scholarly journals Towards Novel Non-Invasive Colorectal Cancer Screening Methods: A Comprehensive Review

2021 ◽  
Author(s):  
Allegra Ferrari ◽  
Isabelle Neefs ◽  
Sarah Hoeck ◽  
Marc Peeters ◽  
Guido Van Hal
Keyword(s):  
Colorectal Cancer ◽  
Early Stage ◽  
Screening Tests ◽  
Screening Methods ◽  
Exhaled Breath ◽  
Sample Collection ◽  
Screening Programs ◽  
Crc Screening ◽  
Low Sensitivity ◽  
Standard Colonoscopy

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%, 47-97%, respectively) while minimizing stress and discomfort for the patient.

scholarly journals Towards Novel Non-Invasive Colorectal Cancer Screening Methods: A Comprehensive Review

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1820
Author(s):  
Allegra Ferrari ◽  
Isabelle Neefs ◽  
Sarah Hoeck ◽  
Marc Peeters ◽  
Guido Van Hal
Keyword(s):  
Colorectal Cancer ◽  
Early Stage ◽  
Screening Tests ◽  
Screening Methods ◽  
Exhaled Breath ◽  
Sample Collection ◽  
Screening Programs ◽  
Crc Screening ◽  
Low Sensitivity ◽  
Standard Colonoscopy

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.

A novel, cost-effective strategy for the screening of colorectal cancer with higher patient compliance.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 407-407
Author(s):  
Afsaneh Motamed-Khorasani ◽  
Andrea Lee Small-Howard
Keyword(s):  
Colorectal Cancer ◽  
Patient Compliance ◽  
Blood Test ◽  
Early Stage ◽  
Cost Effective ◽  
Patient Treatment ◽  
Screening Methods ◽  
Crc Screening ◽  
Combined Test ◽  
Low Sensitivity

407 Background: Routine screening methods for colorectal cancer (CRC) have poor patient compliance and low sensitivity for early stages. The sensitivity rates are 19, 71, 76, and 83% for Fecal Occult Blood test (FOBT), stool DNA test, colonoscopy/sigmoidoscopy, and double-contrast barium enema; respectively. Biological markers have also been tested including CEA (sensitivity of 38.7%); however, its utility in CRC screening is limited due to low sensitivity. Onko-Sure is an FDA-cleared blood test for monitoring of CRC treatment/recurrence. It measures the accumulation of Fibrin/Fibrinogen Degradation products in the serum using anti-DR-70 antibody. The objective was to determine whether DR-70 and CEA combination can improve the sensitivity such that it can be used as a cost-effective alternative to current screening methods yet with a higher patient compliance. Methods: A total of 564 serum samples were retrospectively obtained from a serum bank in two arms: confirmed healthy control (n=298) and biopsy-confirmed CRC (n=266) groups. The samples were tested for DR-70 and CEA. Results: The results showed sensitivity of 58.2% and specificity of 59.83% for DR-70 and CEA combined. The sensitivity for the combined test was 55.5% higher than that of CEA alone. A consistent improvement of sensitivity for the combined usage relative to CEA alone was observed with an increase of 73%, 108%, 58% and 18% in CRC stage I, II, III and IV; respectively. The sensitivity of the combined test was 48%, 47%, 57% and 98% for stages I, II, III and IV. Conclusions: Combining DR-70 and CEA tests showed a significant clinical advantage in CRC screening over using each marker alone. The sensitivity improvement was highest for stages I/II, which has important implications in patient treatment options, prognosis and survival rate due to this early detection. With a 3 times higher sensitivity for early stage CRC compared to using FOBT, this approach should improve the CRC early stage diagnosis. Such early stage detection is less likely using routine approaches for CRC screening because of low sensitivity and low patient compliance.

scholarly journals Screening for Colorectal Cancer Leading into a New Decade: The “Roaring ‘20s” for Epigenetic Biomarkers?

