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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
Insights

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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
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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
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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?

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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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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.

References

Davidson KW , Barry MJ , Mangione CM , et al; US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965-1977. doi:10.1001/jama.2021.6238 PubMed Google Scholar Crossref

Carethers JM . Fecal DNA testing for colorectal cancer screening. Annu Rev Med. 2020;71:59-69. doi:10.1146/annurev-med-103018-123125 PubMed Google Scholar Crossref

Young GP , Symonds EL , Allison JE , et al. Advances in fecal occult blood tests: the FIT revolution. Dig Dis Sci. 2015;60(3):609-622. doi:10.1007/s10620-014-3445-3 PubMed Google Scholar Crossref

Robertson DJ , Lee JK , Boland CR , et al. Recommendations on fecal immunochemical testing to screen for colorectal neoplasia: a consensus statement by the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2017;112(1):37-53. doi:10.1038/ajg.2016.492 PubMed Google Scholar Crossref

Imperiale TF , Ransohoff DF , Itzkowitz SH , et al. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med. 2014;370(14):1287-1297. doi:10.1056/NEJMoa1311194 PubMed Google Scholar Crossref

Pickhardt PJ , Correale L , Hassan C . PPV and detection rate of mt-sDNA testing, FIT, and CT colonograpy for advanced neoplasia: a hierarchic Bayesian meta-analysis of the noninvasive colorectal screening tests. AJR Am J Roentgenol. 2021;217(4):817-830. doi:10.2214/AJR.20.25416 PubMed Google Scholar Crossref

Centers for Medicare and Medicaid Services. Physician fee schedule look-up tool. Accessed January 4, 2023. https://www.cms.gov/medicare/medicare-fee-for-service-payment/PFSlookup

Roos VH , Mangas-Sanjuan C , Rodriguez-Girondo M , et al. Effects of family history on relative and absolute risks for colorectal cancer: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2019;17(13):2657-2667.e9. doi:10.1016/j.cgh.2019.09.007 PubMed Google Scholar Crossref

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 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

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