Assessment of colorectal cancer screening methods

• Κύριος συγγραφέας: Παναγάκη, Αντωνία
• Άλλοι συγγραφείς: Panagaki, Antonia
• Γλώσσα: English
• Έκδοση: 2022
• Θέματα: Colorectal cancer; Screening; gFOBT; Καρκίνος παχέος εντέρου; Πρόληψη

Background: In the light of the 21st century, colorectal cancer (CRC) remains one of the most challenging diseases, as it is the third most commonly occurring cancer that affects humanity. The available screening modalities for CRC fall into two broad categories 1) the in-vitro screening tests that can primarily detect CRC, and 2) the imaging methods that identify precancerous adenomatous polyps and CRC. Tests that primarily detect cancer are: i. Guaiac-based fecal occult blood test (gFOBT) ii. Fecal immunochemical test (FIT) iii. Fecal DNA tests Tests that detect both adenomatous polyps and cancer include: i. Flexible sigmoidoscopy ii. Colonoscopy iii. Double-contrast barium enema iv. Capsule Endoscopy v. Computed tomography colonography The main purpose of this master thesis is to analyze the in-vitro screening methods of the CRC, in a form of a systematic review. Methods: PubMed was screened for relevant studies (meta-analysis, systematic reviews, randomized control trials) over the last five years, in English language, for humans reporting on the characteristics of gFOBT, FIT, and fecal DNA tests used in screening CRC in the asymptomatic population. Results: Out of 132 studies initially identified twenty-three (23) were finally included. The sensitivity and the specificity of each method were pooled, also the advantages and the disadvantage, and comparison between the in-vitro modalities of CRC screening is attempted. Discussion: Among the laboratory methods of CRC screening, FIT is the one that demonstrates better accuracy. Since the cut-off level of Hb/g stool of FIT affects the sensitivity and the specificity of the method, it may be assumed that the optimal threshold is 20 Hb/g in stool. It is considered the most efficient laboratory modality in annual or biannual screening. The gFOBT is as well an available option that is validated in the current guidelines for CRC screening. The newer fecal DNA test presents promising accuracy but needs further research and development to improve its performance and be incorporated into the guidelines.