2021 ◽  
Vol 28 (6) ◽  
pp. 4874-4893
Author(s):  
Hélder Almeida-Lousada ◽  
André Mestre ◽  
Sara Ramalhete ◽  
Aryeh J. Price ◽  
Ramon Andrade de Mello ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Early Stage ◽  
Screening Tests ◽  
Fecal Occult Blood ◽  
Screening Methods ◽  
Average Risk ◽  
Epigenetic Biomarkers ◽  
Pubmed Database ◽  
Incidence And Mortality ◽  
The World

Colorectal cancer (CRC) has an important bearing (top five) on cancer incidence and mortality in the world. The etiology of sporadic CRC is related to the accumulation of genetic and epigenetic alterations that result in the appearance of cancer hallmarks such as abnormal proliferation, evasion of immune destruction, resistance to apoptosis, replicative immortality, and others, contributing to cancer promotion, invasion, and metastasis. It is estimated that, each year, at least four million people are diagnosed with CRC in the world. Depending on CRC staging at diagnosis, many of these patients die, as CRC is in the top four causes of cancer death in the world. New and improved screening tests for CRC are needed to detect the disease at an early stage and adopt patient management strategies to decrease the death toll. The three pillars of CRC screening are endoscopy, radiological imaging, and molecular assays. Endoscopic procedures comprise traditional colonoscopy, and more recently, capsule-based endoscopy. The main imaging modality remains Computed Tomography (CT) of the colon. Molecular approaches continue to grow in the diversity of biomarkers and the sophistication of the technologies deployed to detect them. What started with simple fecal occult blood tests has expanded to an armamentarium, including mutation detection and identification of aberrant epigenetic signatures known to be oncogenic. Biomarker-based screening methods have critical advantages and are likely to eclipse the classical modalities of imaging and endoscopy in the future. For example, imaging methods are costly and require highly specialized medical personnel. In the case of endoscopy, their invasiveness limits compliance from large swaths of the population, especially those with average CRC risk. Beyond mere discomfort and fear, there are legitimate iatrogenic concerns associated with endoscopy. The risks of perforation and infection make endoscopy best suited for a confirmatory role in cases where there are positive results from other diagnostic tests. Biomarker-based screening methods are largely non-invasive and are growing in scope. Epigenetic biomarkers, in particular, can be detected in feces and blood, are less invasive to the average-risk patient, detect early-stage CRC, and have a demonstrably superior patient follow-up. Given the heterogeneity of CRC as it evolves, optimal screening may require a battery of blood and stool tests, where each can leverage different pathways perturbed during carcinogenesis. What follows is a comprehensive, systematic review of the literature pertaining to the screening and diagnostic protocols used in CRC. Relevant articles were retrieved from the PubMed database using keywords including: “Screening”, “Diagnosis”, and “Biomarkers for CRC”. American and European clinical trials in progress were included as well

scholarly journals Epidemiologic Disparities in Colon Cancer Screening and Adherence during the COVID-19 Pandemic: A Retrospective Cohort Analysis

2022 ◽  
Author(s):  
Eugene Chiemeka Nwankwo ◽  
Christian Hendrix ◽  
Kelvin Pollard ◽  
Chad Kallal ◽  
Tim Cruschiel ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
African Americans ◽  
Cohort Analysis ◽  
Screening Methods ◽  
Chi Square ◽  
Screening Programs ◽  
Crc Screening ◽  
Testing Uptake ◽  
Chi Square Analysis ◽  
The Impact

Abstract Background: Colorectal cancer (CRC) is the second-leading cause of death in the US. Despite the National Colorectal Roundtable goal of achieving 80% adherence, CRC screening remains underutilized, especially in the underinsured populations. Screening programs have been heavily disrupted during the COVID-19 pandemic. Aim: This research was performed to explore the impact of the pandemic on the existing ethnic and gender disparities prevalent in CRC screening. Methods: Patients were identified 1 year before and after COVID-19 precautions began, using March 1, 2020, as the inflection point. For each year, the primary inclusion criterion was an ordered colonoscopy. The outcome of interest was a colonoscopy performed. Differences by year and race were assessed using Chi-square analysis. A cohort of 1413 patients between age 45 and 75 for whom a colonoscopy was ordered was selected from EHR at a single large institution. 897 patients were in the pre-COVID group, and 516 were in the post-COVID group. Results: There was a 51% reduction in screening colonoscopies performed. White patients had a decrease of 49%, and African Americans had a 55% reduction. Stool testing increased from 47% prior to the pandemic to 94% during the pandemic representing a greater than 100% increase in stool testing uptake. Conclusion: The true impact of COVID-19 on colorectal cancer is yet to be uncovered as future mortality estimates from CRC are ongoing. Due to the widespread closure of endoscopy centers and delay in screening, we believe that the pandemic worsened the screening disparities most prevalent among minority populations. Our retrospective analysis over the last two years points to the drastic reduction of screening for all races, and especially for African Americans. As life gradually returns to normal, it would be interesting to see how the past year has impacted the incidence and prevalence of CRC.

