Screening tests for colorectal cancer: A menu of options remains relevant

Until the early 1990s, no evidence was available to show that screening for colorectal cancer (CRC) by any means actually saved lives. Subsequently, sufficient evidence for the efficacy of fecal occult blood testing (FOBT) and flexible sigmoidoscopy allowed the US Preventive Services Task Force to publish guidelines for CRC screening. Since that time the major organizations in the United States concerned with screening guidelines have recommended a menu of screening test options including FOBT, flexible sigmoidoscopy, flexible sigmoidoscopy plus FOBT, barium enema, and colonoscopy. No organization, except for the American College of Gastroenterology, has designated any one of these options as “preferred.” Nevertheless, the lay press and many gastroenterology opinion leaders have encouraged Americans to have only one test—colonoscopy. In this review we discuss the rationale for caution in designating one screening test as “the best” and present information on how new stool and serum tests can be used effectively to screen for CRC.

[1]  D. Podolsky.  Going the distance--the case for true colorectal-cancer screening. , 2000, The New England journal of medicine.

[2]  D. Rex,et al.  Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. , 1997, Gastroenterology.

[3]  L M Schuman,et al.  Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. , 1993, The New England journal of medicine.

[4]  Michael Pignone,et al.  Cost-Effectiveness Analyses of Colorectal Cancer Screening , 2002, Annals of Internal Medicine.

[5]  S. Thibodeau,et al.  Colorectal cancer screening by detection of altered human DNA in stool: feasibility of a multitarget assay panel. , 2000, Gastroenterology.

[6]  S. Woolf.  The best screening test for colorectal cancer--a personal choice. , 2000, The New England journal of medicine.

[7]  D. Ransohoff,et al.  Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. , 2000, The New England journal of medicine.

[8]  D. Ransohoff.  Lessons from the UK sigmoidoscopy screening trial , 2002, The Lancet.

[9]  T. Morikawa,et al.  A Comparison of the Immunochemical Fecal Occult Blood Test and Total Colonoscopy in the Asymptomatic Population , 2005 .

[10]  A. Adrain,et al.  A comparison of fecal occult-blood tests for colorectal-cancer screening. , 1996, The New England journal of medicine.

[11]  B. Adam,et al.  SELDI-TOF-MS profiling of serum for early detection of colorectal cancer , 2003 .

[12]  D. Amadori,et al.  Fecal multiple molecular tests to detect colorectal cancer in stool. , 2003, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[13]  S. Bingham,et al.  Analysis of minichromosome maintenance proteins as a novel method for detection of colorectal cancer in stool , 2002, The Lancet.

[14]  D. Lieberman.  Colonoscopy: As Good as Gold? , 2004, Annals of Internal Medicine.

[15]  Frank Diehl,et al.  Detection and quantification of mutations in the plasma of patients with colorectal tumors. , 2005, Proceedings of the National Academy of Sciences of the United States of America.

[16]  D. Lieberman,et al.  One-time screening for colorectal cancer with combined fecal occult-blood testing and examination of the distal colon. , 2001, The New England journal of medicine.

[17]  J. Olsen,et al.  Randomised study of screening for colorectal cancer with faecal-occult-blood test , 1996, The Lancet.

[18]  P. Rozen,et al.  Performance Characteristics and Evaluation of an Automated-Developed and Quantitative, Immunochemical, Fecal Occult Blood Screening Test , 2005, The American Journal of Gastroenterology.

[19]  Shah Nj,et al.  Sigmoidoscopy costs and the limits of altruism. , 1999 .

[20]  M. Toepler,et al.  Pyruvatkinase M2 (Tumor M2-PK) im Stuhl als Screeningparameter für kolorektale Neoplasien. Eine Übersicht über bisher publizierte Daten , 2005 .

[21]  E. Petricoin,et al.  Use of proteomic patterns to screen for gastrointestinal malignancies. , 2004, Surgery.

[22]  A. Schatzkin,et al.  Colonoscopic screening of average-risk women for colorectal neoplasia. , 2005, The New England journal of medicine.

[23]  J. Scholefield,et al.  Population based endoscopic screening for colorectal cancer , 2003 .

[24]  A. Detsky.  Screening for colon cancer--can we afford colonoscopy? , 2001, The New England journal of medicine.

[25]  M. Lawson,et al.  Sensitivity and specificity of a stool DNA multitarget assay panel for the detection of advanced colorectal neoplasia. , 2003, Clinical colorectal cancer.

[26]  J. Cummings,et al.  Quantitation of DNA from exfoliated colonocytes isolated from human stool surface as a novel noninvasive screening test for colorectal cancer. , 1998, Clinical cancer research : an official journal of the American Association for Cancer Research.

[27]  S. Winawer,et al.  Choice of fecal occult blood tests for colorectal cancer screening: recommendations based on performance characteristics in population studies: a WHO (World Health Organization) and OMED (World Organization for Digestive Endoscopy) report. , 2002 .

[28]  C. Willet,et al.  The loss of stool DNA mutation abnormalities in colorectal neoplasia after treatment , 2003 .

[29]  S. Woolf,et al.  Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. , 2003, Gastroenterology.

[30]  S. Stryker,et al.  Natural history of untreated colonic polyps. , 1987, Gastroenterology.

