Blood-Based Versus Stool-Based Biomarker Accuracy in Detection of Colorectal Cancer and Impact of Non-Invasive Tests on Patient Participation

Colorectal cancer is a very treatable cancer when detected early, therefore patient adherence and colorectal cancer screening is key to decrease mortality. The purpose of this research and systematic literature review was to determine how the accuracy of blood-based and stool-based biomarkers compared in the detection of colorectal cancer and how noninvasive testing modalities influence patient participation in colorectal cancer screening. Only articles published within the past 10 years were included. A combination of keywords and MeSH phrases to include but not limited to “adherence,” “SEPT9,” “colonoscopy,” “multitarget stool,” and “colorectal cancer” were used to find relevant articles for each theme. Meta-analyses were excluded. Of note, several articles are used in multiple themes of this literature review. In terms of patient compliance and adherence, the studies comprehensively agree that non-invasive testing modality availability can increase patient participation in screening for colorectal cancer screening. While there was not significant data demonstrating the impact of participation when offering blood testing, various studies demonstrated that this modality is not well known by participants. Overall, MT-sDNA testing showed to be more accurate than SEPT9 in the detection of colorectal cancer and precancerous lesions based on the determined sensitivities and specificities. Of note, SEPT9 did show similar performance to FIT, which is a current FDA approved screening recommendation, in the detection of colorectal cancer and precancerous lesions. Combination testing showed trends that when SEPT9 and FIT were used in combination, sensitivity was increased, however, this in turn decreased specificity of the testing. There are not currently studies available comparing the performance of SEPT9 and MT-sDNA performance in combination, hence, further research is needed in this area to fully optimize available modalities.