scholarly journals Colorectal cancer screening using a stool DNA-based SDC2 methylation test: a multicenter, prospective trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chang Woo Kim ◽  
Hyunjin Kim ◽  
Hyoung Rae Kim ◽  
Bong-Hyeon Kye ◽  
Hyung Jin Kim ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Early Detection ◽  
Prospective Trial ◽  
Screening Colonoscopy ◽  
Quantitative Detection ◽  
Screening Programs ◽  
Crc Screening ◽  
Stool Dna ◽  
Dna 2

Abstract Background Prevention and early detection of colorectal cancer (CRC) is a global priority, with many countries conducting population-based CRC screening programs. Although colonoscopy is the most accurate diagnostic method for early CRC detection, adherence remains low because of its invasiveness and the need for extensive bowel preparation. Non-invasive fecal occult blood tests or fecal immunochemical tests are available; however, their sensitivity is relatively low. Syndecan-2 (SDC2) is a stool-based DNA methylation marker used for early detection of CRC. Using the EarlyTect™-Colon Cancer test, the sensitivity and specificity of SDC2 methylation in stool DNA for detecting CRC were previously demonstrated to be greater than 90%. Therefore, a larger trial to validate its use for CRC screening in asymptomatic populations is now required. Methods All participants will collect their stool (at least 20 g) before undergoing screening colonoscopy. The samples will be sent to a central laboratory for analysis. Stool DNA will be isolated using a GT Stool DNA Extraction kit, according to the manufacturer’s protocol. Before performing the methylation test, stool DNA (2 µg per reaction) will be treated with bisulfite, according to manufacturer’s instructions. SDC2 and COL2A1 control reactions will be performed in a single tube. The SDC2 methylation test will be performed using an AB 7500 Fast Real-time PCR system. CT values will be calculated using the 7500 software accompanying the instrument. Results from the EarlyTect™-Colon Cancer test will be compared against those obtained from colonoscopy and any corresponding diagnostic histopathology from clinically significant biopsied or subsequently excised lesions. Based on these results, participants will be divided into three groups: CRC, polyp, and negative. The following clinical data will be recorded for the participants: sex, age, colonoscopy results, and clinical stage (for CRC cases). Discussion This trial investigates the clinical performance of a device that allows quantitative detection of a single DNA marker, SDC2 methylation, in human stool DNA in asymptomatic populations. The results of this trial are expected to be beneficial for CRC screening and may help make colonoscopy a selective procedure used only in populations with a high risk of CRC. Trial registration: This trial (NCT04304131) was registered at ClinicalTrials.gov on March 11, 2020 and is available at https://clinicaltrials.gov/ct2/show/NCT04304131?cond=NCT04304131&draw=2&rank=1.

scholarly journals To do or not to do – a survey study on factors associated with participating in the Danish screening program for colorectal cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jesper Bo Nielsen ◽  
Gabriele Berg-Beckhoff ◽  
Anja Leppin
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Demographic Data ◽  
Survey Study ◽  
Stepwise Logistic Regression ◽  
Willingness To Participate ◽  
Cross Sectional Survey ◽  
Screening Programs ◽  
Crc Screening ◽  
Screening Participation

Abstract Background Screening programs for colorectal cancer (CRC) exist in many countries, and with varying participation rates. The present study aimed at identifying socio-demographic factors for accepting a cost-free screening offer for CRC in Denmark, and to study if more people would accept the screening offer if the present fecal test was replaced by a blood test. Methods We used a cross-sectional survey design based on a representative group of 6807 Danish citizens aged 50–80 years returning a fully answered web-based questionnaire with socio-demographic data added from national registries. Data were analyzed in STATA and based on bivariate analyses followed by regression models. Results Danes in general have a high level of lifetime participation (+ 80%) in the national CRC screening program. The results of the stepwise logistic regression model to predict CRC screening participation demonstrated that female gender, higher age, higher income, and moderate alcohol intake were positively associated with screening participation, whereas a negative association was observed for higher educational attainment, obesity, being a smoker, and higher willingness to take health risks. Of the 1026 respondents not accepting the screening offer, 61% were willing to reconsider their initial negative response if the fecal sampling procedure were replaced by blood sampling. Conclusion The CRC screening program intends to include the entire population within a certain at-risk age group. However, individual factors (e.g. sex, age obesity, smoking, risk aversity) appear to significantly affect willingness to participate in the screening program. From a preventive perspective, our findings indicate the need for a more targeted approach trying to reach these groups.

