title: Use of faecal markers in screening for colorectal neoplasia: a European group on tumor markers position paper.
abstract: Several randomized controlled trials have shown that population-based screening using faecal occult blood testing (FOBT) can reduce mortality from colorectal neoplasia. Based on this evidence, a number of countries have introduced screening for colorectal cancer (CRC) and high-risk adenoma and many others are considering its introduction. The aim of this article is to critically review the current status of faecal markers as population-based screening tests for these neoplasia. Most of the available faecal tests involve the measurement of either occult blood or a panel of DNA markers. Occult blood may be measured using either the guaiac faecal occult blood test (gFOBT) or a faecal immunochemical test (iFOBT). Although iFOBT may require a greater initial investment, they have several advantages over gFOBT, including greater analytical sensitivity and specificity. Their use results in improved clinical performance and higher uptake rates. Importantly for population screening, some of the iFOBTs can be automated and provide an adjustable cutoff for faecal haemoglobin concentration. However, samples for iFOBT, may be less stable after collection than for gFOBT. For new centres undertaking FOBT for colorectal neoplasia, the European Group on Tumour Markers recommends use of a quantitative iFOBT with an adjustable cutoff point and high throughput analysis. All participants with positive FOBT results should be offered colonoscopy. The panel recommends further research into increasing the stability of iFOBT and the development of improved and affordable DNA and proteomic-based tests, which reduce current false negative rates, simplify sample transport and enable automated analysis.
authors.affiliation: Department of Pathology and Laboratory Medicine, St Vincent's University Hospital, Dublin and UCD School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. Michael.J.Duffy@ucd.ie
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Duffy
authors.forename: Leo G M
authors.initials: LG
authors.lastname: van Rossum
authors.forename: Sietze T
authors.initials: ST
authors.lastname: van Turenhout
authors.forename: Outi
authors.initials: O
authors.lastname: Malminiemi
authors.forename: Catherine
authors.initials: C
authors.lastname: Sturgeon
authors.forename: Rolf
authors.initials: R
authors.lastname: Lamerz
authors.forename: Andrea
authors.initials: A
authors.lastname: Nicolini
authors.forename: Caj
authors.initials: C
authors.lastname: Haglund
authors.forename: Lubos
authors.initials: L
authors.lastname: Holubec
authors.forename: Callum G
authors.initials: CG
authors.lastname: Fraser
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Halloran
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000378:metabolism*; D004273:DNA, Neoplasm / Q000032:analysis; D005060:Europe; D005243:Feces / Q000737:chemistry*; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D009780:Occult Blood; D011237:Predictive Value of Tests; D015203:Reproducibility of Results
chemical_list: D014408:Biomarkers, Tumor; D004273:DNA, Neoplasm