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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: Revised ACS guidelines expand CRC screening options but are intended to complement, not replace, existing methods. Personalized approaches with risk tools and AI assistance may bolster early detection. Updated American Cancer Society guidance is reshaping colorectal cancer screening, expanding testing options and raising questions about where noninvasive tests, AI and risk-based screening fit alongside established approaches. In its recently revised screening guidance, the American Cancer Society (ACS) included two new at-home stool tests and added a limited recommendation for blood-based screening for patients who decline other forms of screening.
The update has sparked concern from ACG, which warned that the new blood-based test guidelines could confuse patients and undermine adherence to higher-sensitivity screening options. \u201cBlood-based tests \u2014 which can detect circulating free DNA associated with colon cancer \u2014 are potentially the holy grail of colon cancer screening,\u201d David Lieberman, MD, professor of gastroenterology and hepatology at Oregon Health & Science University and former AGA president, told Healio. \u201cIf we could [screen] with a blood test, so that people don\u2019t have to deal with stool or bowel prep before having a colonoscopy, that would be great,\u201d he said. \u201cHowever, the current versions of these tests fail to detect many early-stage cancers and advanced polyps, lesions we clearly want to detect to help prevent colon cancer.\u201d Lieberman said it was important to note that in published studies, blood-based tests underperform other screening options at detecting early-stage cancer and precancerous polyps. \u201cWe hope these tests will get better as the science improves,\u201d Lieberman said. A recent CMS decision reflects the evolving landscape of CRC screening, designating fixed sensitivity and specificity thresholds to qualify noninvasive CRC biomarker tests for coverage, streamlining the process for any future options approved by the FDA. \u201cWe all have a part to play in reducing the burden of colorectal cancer,\u201d Shivan J. Mehta, MD, MBA, MSHP, associate professor of medicine and health policy and associate chief innovation officer at University of Pennsylvania Perelman School of Medicine, told Healio. \u201cNo one solution is going to solve the problem alone.\u201d Risk stratification While current guidelines rely largely on age and average-risk categories, researchers are exploring ways to refine screening decisions by incorporating additional markers of individual risk. \u201cAn ideal [CRC] screening program would be risk-based,\u201d Lieberman said. \u201cWe would reserve the most invasive, highest-risk procedures \u2014 which would be colonoscopies \u2014 for the highest-risk individuals, and use less invasive and risky tests for individuals at lower risk.\u201d However, clinicians currently do not have the tools to further stratify risk for CRC among individuals at average-risk. In the near future, polygenic risk scores \u2014 based on genes associated with CRC development\u2014 may be able to address this issue and determine whether patients should opt for stool-based screening or colonoscopy, Lieberman noted. \u201cWhen we break down a large sample of individuals by these risk scores, the individuals at the very lowest end of the score have a very low risk of developing colon cancer, whereas the individuals on the high end have a high risk,\u201d he said. \u201cFor the people in the middle we\u2019re still a little less sure about it, but I think we\u2019re on the cusp of being able to use this kind of information to help risk stratify.\u201d Fecal immunochemical tests, which detect human hemoglobin in a stool sample, also have the potential to provide a more precise risk-stratification assessment. \u201cRight now, the test is reported as a yes or a no. If it reaches a certain threshold, it\u2019s considered positive, and if it doesn\u2019t reach that threshold, it\u2019s considered negative,\u201d Lieberman said. \u201cBut what if we used the quantitative information \u2014 the absolute value of the human hemoglobin? That is potentially a tool that could be applied to help us understand who might be at higher risk and who might be a lower risk.\u201d Clinicians now have the added challenge of deciding where blood-based CRC tests fit into screening efforts. \u201cThe new ACS guidelines say that [blood-based tests] should be offered if patients decline or are not able to participate in other screening options,\u201d Mehta said. \u201cIf we are now able to test a patient who wouldn\u2019t have ordinarily gotten screened because they didn\u2019t want to complete the other screening options, that would be beneficial.\u201d However, blood-based tests should be \u201ca complement, not a substitute,\u201d he emphasized. Colonoscopy remains the most comprehensive test for screening and is the only method that also allows for the removal of polyps. \u201cPatients develop precancerous lesions and polyps in their colon before they develop cancer,\u201d Lieberman said. \u201cIf we can detect the highest risk polyps and remove them, then we have the potential to prevent cancer.\u201d Patient outreach Current screening standards dictate that clinicians should offer all average-risk individuals colonoscopy or stool-based tests at set intervals, but there are still challenges with uptake and adherence. When a patient at average risk receives a negative colonoscopy result, they generally do not have to return for screening for 10 years. \u201cFor stool-based testing, patients have to come back every 1 to 3 years, and the challenge is that life gets in the way,\u201d Mehta said. \u201cUnless there is a systematic or organized program to send outreach, many of those patients forget about it.\u201d Mehta highlighted the importance of patient outreach programs to ensure adherence and follow-up. \u201cWhen Kaiser Permanente in Northern California implemented a population health strategy of mailing stool testing kits to their patients, they found that it reduced the incidence of colorectal cancer, improved outcomes and eliminated disparities between Black and non-Black patients,\u201d he said. Black individuals in the U.S.<\/p>\n","protected":false},"author":1,"featured_media":3201,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-3200","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3200","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3200"}],"version-history":[{"count":0,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3200\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/media\/3201"}],"wp:attachment":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3200"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3200"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3200"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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