Blood-based screening for CRC may be better than no screening at all, but it can't replace colonoscopy as the gold standard, according to two new modeling studies and an expert consensus commentary.
, also known as a "liquid biopsy," may be better than nothing among patients who skip established screening tests, but it can't replaceAlthough some patients find blood-based tests more convenient, the higher numbers of false positives and false negatives could lead to more CRC cases and deaths.
Without screening, the models predicted between 77 and 88 CRC cases and between 32 and 36 deaths per 1,000 individuals, costing between $5.3 million to $5.8 million. Compared with no screening, blood-based screening was considered cost-effective, with an additional cost of $25,600 to $43,700 per quality-adjusted life-year gained .
Overall, a blood-based test at the CMS minimum reduced CRC incidence by 40% and CRC mortality by 52% versus no screening. However, a blood-based test was significantly less effective than triennial stool DNA testing, annual FIT, and colonoscopy every 10 years, which reduced CRC incidence by 68%-79% and CRC mortality by 73%-81%.
"High APL sensitivity, which can result in CRC prevention, should be a top priority for screening test developers," the authors wrote. "APL detection should not be penalized by a definition of test specificity that focuses on CRC only."The AGA CRC Workshop Panel met in September 2023 to review the two modeling studies and other data on blood-based tests for CRC.
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