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Stool Based Testing for Colorectal Cancer: an Overview of Available Evidence

  • Large Intestine (B Cash, Section Editor)
  • Published:
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Abstract

Purpose of Review

The goal of this review is to summarize stool-based testing for colorectal cancer (CRC). The key questions answered in this review were the advantages and limitations of each available stool-based test for CRC and to examine their comparative efficacy.

Recent Findings

Guaiac-based fecal occult blood testing (gFOBT) is no longer a relevant test for CRC screening. fecal immunochemical testing (FIT) tests, especially quantitative assays, are clearly a reliable stool-based test. Multitarget DNA (mtsDNA) stool testing may represent a viable option as well, although cost and test characteristics are yet fully defined.

Summary

FIT and mtsDNA represent the options for stool-based CRC screening. In larger screening centers, quantitative FIT assays represent an attractive option for stool-based testing. Qualitative FIT has applicability in smaller centers. Although a large validation trial showed promising results for mtsDNA, further head-to-head trials with FIT will help define the ultimate role of mtsDNA. Ultimately, however, the best test for CRC screening is the one performed stool-based CRC screening as an initial or alternative option can increase participation in CRC screening.

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References

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

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7–30.

    Article  PubMed  Google Scholar 

  2. Centers for Disease Control and Prevention (CDC). Vital signs: colorectal cancer screening test use—United States, 2012. MMWR. 2013;62(44):881.

    Google Scholar 

  3. DeBourcy AC, Lichtenberger S, Felton S, Butterfield KT, Ahnen DJ, Denberg TD. 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 

  4. Inadomi JM, Vijan S, Janz NK, Fagerlin A, Thomas JP, Lin YV, 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 

  5. Levin TR. Colorectal cancer screening: 80% by 2018. Colonoscopists simply cannot do it alone. Gastrointest Endosc. 2016;83(3):552–4.

    Article  PubMed  Google Scholar 

  6. Mandel JS, Church TR, Ederer F, Bond JH. Colorectal cancer mortality: effectiveness of biennial screening for fecal occult blood. J Natl Cancer Inst. 1999;91(5):434–7.

    Article  CAS  PubMed  Google Scholar 

  7. Shaukat A, Mongin SJ, Geisser MS, Lederle FA, Bond JH, Mandel JS, et al. Long-term mortality after screening for colorectal cancer. N Engl J Med. 2013;369(12):1106–14.

    Article  CAS  PubMed  Google Scholar 

  8. Hardcastle JD, Armitage NC, Chamberlain J, Amar SS, James PD, Balfour TW. Fecal occult blood screening for colorectal cancer in the general population results of a controlled trial. Cancer. 1986;58(2):397–403.

    Article  CAS  PubMed  Google Scholar 

  9. • Robertson DJ, Lee JK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Lieberman D, Levin TR, Rex DK. Recommendations on fecal immunochemical testing to screen for colorectal neoplasia: a consensus statement by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2016. This article provides a concise and relevant set of recommendations regarding FIT testing and addresses several technical questions regarding test characteristics, advantages and shortcomings and practical questions regarding implementation of FIT testing in a practice environment.

  10. Faivre J, Dancourt V, Lejeune C, Tazi MA, Lamour J, Gerard D, et al. Reduction in colorectal cancer mortality by fecal occult blood screening in a French controlled study. Gastroenterology. 2004;126(7):1674–80.

    Article  PubMed  Google Scholar 

  11. Kronborg O, Fenger C, Olsen J, Jørgensen OD, Søndergaard O. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996;348(9040):1467–71.

    Article  CAS  PubMed  Google Scholar 

  12. Lindholm E, Brevinge H, Haglind E. Survival benefit in a randomized clinical trial of faecal occult blood screening for colorectal cancer. Br J Surg. 2008;95(8):1029–36.

    Article  CAS  PubMed  Google Scholar 

  13. Malila N, Palva T, Malminiemi O, Paimela H, Anttila A, Hakulinen T, et al. Coverage and performance of colorectal cancer screening with the faecal occult blood test in Finland. J Med Screen. 2011;18(1):18–23.

    Article  PubMed  Google Scholar 

  14. Scholefield JH, Moss SM, Mangham CM, Whynes DK, Hardcastle JD. Nottingham trial of faecal occult blood testing for colorectal cancer: a 20-year follow-up. Gut. 2011:gutjnl-2011.

  15. Allison JE, Tekawa IS, Ransom LJ, Adrain AL. A comparison of fecal occult-blood tests for colorectal-cancer screening. N Engl J Med. 1996;334(3):155–60.

    Article  CAS  PubMed  Google Scholar 

  16. Levi Z, Birkenfeld S, Vilkin A, Bar-Chana M, Lifshitz I, Chared M, et al. A higher detection rate for colorectal cancer and advanced adenomatous polyp for screening with immunochemical fecal occult blood test than guaiac fecal occult blood test, despite lower compliance rate. A prospective, controlled, feasibility study. Int J Cancer. 2011;128(10):2415–24.

    Article  CAS  PubMed  Google Scholar 

  17. Allison JE, Sakoda LC, Levin TR, Tucker JP, Tekawa IS, Cuff T, et al. Screening for colorectal neoplasms with new fecal occult blood tests: update on performance characteristics. J Natl Cancer Inst. 2007;99(19):1462–70.

    Article  PubMed  Google Scholar 

  18. Ahlquist DA, Sargent DJ, Loprinzi CL, Levin TR, Rex DK, Ahnen DJ, et al. Stool DNA and occult blood testing for screen detection of colorectal neoplasia. Ann Intern Med. 2008;149(7):441–50.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fenton JJ, Elmore JG, Buist DS, Reid RJ, Tancredi DJ, Baldwin LM. Longitudinal adherence with fecal occult blood test screening in community practice. Ann Fam Med. 2010;8(5):397–401.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Whitlock EP, Lin JS, Liles E, Beil TL, Fu R. Screening for colorectal cancer: a targeted, updated systematic review for the US Preventive Services Task Force. Ann Intern Med. 2008;149(9):638–58.