[31]  Tim Byers,et al.  Erratum: "American cancer society guidelines for the early detection of cancer: Update of early detection guidelines for prostate, colorectal, and endometrial cancer" (CA A Cancer Journal for Clinicians) (2001) vol. 51 (38-75)) , 2001 .

[32]  T. Levin,et al.  Colonoscopy capacity: Can we build it? Will they come? , 2004, Gastroenterology.

[33]  D. Asch,et al.  Barriers to Office-Based Screening Sigmoidoscopy: Does Reimbursement Cover Costs? , 1999 .

[34]  Perry Pickhardt,et al.  Location of Adenomas Missed by Optical Colonoscopy , 2004, Annals of Internal Medicine.

[35]  C. Boland,et al.  Genetic instability and chromosomal aberrations in colorectal cancer: a review of the current models. , 1998, Cancer detection and prevention.

[36]  M. Cowen,et al.  The impact of a celebrity promotional campaign on the use of colon cancer screening: the Katie Couric effect. , 2003, Archives of internal medicine.

[37]  B. Vogelstein,et al.  A genetic model for colorectal tumorigenesis , 1990, Cell.

[38]  Jingsong He,et al.  Colonoscopic miss rates for right-sided colon cancer: a population-based analysis. , 2004, Gastroenterology.

[39]  H. Sugimura,et al.  Potential usefulness of detecting cyclooxygenase 2 messenger RNA in feces for colorectal cancer screening. , 2004, Gastroenterology.

[40]  R Wender,et al.  American Cancer Society Guidelines for the Early Detection of Cancer: Update of Early Detection Guidelines for Prostate, Colorectal, and Endometrial Cancers: ALSO: Update 2001—Testing for Early Lung Cancer Detection , 2001, CA: a cancer journal for clinicians.

[41]  H. Nakama,et al.  Relationship between fecal sampling times and sensitivity and specificity of immunochemical fecal occult blood tests for colorectal cancer , 1997, Diseases of the colon and rectum.

[42]  L M Schuman,et al.  The effect of fecal occult-blood screening on the incidence of colorectal cancer. , 2000, The New England journal of medicine.

[43]  D. Lieberman,et al.  Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. , 2000, The New England journal of medicine.

[44]  L. Kann,et al.  Enhanced retrieval of DNA from human fecal samples results in improved performance of colorectal cancer screening test. , 2004, The Journal of molecular diagnostics : JMD.

[45]  U. Ladabaum,et al.  Projected national impact of colorectal cancer screening on clinical and economic outcomes and health services demand. , 2005, Gastroenterology.

[46]  D. Ransohoff.  Colon cancer screening in 2005: status and challenges. , 2005, Gastroenterology.

[47]  R. Fletcher.  Screening sigmoidoscopy-- how often and how good? , 2003, JAMA.

[48]  U. P. S. T. Force,et al.  Screening for Colorectal Cancer: Recommendation and Rationale , 2002, Annals of Internal Medicine.

[49]  Emanuel F Petricoin,et al.  Serum proteomic profiling can discriminate prostate cancer from benign prostates in men with total prostate specific antigen levels between 2.5 and 15.0 ng/ml. , 2004, The Journal of urology.

[50]  L. Seeff,et al.  Is there endoscopic capacity to provide colorectal cancer screening to the unscreened population in the United States? , 2004, Gastroenterology.

[51]  A. Shamsuddin,et al.  Usefulness of galactose oxidase-Schiff test in rectal mucus for screening of colorectal malignancy. , 2001, Anticancer research.

[52]  J. Allison.  Screening for colorectal cancer 2003: is there still a role for the FOBT? , 2003 .

[53]  S. Winawer,et al.  Choice of fecal occult blood tests for colorectal cancer screening: recommendations based on performance characteristics in population studies , 2002, American Journal of Gastroenterology.

[54]  S. Goodman,et al.  Detecting colorectal cancer in stool with the use of multiple genetic targets. , 2001, Journal of the National Cancer Institute.

[55]  R. Schoen,et al.  Colon cancer specific nuclear matrix protein alterations in human colonic adenomatous polyps , 2004, Journal of cellular biochemistry.

[56]  S. Moss,et al.  Randomised controlled trial of faecal-occult-blood screening for colorectal cancer , 1989, The Lancet.

[57]  Tim Byers,et al.  Colorectal cancer in patients under close colonoscopic surveillance. , 2005, Gastroenterology.

[58]  Colorectal cancer prevention 2000: screening recommendations of the American College of Gastroenterology , 2000 .

[59]  T. Eide.  Risk of colorectal cancer in adenoma‐bearing individuals within a defined population , 1986, International journal of cancer.

[60]  Robert A Smith,et al.  American Cancer Society guidelines for the early detection of cancer , 2000, CA: a cancer journal for clinicians.

[61]  Fecal Adnab-9 binding as a risk marker for colorectal neoplasia. , 2006, Cancer letters.

[62]  E. Petricoin,et al.  Use of proteomic patterns in serum to identify ovarian cancer , 2002, The Lancet.

[63]  S R Cole,et al.  A Randomised Trial of the Impact of New Faecal Haemoglobin Test Technologies on Population Participation in Screening for Colorectal Cancer , 2003, Journal of medical screening.

[64]  D. Ransohoff,et al.  Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population. , 2004, The New England journal of medicine.