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Vol. 30, Suppl. 2, 2012
Issue release date: November 2012
Section title: From Bench to Bed: Molecular Markers for Clinical Use
Dig Dis 2012;30(suppl 2):16–26
(DOI:10.1159/000341884)

Noninvasive Screening Tests for Colorectal Cancer

Imperiale T.F.
Indiana University School of Medicine, Regenstrief Institute, Inc. and Richard L. Roudebush VA Medical Center, Indianapolis, Ind., USA

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Article / Publication Details

First-Page Preview
Abstract of From Bench to Bed: Molecular Markers for Clinical Use

Published online: 11/23/2012

Number of Print Pages: 11
Number of Figures: 0
Number of Tables: 6

ISSN: 0257-2753 (Print)
eISSN: 1421-9875 (Online)

For additional information: http://www.karger.com/DDI

Abstract

Background: Identifying an accurate, reliable, affordable, and acceptable noninvasive screening test for colorectal cancer (CRC) would greatly facilitate population screening. Methods: Published literature from 2000 through February 2012 on noninvasive CRC screening tests was identified, reviewed, and summarized. Results: The highest quality evidence for noninvasive screening exists for guaiac-based fecal occult blood tests (gFOBTs), for which the CRC-specific incidence and mortality reductions are modest. Fecal immunochemical tests (FITs) offer better sensitivity and comparable specificity. Cross-sectional studies comparing gFOBTs and FITs suggest that FITs provide higher detection of advanced neoplasia. Modeling studies favor FITs over gFOBTs with respect to effectiveness and cost-effectiveness. A myriad of studies report the performance of fecal-based and blood-based genetic and protein-based biomarkers; the studies differ in patient population assembled, marker selection, and assay methods. Several markers and panels of markers are promising, although nearly all studies focus on new markers and/or assay methods on small sets of referred patients rather than validating markers using optimal assays in a screening setting. Conclusion: In the absence of long-term randomized trials, adoption of the noninvasive tests will require cross-sectional data on test characteristics obtained from the screening setting, where CRC prevalence is low and the full spectrum of colorectal findings exists, along with estimates of cumulative risks, benefits, and cost-effectiveness. Test adoption will ultimately depend on test characteristics, availability, affordability, and user appeal. There is no noninvasive substitute for the currently recommended screening tests. FITs should replace gFOBTs wherever gFOBTs are used for screening.


Article / Publication Details

First-Page Preview
Abstract of From Bench to Bed: Molecular Markers for Clinical Use

Published online: 11/23/2012

Number of Print Pages: 11
Number of Figures: 0
Number of Tables: 6

ISSN: 0257-2753 (Print)
eISSN: 1421-9875 (Online)

For additional information: http://www.karger.com/DDI


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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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