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Mapping a positive direction for colorectal cancer screening

Mapping a positive direction for colorectal cancer screening


This transcript has been edited for clarity.

Hello. I'm David Kerr, Professor of Cancer Medicine at the University of Oxford.recent articles New England Medical Journal has given us some very interesting new insights into how we can continue screening and improve screening. colorectal cancer. As a practicing cancer physician, I have said many times that prevention is better than cure.

As I get older and wiser, and although this is debatable, I appreciate the importance of screening and early detection of the disease and the impact it has had on reducing colorectal cancer incidence and improving survival rates. I feel the impact. That's a big deal. The National Cancer Screening Program for colorectal cancer has truly had a huge impact.

Any new tests that may help advance this field further are welcome. We believe that an uptake of 80% of the population is desirable for whatever screening test is offered, but we know that typically she is less than 50%.

Whether it's a fecal occult blood test, a blood test, or an invasive test such as: colonoscopyYou can imagine that the more invasive the test, such as sigmoidoscopy, the less frequently these tests are performed. We are falling short of our goal, which is the global standard of testing 80% of the relevant population by any means.

There is a great article by Chung that I think is worth reading and interrogating. They looked at cell-free DNA, so it's a blood test. We use a very interesting commercially available test. Focus on the cell-free DNA of the trait. The test has three elements. One is to look at methylation patterns. One is to focus on fragmentomics. This is a pattern of circulating DNA fragments. Third, we look for somatic mutations in two genes that are biologically important for colorectal cancer. class and APC. The various elements of that test are bioinformatically integrated into some output. They examined approximately 8,000 patients with a median age of 60 years.

They demonstrated that this test detected colorectal cancer with a sensitivity of 83%. Progressive neoplasm. Examines different stages (I, II, III) of colorectal cancer with 90% specificity. Sensitivity for advanced precancerous lesions such as adenomatous polyps and sessile serrated lesions is only 13%. There is some evidence to suggest that the specificity of detection of advanced neoplasms is probably inversely related to age.

Most fundamentally, Chung and his team demonstrated the feasibility of using cell-free DNA as a screening test for colorectal cancer. It has some limitations due to its relatively low sensitivity in detecting precancerous lesions. It must be said that this is a step in the right direction and an attractive application of DNA technology at the highest level, but compared to sigmoidoscopy and colonoscopy, it is difficult to detect pre-cancer It is quite inadequate in terms of sensitivity to detect lesions.

I think we need to work on it more. Some kind of innovation is required in consideration of cost-effectiveness. We need to better understand that susceptibility may decrease with age. What supports that? From the three components of the test (methylation pattern, mutational screening, fragmentomics), it is not possible for us to analyze whether there is one particular part that tends to decline with age.

We don't know because the data is fully integrated. We need a little more information, and perhaps further prospective trials to understand what the real impact is. But what it does show is that it's an active area of ​​research.

In the same issue New England Medical JournalSome interesting advances have been made. Fecal occult blood test. The field is moving and concentrating. In addition to being smarter about the testing we apply, we need to make testing more available and encourage more people to participate in testing programs.

Prevention is better than treatment. Smart technology applications are moving the field forward, but we need better dissemination and testing that is more appealing to our interested citizens. One of the areas that I'm interested in that I've talked about before is: Examine DNA polygenic risk scores and examine patterns of inherited single nucleotide polymorphisms.

We may need to bring these different groups together and integrate the stool tests that we just discussed and look at these polygenic risk scores and see if we can combine them to improve further.

Please see the problem with New England Medical Journal. I think it's interesting and you can see that we're starting to plan for an improved and proactive approach to colorectal cancer screening.

Thank you for listening. If you have any comments or requests, please let us know. For now, Medscapers, Ahoy. thank you.




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