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Colorectal cancer (CRC), is the third most common cancer affecting close to 10,00,000 people worldwidecausingsecond most cancer-related deathswith6,55,000 death toll per year.1Recommended by The U.S. Preventive Services Task Force (USPSTF) in average-risk adults between 50–75 years of age, regular screening through colonoscopy every 10 years or yearly faecal occult blood testing can prevent atleast 60% of deaths from colorectal cancer.2Current epidemiologic dataon CRC in Pakistan is limited but according to a study3there has been a 41%increase in incidence between 1995 and1999 in males indicating a higher incidenceat present. But unfortunately, CRC screening is not done routinely in our country. Lack of patient acceptance particularly among females, cultural barriers, financial limitation, lack of resources, lack of physician/public awareness and lack of epidemiological research are paramount reasons for this.4The U.S. Food and Drug Administration in2014 approved the first stool-DNA colorectal screening test-The Cologuard test.2 It is a multi-target test that detects the presence of haemoglobinandcolorectal cancer-related DNA mutationsinshed abnormal cellsusing nine biomarkers. Repeated once every three years,this screening test may reveal eventhe presence of an advanced precancerous lesion from the sample send from the privacy of home.Compared tocolonoscopy-themost sensitive of all,the cologuard testrequires no bowel preparation, dietary changes or sedation. Conversely colonoscopy being invasive and less acceptable to patients,requires an in-patient setting with an experienced personnelandcosts around $100 in our country. The other relatively inexpensiveguaiac-based-FOBTneeds to be repeated every year and does not detect some cancers.5Effectiveness of cologuard test was established in a clinical trial that screened 10,023 asymptomatic adults between 50 and 84 years of age. The trial compared cologuard test to the faecalimmunochemical test (FIT), another non-invasive screening test. The sensitivity for detecting CRC using DNA test and FIT was found to be 92.3% and73.8% (p=0.002) respectively. For advanced precancerous lesions sensitivity of DNA testwas 42.4% and for FIT was 23.8%(p<0.001). Although with lower specificity, DNA testing had a 27% relative increase in the detection rate of stage I–III colorectal cancers and a 78% relative increase in advanced precancerous lesions compared to FIT.6However a positive result with either test should be followed by a diagnostic colonoscopy.In conclusion,offering a convenient, non-invasive andinexpensive screening optionwith a high sensitivity for curable-stage cancer may improve uptake by the people in our country. With appropriate physician and public awareness, cologuard test can be integrated intocolon cancer screening program in our country, specifically helpfulfor those who refuseto undergo colonoscopy.Keywords: Cologuard test; Stool-DNA test; FIT-DNA test;colorectal cancer; CRC; ColonoscopyREFERENCES1.Zhao R. Perspectives on the treatment of colorectal carcinoma. World JGastrointest Oncol 2010;2(5):229–34.2.FDA approves first non-invasive DNA screening test for colorectal cancer [Internet]. U.S. Food and Drug Administration. 2014 [cited 2017Jan17]. Available from: http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm409021.htm3.Bhurgri Y, Bhurgri A, Nishter S, Ahmed A, Usman A, Pervez S, et al. Pakistan-country profile of cancer and cancer control 1995–2004. J Pak Med Assoc 2006;56(3):124–30.4.Ahmed F. Barriers to colorectal cancer screening in the developing world: The view from Pakistan. World JGastrointest PharmacolTher 2013;4(4):83–5.5.Tests to Detect Colorectal Cancer and Polyps [Internet]. National Cancer Institute. 2016 [cited 2017Jan17]. Available from: https://www.cancer.gov/types/colorectal/screening-fact-sheet.6.Imperiale TF, Ransohoff DF, Itzkowitz SH, Levin TR, Lavin P, Lidgard GP, et al. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med 2014;370(14):1287–97.Received: 19 January, 2017Revised: --Accepted: 25 January, 2017Address for Correspondence: Muhammad Arsalan Karim, Dow Medical College,Dow University of Health Sciences, Karachi-PakistanEmail:arsalan_dowite@hotmail.com
Muhammad Arsalan Karim,. (2017) COLOGUARD TEST: A POSSIBLE ALTERNATE TO COLONOSCOPY, JOURNAL OF AYUB MEDICAL COLLEGE ABBOTTABAD, Volume 29, Issue 1.
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