    Article  PubMed  Google Scholar 

  21. Songster CL, Barrows GH, Jarrett DD. Immunochemical detection of fecal occult blood–. The fecal smear punch-disc test: a new non-invasive screening test for colorectal cancer. Cancer. 1980;45(S5):1099–102.

    Article  CAS  PubMed  Google Scholar 

  22. Allison JE. 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 

  23. Levy BT, Bay C, Xu Y, Daly JM, Bergus G, Dunkelberg J, et al. Test characteristics of faecal immunochemical tests (FIT) compared with optical colonoscopy. J Med Screen. 2014;21(3):133–43.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Tao S, Seiler CM, Ronellenfitsch U, Brenner H. Comparative evaluation of nine faecal immunochemical tests for the detection of colorectal cancer. Acta Oncol. 2013;52(8):1667–75.

    Article  PubMed  Google Scholar 

  25. •• Lin JS, Piper M, Perdue LA. Screening for colorectal cancer: a systematic review for the US Preventive Services Task Force: evidence synthesis no. 135. Rockville, MD: Agency for Healthcare Research and Quality. 2016. This study provides the most comprehensive summary of information regarding screening tests for colonoscopy and is a highly inclusive reference for specific questions.

  26. Zorzi M, Fedeli U, Schievano E, Bovo E, Guzzinati S, Baracco S, et al. Impact on colorectal cancer mortality of screening programmes based on the faecal immunochemical test. Gut. 2015;64(5):784–90.

    Article  PubMed  Google Scholar 

  27. Chiu HM, Lee YC, Tu CH, Chen CC, Tseng PH, Liang JT, et al. Association between early stage colon neoplasms and false-negative results from the fecal immunochemical test. Clin Gastroenterol Hepatol. 2013;11(7):832–8.

    Article  PubMed  Google Scholar 

  28. Lee JK, Liles EG, Bent S, Levin TR, Corley DA. Accuracy of fecal immunochemical tests for colorectal cancer systematic review and meta-analysis. Ann Intern Med. 2014;160(3):171–81.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Cheng TI, Wong JM, Hong CF, Cheng SH, Cheng TJ, Shieh MJ, et al. Colorectal cancer screening in asymptomatic adults: comparison of colonoscopy, sigmoidoscopy and fecal occult blood tests. J Formos Med Assoc. 2002;101(10):685–90.

    PubMed  Google Scholar 

  30. Morikawa T, Kato J, Yamaji Y, Wada R, Mitsushima T, Sakaguchi K, et al. Sensitivity of immunochemical fecal occult blood test to small colorectal adenomas. Am J Gastroenterol. 2007;102(10):2259–64.

    Article  PubMed  Google Scholar 

  31. Robertson DJ, Lee JK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Lieberman D, Levin TR, Rex DK. Recommendations on fecal immunochemical testing to screen for colorectal neoplasia: a consensus statement by the US Multi-Society Task Force on colorectal cancer. Gastroenterology 2016.

  32. Plumb AA, Halligan S, Pendsé DA, Taylor SA, Mallett S. Sensitivity and specificity of CT colonography for the detection of colonic neoplasia after positive faecal occult blood testing: systematic review and meta-analysis. Eur Radiol. 2014;24(5):1049–58.

    Article  PubMed  Google Scholar 

  33. Lin JS, Webber EM, Beil TL, Goddard KA, Whitlock EP. Fecal DNA testing in screening for colorectal cancer in average-risk adults.

  34. • Imperiale TF, Ransohoff DF, Itzkowitz SH, Levin TR, Lavin P, Lidgard GP, et al. Multitarget stool DNA testing for colorectal-cancer screening. New England Journal of Medicine. 2014;370(14):1287–97. A large study and the most comprehensive validation of mtsDNA provides good perspective on advantages and disadvantages of testing and potential implications of mtsDNA testing

    Article  CAS  PubMed  Google Scholar 

  35. Robertson DJ, Dominitz JA. Stool DNA and colorectal-cancer screening. N Engl J Med. 2014;370(14):1350.

    Article  CAS  PubMed  Google Scholar 

  36. Lee JK, Levin TR, Corley DA. The road ahead: what if gastroenterologists were accountable for preventing colorectal cancer? Clin Gastroenterol Hepatol. 2013;11(3):204.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Levin TR, Jamieson L, Burley DA, Reyes J, Oehrli M, Caldwell C. Organized colorectal cancer screening in integrated health care systems. Epidemiol Rev. 2011:mxr007.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    Kevin M. Rank & Aasma Shaukat

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  1. Kevin M. Rank
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  2. Aasma Shaukat
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Correspondence to Aasma Shaukat.

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Conflict of Interest

Kevin Rank and Aasma Shaukat declare no conflict of interest.

David Graham is a consultant for RedHill Biopharma regarding novel H. pylori therapies and has received research support for culture of Helicobacter pylori and is the PI of an international study of the use of antimycobacterial therapy for Crohn’s disease. He is also a consultant for BioGaia in relation to probiotic therapy for H. pylori infection and for Takeda in relation to H. pylori therapies.

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

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Rank, K.M., Shaukat, A. Stool Based Testing for Colorectal Cancer: an Overview of Available Evidence. Curr Gastroenterol Rep 19, 39 (2017). https://doi.org/10.1007/s11894-017-0579-4

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  • DOI: https://doi.org/10.1007/s11894-017-0579-4

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