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Cancer Screening, Prevention, Control

Stool-Based Screening Tests for Colorectal Cancer

Educational Objective
To understand how to interpret the results of diagnostic tests and apply them clinically.

1 Credit CME

JAMA

Published Online: February 17, 2023

JAMA Diagnostic Test Interpretation

Article Information and Disclosures

John M. Carethers, MD¹

Author Affiliations

¹Division of Gastroenterology, Department of Medicine, University of California, San Diego

Read article on JAMA Network

JAMA Clinical Guidelines Synopsis

Recommendations for Colorectal Cancer Screening

Nina Gupta, MD; Sonia S. Kupfer, MD; Andrew M. Davis, MD, MPH
US Preventive Services Task Force

USPSTF Recommendation: Screening for Colorectal Cancer

US Preventive Services Task Force; Karina W. Davidson, PhD, MASc; Michael J. Barry, MD; Carol M. Mangione, MD, MSPH; Michael Cabana, MD, MA, MPH; Aaron B. Caughey, MD, PhD; Esa M. Davis, MD, MPH; Katrina E. Donahue, MD, MPH; Chyke A. Doubeni, MD, MPH; Alex H. Krist, MD, MPH; Martha Kubik, PhD, RN; Li Li, MD, PhD, MPH; Gbenga Ogedegbe, MD, MPH; Douglas K. Owens, MD, MS; Lori Pbert, PhD; Michael Silverstein, MD, MPH; James Stevermer, MD, MSPH; Chien-Wen Tseng, MD, MPH, MSEE; John B. Wong, MD
US Preventive Services Task Force

USPSTF Modeling Study: Colorectal Cancer Screening

Amy B. Knudsen, PhD; Carolyn M. Rutter, PhD; Elisabeth F. P. Peterse, PhD; Anna P. Lietz, BA; Claudia L. Seguin, BA; Reinier G. S. Meester, PhD; Leslie A. Perdue, MPH; Jennifer S. Lin, MD; Rebecca L. Siegel, MPH; V. Paul Doria-Rose, DVM, PhD; Eric J. Feuer, PhD; Ann G. Zauber, PhD; Karen M. Kuntz, ScD; Iris Lansdorp-Vogelaar, PhD
US Preventive Services Task Force

USPSTF Review: Screening for Colorectal Cancer

Jennifer S. Lin, MD; Leslie A. Perdue, MPH; Nora B. Henrikson, PhD; Sarah I. Bean, MPH; Paula R. Blasi, MPH
Insights

Colorectal Cancer Screening and Prevention in the COVID-19 Era

Rachel B. Issaka, MD, MAS; Ma Somsouk, MD, MAS
Original Investigation

Screening Endoscopy and Colorectal Cancer in Older Adults

Wenjie Ma, ScD; Kai Wang, PhD; Long H. Nguyen, MD; Amit Joshi, PhD; Yin Cao, ScD; Reiko Nishihara, PhD; Kana Wu, MD, PhD; Shuji Ogino, MD, PhD; Edward L. Giovannucci, MD, ScD; Mingyang Song, MD, ScD; Andrew T. Chan, MD, MPH
Viewpoint

Colorectal Cancer Screening in the US—Still Putting the Cart Before the Horse?

Ricardo J. Bello, MD, MPH; George J. Chang, MD, MS; Nader N. Massarweh, MD, MPH

Read Case Take Quiz Answer

A 56-year-old man with no significant medical history was seen in clinic by his primary care physician. The patient had not followed the physician’s recommendation at prior clinic visits to undergo colonoscopy for colorectal cancer (CRC) screening, and during this visit he declined colonoscopy without first undergoing a less invasive screening test for CRC. The patient had no history of hematochezia or abnormal bowel movements but reported that his father had died from CRC at age 80 years. His hemoglobin was 13.7 g/dL (reference, 13.5-17.0 g/dL).

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A 56-year-old man with no significant medical history was seen in clinic by his primary care physician. The patient had not followed the physician’s recommendation at prior clinic visits to undergo colonoscopy for colorectal cancer (CRC) screening, and during this visit he declined colonoscopy without first undergoing a less invasive screening test for CRC. The patient had no history of hematochezia or abnormal bowel movements but reported that his father had died from CRC at age 80 years. His hemoglobin was 13.7 g/dL (reference, 13.5-17.0 g/dL).

D. Recommend A, B, or C

High-sensitivity guaiac fecal occult blood test (gFOBT), fecal immunochemical test (FIT), and multitarget stool DNA-FIT (s-DNA-FIT) are the stool-based tests recommended by the US Preventive Services Task Force (USPSTF) for colorectal cancer (CRC) screening in asymptomatic persons at average risk of CRC beginning at age 45 years.¹ Colonoscopy, instead of stool-based testing, is recommended for screening individuals with a personal or family history of polyps or CRC, inflammatory bowel disease, or those with inherited cancer syndromes.² Importantly, in order for stool-based screening tests to provide benefit, a positive result must be followed up with a colonoscopy, which generates the tissue diagnosis of CRC.

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Article Information

Corresponding Author: John M. Carethers, MD, Division of Gastroenterology, Department of Medicine, University of California, San Diego, Biomedical Sciences Bldg, Room 1318A, 9500 Gilman Dr, La Jolla, CA 92093-0602 (jcarethers@ucsd.edu).

Published Online: February 17, 2023. doi:10.1001/jama.2023.0547

Conflict of Interest Disclosures: Dr Carethers reported receiving grants from the National Cancer Institute and funds from the University of Michigan (where he was employed through 2022) during the conduct of the work. He reported receiving personal fees from Avantor Inc, consulting for Geneoscopy Inc, and being a board member for the American Gastroenterological Association and on the advisory board for the National Institute for Diabetes and Digestive and Kidney Diseases, outside of the submitted work.

Funding/Support: Dr Carethers’ work is supported by the National Institutes of Health (R01 CA258519).

Role of the Funder/Sponsor: The NIH had no role in the preparation, review, or approval of the manuscript or decision to submit the manuscript for publication.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.