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Some studies suggest that fecal occult blood tests (FOBT) significantly reduce colorectal cancer mortality and incidence, while other studies indicate that blood markers and anti-p53 antibodies show promise but require further validation.
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Colorectal cancer (CRC) is a significant health concern worldwide, with high morbidity and mortality rates. Early detection through screening is crucial for improving survival rates. Traditional screening methods include fecal occult blood tests (FOBT) and colonoscopy, but there is growing interest in blood-based biomarkers for CRC detection due to their potential for higher patient compliance and early detection capabilities.
G-FOBT has been widely used for CRC screening. Studies have shown that annual G-FOBT screening can reduce CRC mortality by 33%. However, G-FOBT has limitations, including lower sensitivity and specificity compared to newer methods. Despite these limitations, G-FOBT remains a common screening tool due to its simplicity and cost-effectiveness.
I-FOBT, which detects human hemoglobin, has shown better performance than G-FOBT. Randomized studies indicate that I-FOBT has higher participation and detection rates for advanced adenomas and cancer. The sensitivity of I-FOBT for detecting CRC is significantly higher, making it a more effective screening tool.
Research into blood-based biomarkers for CRC has identified several promising candidates. The anti-p53 antibody has shown consistent results in multiple studies, making it a leading candidate for CRC screening. Other potential biomarkers include carcinoembryonic antigen (CEA), C-reactive protein (CRP), and various proteins such as AREG, MIC-1/GDF15, LRG1, and FGF-21.
Studies suggest that panels of multiple biomarkers perform better than single markers. Combining different biomarkers can improve the sensitivity and specificity of blood tests for CRC detection. This approach is promising for developing more reliable and non-invasive screening methods.
While FOBT, particularly I-FOBT, remains effective for CRC screening, blood tests offer a less invasive alternative that may increase patient compliance. Systematic reviews highlight the need for further validation of blood-based biomarkers in pre-diagnostic settings to confirm their effectiveness .
Faecal immunochemical tests (FITs) have been found to be cost-effective for triaging patients with lower abdominal symptoms in primary care settings. FITs can rule out CRC and avoid unnecessary colonoscopies in a significant proportion of symptomatic patients, making them a valuable tool in primary care.
Screening for colorectal cancer is essential for early detection and reducing mortality. While traditional methods like FOBT are effective, blood-based biomarkers offer a promising alternative that could improve patient compliance and early detection rates. Further research and validation of these biomarkers are necessary to establish their role in CRC screening protocols. Combining multiple biomarkers into panels may enhance the accuracy and reliability of blood tests, potentially transforming CRC screening practices in the future.
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