Blood-Based Testing for Colorectal Cancer Screening
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REVIEW ARTICLE
Blood-Based Testing for Colorectal Cancer Screening Karen A. Heichman
Published online: 5 December 2013 Ó Springer International Publishing Switzerland 2013
Abstract Colorectal cancer (CRC) is the third most common non-skin cancer diagnosed in men and women in the USA and worldwide. While it has been clearly established that screening for CRC, using a variety of methods, is cost effective and has a significant impact on overall survival, screening rates have proven to be sub-optimal. It has been long conjectured that a simple blood-based test, with a specimen drawn at a routine doctor’s office visit, would encourage those individuals who have refused or ignored screening recommendations to undergo screening. This article reviews the currently available blood-based screening tests for CRC, including the ColonSentryTM messenger RNA (mRNA) expression panel and the SEPT9 methylated DNA test, and explores newer biomarkers that are near clinical implementation. Also discussed are additional applications for blood-based CRC testing, such as assessing prognosis, disease surveillance, and expansion of screening tests to high-risk populations, such as the estimated 1.4 million individuals in the USA with inflammatory bowel disease.
1 Introduction Colorectal cancer (CRC) is the third most common nonskin cancer diagnosed in men and women in the USA and
K. A. Heichman (&) Oncology Technology Development and Licensing, ARUP Laboratories Inc., 500 Chipeta Way, Mail stop #209, Salt Lake City, UT 84108, USA e-mail: [email protected] K. A. Heichman Department of Pathology, University of Utah School of Medicine, Salt Lake City, USA
worldwide, with over 140,000 new cases predicted in the USA for 2013 [1]. American men and women have a 1 in 20 lifetime risk of getting CRC. CRC is the second leading cause of cancer death in the USA if both sexes are taken together as a group, with an estimated 50,000 deaths attributed to the disease expected in 2013 [1]. Death rates have decreased over the past 20 years, due in part to screening efforts, early detection, and improved treatment options. CRC can be prevented by the removal of polyps during colonoscopy. Tumors detected at an early stage can be more effectively and less expensively treated, with 5-year survival rates of 90 %. Unfortunately, many CRCs are diagnosed when the disease has spread beyond the primary site, with greatly reduced survival rates.
2 Screening and Compliance Although screening can dramatically lower mortality due to CRC, less than two-thirds of Americans aged 50 years and older currently undergo any kind of screening [2], with much lower screening rates reported in other countries [3]. Globally, stool-based testing predominates; however, in the USA, screening methods other than colonoscopy, such as fecal testing, have declined in recent years [4]. Patient compliance is a major barrier to achieving universal screening [5]. Individuals who otherwise adhere to screening recommendations for other cancers, such as those who routinely undergo mamm
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