Published online Nov 15, 2016. doi: 10.4251/wjgo.v8.i11.793
Peer-review started: June 17, 2016
First decision: July 30, 2016
Revised: August 1, 2016
Accepted: August 30, 2016
Article in press: August 31, 2016
Published online: November 15, 2016
Colorectal cancer (CRC) has become the third most common cancer in the world. Screening has been shown to be an effective way to identify early CRC and precancerous lesions, and to reduce its morbidity and mortality. Several types of noninvasive tests have been developed for CRC screening, including the fecal occult blood test (FOBT), the fecal immunochemical test (FIT), the fecal-based DNA test and the blood-based DNA test (the SEPT9 assay). FIT has replaced FOBT and become the major screening test due to high sensitivity, specificity and low costs. The fecal DNA test exhibited higher sensitivity than FIT but its current cost is high for a screening assay. The SEPT9 assay showed good compliance while its performance in screening needs further improvements. These tests exhibited distinct sensitivity and specificity in screening for CRC and adenoma. This article will focus on the performance of the current noninvasive in vitro diagnostic tests that have been used for CRC screening. The merits and drawbacks for these screening methods will also be compared regarding the techniques, usage and costs. We hope this review can provide suggestions for both the public and clinicians in choosing the appropriate method for CRC screening.
Core tip: The choice of colorectal cancer (CRC) screening methods is crucial for screening validity and compliance. Currently, the fecal immunochemical test (FIT), fecal DNA and the blood-based SEPT9 assays are the three in vitro diagnostic tests for CRC screening. In this article, we reviewed the current application of the three types of assays and compared their performance in CRC screening. FIT is still the cheapest method with high screening validity, and fecal DNA tests also exhibit high validity but its price is high. In contrast, the SEPT9 assay showed high compliance with acceptable performance. The choice of screening test may depend on the balance of performance, compliance and costs.