Blood-Based Colorectal Cancer Screening: The Illusion of Simplicity and the Cancer Prevention Paradox
Menée aux Etats-Unis et aux Emirats arabes unis auprès de 27 010 personnes asymptomatiques présentant un risque moyen de développer un cancer colorectal (âge médian : 57 ans ; 55,8 % de femmes), cette étude multicentrique évalue la performance, du point de vue de la sensibilité, de la spécificité, de la valeur prédictive positive et de la valeur prédictive négative, d'un test sanguin de dépistage basé sur l'ADN tumoral circulant
Despite a significant decline in colorectal cancer (CRC) incidence and mortality over the past several decades in the US, CRC remains the second leading cause of cancer deaths. Most of these deaths could be prevented if the 42% of Americans aged 45 to 75 years who are not up to date with screening would participate. There is strong evidence supporting screening with lower intestinal endoscopy (ie, colonoscopy or flexible sigmoidoscopy) or repeated rounds of occult blood–based stool screening tests. These screening tests are effective in detecting cancer at early, curable stages as well as preventing cancer through detection and removal of advanced precancerous lesions, including adenomas and serrated colorectal lesions. Despite public awareness campaigns, organized screening (eg, programmatic mailed stool-based tests), and patient decision aids and navigation, participation is suboptimal, and closing the screening gap remains elusive. This gap may result from reluctance to complete screening due to inconvenience, discomfort, embarrassment, aversion to handling stool, or fear of complications. The ideal CRC screening test would be noninvasive and acceptable to those being screened, be highly sensitive for both early cancer and advanced precancerous lesions, have excellent specificity, and be widely accessible. All of the currently available CRC screening test options fall short of this ideal in at least 1 way, limiting their effectiveness. Thus, there is an ongoing search for more agreeable screening test options.
JAMA , éditorial, 2025