a true screening setting. Oncotarget. 2016;7(13):16420–32.

    PubMed  PubMed Central  Google Scholar 

  61. Issa IA, Noureddine M. Colorectal cancer screening: an updated review of the available options. World J Gastroenterol. 2017;23(28):5086–96.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Werner S, et al. Evaluation of a 5-marker blood test for colorectal cancer early detection in a colorectal cancer screening setting. Clin Cancer Res. 2016;22(7):1725–33.

    Article  CAS  PubMed  Google Scholar 

  63. Li D. Recent advances in colorectal cancer screening. Chronic Dis Transl Med. 2018;4(3):139–47.

    Article  PubMed  PubMed Central  Google Scholar 

  64. •• Check-CapAbbounces FDA Conditional Approval of IDE to Initiate U.S. Pilot Study of C-Scan. 2018 1/4/2019]; Available from: http://ir.check-cap.com/2018-12-13-Check-Cap-Announces-FDA-Conditional-Approval-of-IDE-to-Initiate-U-S-Pilot-Study-of-C-Scan-R Exciting news announcing the initiation of a pilot study regarding preparation-free capsule-based colorectal cancer screening.

  65. Outsense Toilet IOT Sensor. 1/4/2019]; Available from: https://outsense.co.il/.

  66. Hornbrook MC, et al. Early colorectal cancer detected by machine learning model using gender, age, and complete blood count data. Dig Dis Sci. 2017;62(10):2719–27.

    Article  PubMed  Google Scholar 

  67. •• Urban G, et al. Deep learning localizes and identifies polyps in real time with 96% accuracy in screening colonoscopy. Gastroenterology. 2018;155(4):1069–78 e8 Important machine-learning algorithms to improve polyp detection during colonoscopy, making invasive testing more effective.

  68. DeBourcy AC, et al. Community-based preferences for stool cards versus colonoscopy in colorectal cancer screening. J Gen Intern Med. 2008;23(2):169–74.

    Article  PubMed  Google Scholar 

  69. Ho W, et al. Analysis of barriers to and patients’ preferences for CT colonography for colorectal cancer screening in a nonadherent urban population. AJR Am J Roentgenol. 2010;195(2):393–7.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Holden DJ, et al. Systematic review: enhancing the use and quality of colorectal cancer screening. Ann Intern Med. 2010;152(10):668–76.

    Article  PubMed  Google Scholar 

  71. Pignone M, Bucholtz D, Harris R. Patient preferences for colon cancer screening. J Gen Intern Med. 1999;14(7):432–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Ruffin MTt, et al. Factors influencing choices for colorectal cancer screening among previously unscreened African and Caucasian Americans: findings from a triangulation mixed methods investigation. J Community Health. 2009;34(2):79–89.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Wolf RL, et al. Patient preferences and adherence to colorectal cancer screening in an urban population. Am J Public Health. 2006;96(5):809–11.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Inadomi JM, et al. Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies. Arch Intern Med. 2012;172(7):575–82.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. VA North Texas Health Care System, Department of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Divya B. Bhatt

  2. VA North Texas Health Care System, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Valerie-Sue Emuakhagbon

Authors
  1. Divya B. Bhatt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Valerie-Sue Emuakhagbon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Valerie-Sue Emuakhagbon.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Surgery and Surgical Innovations in Colorectal Cancer

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bhatt, D.B., Emuakhagbon, VS. Current Trends in Colorectal Cancer Screening. Curr Colorectal Cancer Rep 15, 45–52 (2019). https://doi.org/10.1007/s11888-019-00432-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11888-019-00432-4

Keywords

Search

Navigation