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

Abstract

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.

Follow-up colonoscopy after an abnormal stool-based colorectal cancer screening result: analysis of steps in the colonoscopy completion process

“…Innovations in non-invasive screening technology, such as urine tests, exhaled breath tests, and blood-based tests, could minimize patient stress and discomfort and improve adherence to CRC screening [ 23 , 24 ]. However, research is scarce on the performance of these innovations to identify patients with advanced adenomas [ 24 ].…”

“…Innovations in non-invasive screening technology, such as urine tests, exhaled breath tests, and blood-based tests, could minimize patient stress and discomfort and improve adherence to CRC screening [ 23 , 24 ]. However, research is scarce on the performance of these innovations to identify patients with advanced adenomas [ 24 ]. Irrespective of first-line test choice, efforts will likely still be needed to assure that those with limited access to health care can get a follow-up colonoscopy.…”

Colorectal Cancer Screening: Have We Addressed Concerns and Needs of the Target Population?

“…A number of reviews have synthesized the available information on the advantages and disadvantages of the available CRC screening tests from the perspectives of experts [36][37][38][39]. In the past fifteen years, many single studies have also attempted to investigate the preference of the general population for both the conventional and emerging CRC screening techniques; however, an up-to-date review on this topic is currently lacking [40].…”

Promising Epigenetic Biomarkers for the Early Detection of Colorectal Cancer: A Systematic Review

“…Besides Cologuard ® and Epi proColon ® , single-target stool DNA tests are also available for CRC screening. EarlyTect™-Colon Cancer (Genomictree, South Korea) approved by the Korean [30], and Colosafe ® (Creative Biosciences China), approved by the China National Medical Products Administration are two st-sDNAs [31,32] (Table 1, Figure 3). We examined the last five years' literature for methylated genes currently targeted by FDA or NMPA screening kits: mSDC2, mSEPT9, mNDRG4, and mBMP3.…”