Study Supports 3-Year Interval Between Multi-Target Stool DNA Screening for Colorectal Cancer

A new study evaluating the appropriate interval for colorectal cancer (CRC) screening using a non-invasive multi-target stool DNA test in those with average risk for CRC found no sign of the disease 3 years following an initial test. The findings indicate that an interval of at least 3 years between multi-target stool DNA testing for CRC is clinically appropriate, according to the study, which was published in Cancer Prevention Research.

"This study provides screening age range adults and their clinicians with evidence-based information that they need on multi-target stool DNA screening frequency," study lead Thomas F. Imperiale, MD, Regenstrief Institute research scientist and Indiana University School of Medicine faculty member, said in a press release. "However, due to the constraints imposed by the pandemic when individuals and health care systems postponed or canceled appointments, the number of participants dwindled over the 3 years, and further study of the test interval is required. A 3-year interval may be the most appropriate, but it is possible that a longer interval may work as well or better."

The findings of the study were determined by repeating the multi-target stool DNA test at year 3 and using a colonoscopy to confirm the results. The test uses a single stool sample expelled from the body directly into a container.

Although CRC was not detected by screening at the 3-year interval, there were 63 advanced precancerous lesions detected among 591 individuals enrolled in the study. The investigators noted that the multi-target stool DNA test targets cancer and high-risk pre-cancerous polyps and was not developed to identify non-advanced lesions. Therefore, lesions observed at the 3-year mark may have since become advanced since the preceding screening was conducted.

A 2014 study published in the New England Journal of Medicine led by Imperiale among 10,000 patients found that that multi-target stool DNA testing can detect 92.3% of colon cancers. The ability of a cancer screening test to detect disease is its most important characteristic because its primary role is to rule out disease, according to the study authors.

In 2021, national guidelines reduced the recommended age to begin colon cancer screening from 50 to 45 years. According to the study, approximately 7-8 out of 10 individuals within this recommended age range are considered to have an average risk for CRC, which is the third most common cancer in the United States.

"Colon cancer screening tests like the multi-target stool DNA or the less sensitive annual fecal immunochemical test [FIT] are efficient ways to screen the population, especially those at the low-risk end of the average risk population, which includes most individuals in the younger age range of screening," Imperiale said in the release. "Using at-home tests encourages those who appreciate their ease of use and lower hassle factor to be screened. And it doesn't simply benefit the individual, it benefits others who are high risk and are best screened with colonoscopy."

Reference

Thomas F. Imperiale, Philip T. Lavin, Tara N. Marti, Debbie Jakubowski, Steven H. Itzkowitz, Folasade P. May, Paul J. Limburg, Seth Sweetser, Anas Daghestani, Barry M. Berger. Three-Year Interval for the Multi-Target Stool DNA Test for Colorectal Cancer Screening: A Longitudinal Study. Cancer Prevention Research, 2022; DOI: 10.1158/1940-6207.CAPR-22-0238