Non-endoscopic screening for colorectal cancer. What follows fecal immunochemical testing?

Colonoscopy is the most effective method for colorectal cancer (CRC) screening and prevention, but its widespread application is hindered by the invasiveness and hence the low acceptance rate of the examination. Therefore, noninvasive screening tests are important to encourage adequate CRC screening. Sensitivity and specificity of the contemporary fecal immunochemical test (FIT) are already high and its sensitivity can possibly be further enhanced by low-dose aspirin treatment. Future tests will rely mainly on the detection of tumor-associated DNA in stool or blood samples. Currently, these tests are expensive and do not offer asignificant advantage compared to aFIT for colorectal cancer screening. However, the analysis of circulating tumor DNA will allow various diagnostic applications, including the detection of therapeutically and prognostically relevant genetic aberrations, from patient blood samples in the future.