Blood-Based Colorectal Cancer Screening: A New Era of Compliance and Complexity
Blood-Based Colorectal Cancer Screening: A New Era of Compliance and Complexity
Blood-based screenings are reshaping expectations for compliance and detection, offering less invasive options that address longstanding barriers in colorectal cancer screening—but they bring new complexities.
Despite the proven efficacy of colonoscopy and fecal immunochemical tests, only about 66.8% of adults aged 50–75 were up-to-date with colorectal cancer screening in 2020, according to the Centers for Disease Control and Prevention.
As emerging research on blood-based tests show promise for colorectal cancer screening, clinicians are considering these assays as a less invasive alternative to improve patient compliance, although the US Preventive Services Task Force currently does not recommend them as a primary screening option pending further evidence.
The convenience of a simple blood draw could translate into higher initial screening uptake, yet sensitivity for advanced adenomas remains lower than with established modalities. Follow-up adherence further complicates the sequence of follow-up steps after screening: only about 49% of patients complete a colonoscopy within six months after a positive blood-based result, underscoring how blood tests show potential but follow-up falls short in real-world practice.
Moreover, blood-based assays demonstrate around 74% sensitivity for colorectal cancer detection compared to approximately 95% sensitivity for colonoscopy and 79% for fecal immunochemical testing, as reported in a comparative effectiveness study.
In one urban practice, clinicians at the UCLA Health Jonsson Comprehensive Cancer Center observed that offering a blood test to patients overdue for screening increased completion rates by nearly 15%, yet coordinating timely colonoscopy referrals remained challenging. Patient navigation protocols, automated reminders and streamlined insurance authorizations were essential to convert initial blood-test compliance into actionable diagnostic follow-up.
Integrating blood-based assays into colorectal cancer screening pathways demands a balanced approach: leveraging their appeal to untested patients while reinforcing robust systems for follow-up colonoscopy. Tailored patient education, real-time EMR alerts and dedicated care coordinators can bridge adherence gaps, and ongoing advances in methylation and multi-omic markers (comprehensive analyses of multiple molecular data types) may soon enhance assay sensitivity to meet clinical thresholds for broader adoption.
Key Takeaways:
- Blood-based tests offer a less invasive alternative that may improve compliance in colorectal cancer screening.
- Current challenges include low follow-up adherence rates and limitations in early cancer detection compared to traditional methods.
- Enhancing test sensitivity and adherence strategies remains crucial for widespread clinical adoption.