scholarly journals Selection of patients for large mailed fecal immunochemical test colorectal cancer screening outreach programs: A systematic review

2021 ◽  
pp. 096914132199748
Author(s):  
Andrew Wang ◽  
Briton Lee ◽  
Shreya Patel ◽  
Evans Whitaker ◽  
Rachel B Issaka ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Health Care ◽  
Cancer Screening ◽  
Patient Selection ◽  
Implementation Strategies ◽  
Screening Programs ◽  
Crc Screening ◽  
Key Informant ◽  
Immunochemical Test

Objective Digital health care offers an opportunity to scale and personalize cancer screening programs, such as mailed outreach for colorectal cancer (CRC) screening. However, studies that describe the patient selection strategy and process for CRC screening are limited. Our objective was to evaluate implementation strategies for selecting patients for CRC screening programs in large health care systems. Methods We conducted a systematic review of 30 studies along with key informant surveys and interviews to describe programmatic implementation strategies for selecting patients for CRC screening. PubMed and Embase were searched since inception through December 2018, and hand searches were performed of the retrieved reference lists but none were incorporated ( n = 0). No language exclusions were applied. Results Common criteria for outreach exclusion included: being up-to-date with routine CRC screening ( n = 22), comorbidities ( n = 20), and personal history ( n = 22) or family history of cancer ( n = 9). Key informant surveys and interviews were performed ( n = 28) to understand data sources and practices for patient outreach selection, and found that 13 studies leveraged electronic medical care records, 10 studies leveraged a population registry (national, municipal, community, health), 4 studies required patient opt-in, and 1 study required primary care provider referral. Broad ranges in fecal immunochemical test completion were observed in community clinic ( n = 8, 31.0–59.6%), integrated health system ( n = 5, 21.2–82.7%), and national regional CRC screening programs ( n = 17, 23.0–64.7%). Six studies used technical codes, and four studies required patient self-reporting from a questionnaire to participate. Conclusion This systematic review provides health systems with the diverse outreach practices and technical tools to support efforts to automate patient selection for CRC screening outreach.

scholarly journals Geographical Variation and Factors Associated with Colorectal Cancer Mortality in a Universal Health Care System

2014 ◽  
Vol 28 (4) ◽  
pp. 191-197 ◽  
Author(s):  
Mahmoud Torabi ◽  
Christopher Green ◽  
Zoann Nugent ◽  
Salaheddin M Mahmud ◽  
Alain A Demers ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Geographical Variation ◽  
Geographical Area ◽  
Capital City ◽  
Universal Health Care ◽  
Screening Programs ◽  
Crc Screening ◽  
Factors Associated ◽  
Universal Health

OBJECTIVE: To investigate the geographical variation and small geographical area level factors associated with colorectal cancer (CRC) mortality.METHODS: Information regarding CRC mortality was obtained from the population-based Manitoba Cancer Registry, population counts were obtained from Manitoba’s universal health care plan Registry and characteristics of the area of residence were obtained from the 2001 Canadian census. Bayesian spatial Poisson mixed models were used to evaluate the geographical variation of CRC mortality and Poisson regression models for determining associations with CRC mortality. Time trends of CRC mortality according to income group were plotted using joinpoint regression.RESULTS: The southeast (mortality rate ratio [MRR] 1.31 [95% CI 1.12 to 1.54) and southcentral (MRR 1.62 [95% CI 1.35 to 1.92]) regions of Manitoba had higher CRC mortality rates than suburban Winnipeg (Manitoba’s capital city). Between 1985 and 1996, CRC mortality did not vary according to household income; however, between 1997 and 2009, individuals residing in the highest-income areas were less likely to die from CRC (MRR 0.77 [95% CI 0.65 to 0.89]). Divergence in CRC mortality among individuals residing in different income areas increased over time, with rising CRC mortality observed in the lowest income areas and declining CRC mortality observed in the higher income areas.CONCLUSIONS: Individuals residing in lower income neighbourhoods experienced rising CRC mortality despite residing in a jurisdiction with universal health care and should receive increased efforts to reduce CRC mortality. These findings should be of particular interest to the provincial CRC screening programs, which may be able to reduce the disparities in CRC mortality by reducing the disparities in CRC screening participation.

