Reimagining Colorectal Cancer Screening: Innovations and Challenges with Dr. Aasma Shaukat

Author:

Cortiana Viviana1ORCID,Joshi Muskan2,Chorya Harshal3ORCID,Vallabhaneni Harshitha4ORCID,Kannan Shreevikaa2ORCID,Coloma Helena S.5ORCID,Park Chandler H.6,Leyfman Yan7ORCID

Affiliation:

1. Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy

2. Tbilisi State Medical University, Tbilisi 0186, Georgia

3. Medical College Baroda, Vadodara 390018, India

4. Apollo Institute of Medical Sciences and Research, Hyderabad 517001, India

5. Harvard University, Cambridge, MA 02138, USA

6. Norton Cancer Institute, Louisville, KY 40202, USA

7. Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA

Abstract

Colorectal cancer (CRC) currently ranks as the third most common cancer and the second leading cause of cancer-related deaths worldwide, posing a significant global health burden to the population. Recent studies have reported the emergence of a new clinical picture of the disease, with a notable increase in CRC rates in younger populations of <50 years of age. The American Cancer Society (ACS) now recommends CRC screening starting at age 45 for average-risk individuals. Dr. Aasma Shaukat’s Keynote Conference highlights the critical need for updated screening strategies, with an emphasis on addressing the suboptimal adherence rates and the effective management of the growing burden of CRC. Lowering the adenoma detection screening age can facilitate early identification of adenomas in younger asymptomatic patients, altering the epidemiologic landscape. However, its implications may not be as profound unless a drastic shift in the age distribution of CRC is observed. Currently, various screening options are available in practice, including stool-based tests like multitarget stool DNA (mtDNA) tests, fecal immunochemical testing (FIT), and imaging-based tests. In addition to existing screening methods, blood-based tests are now emerging as promising tools for early CRC detection. These tests leverage innovative techniques along with AI and machine learning algorithms, aiding in tumor detection at a significantly earlier stage, which was not possible before. Medicare mandates specific criteria for national coverage of blood-based tests, including sensitivity ≥ 74%, specificity ≥ 90%, FDA approval, and inclusion in professional society guidelines. Ongoing clinical trials, such as Freenome, Guardant, and CancerSEEK, offer hope for further advancements in blood-based CRC screening. The development of multicancer early detection tests like GRAIL demonstrates a tremendous potential for detecting various solid tumors and hematologic malignancies. Despite these breakthroughs, the question of accessibility and affordability still stands. The ever-evolving landscape of CRC screening reflects the strength of the scientific field in light of an altered disease epidemiology. Lowering screening age along with the integration of blood-based tests with existing screening methods holds great potential in reducing the CRC-related burden. At the same time, it is increasingly important to address the challenges of adaptation of the healthcare system to this change in the epidemiologic paradigm.

Publisher

MDPI AG

Reference32 articles.

1. Hossain, M.S., Karuniawati, H., Jairoun, A.A., Urbi, Z., Ooi, D.J., John, A., Lim, Y.C., Kibria, K.M., Mohiuddin, A.K.M., and Ming, L.C. (2022). Colorectal Cancer: A Review of Carcinogenesis, Global Epidemiology, Current Challenges, Risk Factors, Preventive and Treatment Strategies. Cancers, 14.

2. (2024, March 19). MedNews Week Keynote Conference—Dr. Aasma Shaukat (NYU Langone Health)—Colorectal Cancer. Available online: https://www.youtube.com/watch?v=GhP_5AsM-IA.

3. Current and Future Colorectal Cancer Screening Strategies;Shaukat;Nat. Rev. Gastroenterol. Hepatol.,2022

4. Increasing Incidence of Colorectal Cancer in Young Adults;Umar;J. Cancer Epidemiol.,2019

5. Young-onset colorectal cancer;Spaander;Nat. Rev. Dis. Primers,2023

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