A new stool test detects colorectal cancer more effectively than previous tests, according to a study published in The Lancet Oncology. The authors believe this could further reduce the number of people dying from the disease.
Every year, almost 2 million people are diagnosed with colorectal cancer, and about half lose their lives as a result of the condition. If detected early, it can be curable in many patients. However, by the time patients notice symptoms — weight loss and blood in stools — it’s often too late. For this reason, many countries use population-wide screening programs. In most of Europe, people of a certain age are invited to be tested every two years. These programs have proved to be very successful in detecting cases early and reducing mortality.
Most countries use the fecal immunochemical test (FIT), which measures the presence of the blood protein hemoglobin. However, a team of researchers from the Netherlands Cancer Institute believes there are better ways. “The current test performs well but leaves room for improvement,” says Gerrit Meijer. “We want to be able to detect the tumors before they have become invasive, that is at the stage of larger premalignant polyps. Treating physicians then can remove these polyps during a colonoscopy, rather than by surgery.”
The authors have been working on a new test for years. To be more accurate, their multitarget FIT test (mFIT) measures hemoglobin and two more proteins. The researchers found promising results when comparing the two tests with over 13,000 participants from the Dutch national population-based screening program. “The new test can detect cancer precursors more effectively,” Meijer explains. “Our results predict that the test can reduce the number of new cases of colorectal cancer and mortality resulting from it.” In addition, the new test is just as easy to use as the current test.
The new test produces more positive tests than the current test. While this led to more colonoscopies, the new mFIT test found abnormalities in 299 people compared to only 159 with the current FIT test. “The new test detects more larger polyps without a significant increase in ‘false-positive’ results and thus unnecessary colonoscopies,” said Meijer.
The exact number of cases that could be detected with the new test depends on how the FIT is used in different countries. “The Dutch screening program applies a relatively high cutoff value to consider the FIT test positive, meaning unfavorable. Here, the new mtFIT test could lead to 21% fewer cases of colorectal cancer and 18% fewer mortalities. In countries that already use a lower FIT cutoff value, these figures would be lower, but likely at least 5% fewer people would develop colorectal cancer, with at least 4% fewer mortalities. In both scenarios, the new test could be cost-effective,” said Meijer.
Wisse PHA, de Klaver W, van Wifferen F, van Maaren-Meijer FG, van Ingen HE, Meiqari L, Huitink I, Bierkens M, Lemmens M, Greuter MJE, van Leerdam ME, Spaander MCW, Dekker E, Coupé VMH, Carvalho B, de Wit M, Meijer GA. The multitarget faecal immunochemical test for improving stool-based colorectal cancer screening programmes: a Dutch population-based, paired-design, intervention study. Lancet Oncol. 2024 Mar;25(3):326-337. doi: 10.1016/S1470-2045(23)00651-4