Provinciale responsverschillen in het Vlaamse Bevolkingsonderzoek Dikkedarmkanker: inzichten uit gemeentelijke socio-demografische en gezondheidsgerelateerde kenmerken

2021 ◽  
Author(s):  
T.N. TRAN ◽  
G. VAN HAL ◽  
M. PEETERS ◽  
S. JIDKOVA ◽  
S. HOECK
Keyword(s):  
Colorectal Cancer ◽  
Response Rate ◽  
Response Rates ◽  
Target Population ◽  
Wilcoxon Test ◽  
Future Research ◽  
Screening Methods ◽  
Average Income ◽  
Medical File ◽  
Crc Screening

Municipal characteristics associated with response rate to organised colorectal cancer screening in Flanders Introduction In Flanders (Belgium), the response rate to organised colorectal cancer (CRC) screening is still suboptimal (~ 50%). We studied the characteristics of municipalities in the Flemish provinces with the highest and lowest response rates to explore factors that might be associated with the response rate to organised CRC screening. Methods The response rates of municipalities in 5 Flemish provinces and the characteristics of municipalities in the provinces with the highest and lowest response rates were compared to the average measures of Flanders (data 2017) using an unpaired two-sample Wilcoxon test. Results The municipal response rates in Limburg and Antwerp were significantly higher, and those in West Flanders and Flemish Brabant significantly lower compared to Flanders. Further analyses of Limburg (highest response rate) and Flemish Brabant (lowest response rate) suggested that municipalities with higher response rates had more men and people aged 60-64 in the target population, more jobseekers and more people who contacted GPs/specialists frequently, but fewer people aged 70-74 in the target population and with a lower average income compared to Flanders. In contrast, municipalities with lower response rates had fewer men in the target population, fewer people having a partner, fewer jobseekers and fewer people having a global medical file, but more people with a non-Dutch or non-Belgian nationality and a higher average income (p-values < 0.01). Conclusion This exploratory study identifies certain demographic, socioeconomic and health‑related municipal characteristics that may be related to the response rate to CRC screening in Flanders. These findings can guide future research and investigations with the aim to improve the response rate to CRC screening.

scholarly journals The CRCbiome study: a large prospective cohort study examining the role of lifestyle and the gut microbiome in colorectal cancer screening participants

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ane Sørlie Kværner ◽  
Einar Birkeland ◽  
Cecilie Bucher-Johannessen ◽  
Elina Vinberg ◽  
Jan Inge Nordby ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Gut Microbiome ◽  
Precancerous Lesions ◽  
Colorectal Carcinogenesis ◽  
Screening Tools ◽  
Screening Methods ◽  
Crc Screening ◽  
Link Type ◽  
Incidence And Mortality

Abstract Background Colorectal cancer (CRC) screening reduces CRC incidence and mortality. However, current screening methods are either hampered by invasiveness or suboptimal performance, limiting their effectiveness as primary screening methods. To aid in the development of a non-invasive screening test with improved sensitivity and specificity, we have initiated a prospective biomarker study (CRCbiome), nested within a large randomized CRC screening trial in Norway. We aim to develop a microbiome-based classification algorithm to identify advanced colorectal lesions in screening participants testing positive for an immunochemical fecal occult blood test (FIT). We will also examine interactions with host factors, diet, lifestyle and prescription drugs. The prospective nature of the study also enables the analysis of changes in the gut microbiome following the removal of precancerous lesions. Methods The CRCbiome study recruits participants enrolled in the Bowel Cancer Screening in Norway (BCSN) study, a randomized trial initiated in 2012 comparing once-only sigmoidoscopy to repeated biennial FIT, where women and men aged 50–74 years at study entry are invited to participate. Since 2017, participants randomized to FIT screening with a positive test result have been invited to join the CRCbiome study. Self-reported diet, lifestyle and demographic data are collected prior to colonoscopy after the positive FIT-test (baseline). Screening data, including colonoscopy findings are obtained from the BCSN database. Fecal samples for gut microbiome analyses are collected both before and 2 and 12 months after colonoscopy. Samples are analyzed using metagenome sequencing, with taxonomy profiles, and gene and pathway content as primary measures. CRCbiome data will also be linked to national registries to obtain information on prescription histories and cancer relevant outcomes occurring during the 10 year follow-up period. Discussion The CRCbiome study will increase our understanding of how the gut microbiome, in combination with lifestyle and environmental factors, influences the early stages of colorectal carcinogenesis. This knowledge will be crucial to develop microbiome-based screening tools for CRC. By evaluating biomarker performance in a screening setting, using samples from the target population, the generalizability of the findings to future screening cohorts is likely to be high. Trial registration ClinicalTrials.gov Identifier: NCT01538550.

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