Fecal DNA versus Fecal Occult Blood for Colorectal-Cancer Screening in an Average-Risk Population

This prospective study of asymptomatic people 50 years of age or older compared a fecal DNA panel with a fecal occult-blood test (Hemoccult II) for colorectal-cancer screening. Colonoscopy was the reference standard. The fecal DNA panel detected 52 percent of cancers, whereas Hemoccult II detected only 13 percent. The sensitivity of the fecal DNA panel for any advanced neoplasia was 18 percent, as compared with 11 percent for Hemoccult II. The two tests had similar specificity. The fecal DNA panel is more sensitive than Hemoccult II, but the majority of cancers and polyps found by colonoscopy were not detected by a one-time use of either noninvasive test. Colorectal cancer is the second leading cause of death from cancer among adults. 1 , 2 Despite recommendations endorsing screening, less than 40 percent of people 50 years of age or older undergo screening for colorectal cancer. 3 Guaiac-based chemical detection of fecal occult blood is the only noninvasive screening method with proven effectiveness, reducing both the incidence 4 and the risk of death from colorectal cancer 5 – 7 when used programmatically. However, the sensitivity of fecal occult-blood testing for colorectal cancer and especially for colorectal adenomas is low because neoplasms may not bleed and thus cannot be detected in this way. 2 The availability of . . .