title: Stool DNA Testing for Screening Detection of Colorectal Neoplasia in Alaska Native People.
abstract: OBJECTIVE
  To assess the accuracy of a multitarget stool DNA test (MT-sDNA) compared with fecal immunochemical testing for hemoglobin (FIT) for detection of screening-relevant colorectal neoplasia (SRN) in Alaska Native people, who have among the world's highest rates of colorectal cancer (CRC) and limited access to conventional screening approaches.
  
  
  METHODS
  We performed a prospective, cross-sectional study of asymptomatic Alaska Native adults aged 40-85 years and older undergoing screening or surveillance colonoscopy between February 6, 2012, and August 7, 2014.
  
  
  RESULTS
  Among 868 enrolled participants, 661 completed the study (403 [61%] women). Overall, SRN detection by MT-sDNA (49%) was superior to that by FIT (28%; P<.001); in the screening group, SRN detection rates were 50% and 31%, respectively (P=.01). Multitarget stool DNA testing detected 62% of adenomas 2 cm or larger vs 29% by FIT (P=.05). Sensitivity by MT-sDNA increased with adenoma size (to 80% for lesions ≥3 cm; P=.01 for trend) and substantially exceeded FIT sensitivity at all adenoma sizes. For sessile serrated polyps larger than 1 cm (n=9), detection was 67% by MT-sDNA vs 11% by FIT (P=.07). For CRC (n=10), detection was 100% by MT-sDNA vs 80% by FIT (P=.48). Specificities were 93% and 96%, respectively (P=.03).
  
  
  CONCLUSIONS
  The sensitivity of MT-sDNA for cancer and larger polyps was high and significantly greater than that of FIT for polyps of any size, while specificity was slightly higher with FIT. These findings could translate into high cumulative neoplasm detection rates on serial testing within a screening program. The MT-sDNA represents a potential strategy to expand CRC screening and reduce CRC incidence and mortality, especially where access to endoscopy is limited.
authors.affiliation: Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK. Electronic address: dredwood@anthc.org.
authors.forename: Diana G
authors.initials: DG
authors.lastname: Redwood
authors.affiliation: Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK.
authors.forename: Elvin D
authors.initials: ED
authors.lastname: Asay
authors.affiliation: Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Blake
authors.affiliation: Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK.
authors.forename: Pamela E
authors.initials: PE
authors.lastname: Sacco
authors.affiliation: Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK.
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Christensen
authors.affiliation: Department of Surgery, Alaska Native Medical Center, Anchorage, AK.
authors.forename: Frank D
authors.initials: FD
authors.lastname: Sacco
authors.affiliation: Department of Pathology, Alaska Native Medical Center, Anchorage, AK.
authors.forename: James J
authors.initials: JJ
authors.lastname: Tiesinga
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Devens
authors.affiliation: Department of Medical Oncology, Mayo Clinic, Rochester, MN.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Alberts
authors.affiliation: Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Mahoney
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
authors.forename: Tracy C
authors.initials: TC
authors.lastname: Yab
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Foote
authors.affiliation: Department of Anatomic Pathology, Mayo Clinic, Rochester, MN.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Smyrk
authors.affiliation: Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK.
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Provost
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
authors.forename: David A
authors.initials: DA
authors.lastname: Ahlquist
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D000413:Alaska / Q000453:epidemiology; D003113:Colonoscopy / Q000379:methods / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology; D016549:United States Indian Health Service / Q000706:statistics & numerical data