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,Multitarget Stool DNA Testing for Colorectal-Cancer Screening,N Engl J Med.2014 Apr 3;370(14):1287-97,IF:54.42,Background,CRC: major cause of death and disease,Background,Processes of colorectal carcinogenesis lend themselves to screening,Background,A substantial proportion never tested!Screening for CRC is cost-effectiveA simple, noninvasive test might improve clinical out-comes,28%,Background,Colorectal cancer arises from accumulated genetic and epigenetic alterations,Aim,Evaluate the multitarget stool DNA test as a tool for screening,Aim,Primary aim: DNA test in the detection of CRC Secondary aims: DNA test in the detection of advanced precancerous lesions and to compare it with a commercially available fecal immunochemical test (FIT),DNA test,VS,Methods,Study Population: 2011.6-2012.11 90 sites,Methods,Excluded personal history : colorectal neoplasia, digestive cancer, or inflammatory bowel disease previous colonoscopy , barium enema, CT ,sigmoidoscopy positive results on fecal blood testing, rectal bleeding undergone colorectal resection family history,Methods,Primary and Secondary OutcomesCRC, stage determined with the use of the AJCC staging system Advanced precancerous lesions: Advanced adenomas high-grade dysplasia with 25% villous histologic features measure 1cm in the greatest dimension Sessile serrated polyps measuring 1 cm or more in diameter,aberrantly methylated BMP3 and NDRG4promoter regions,mutant KRAS,immunochemical assay for human hemoglobin,FIT,Multitarget stool DNA test,Results,12776,Results,Results,Results,Figure 3.Receiver Operating Characteristic (ROC) Curves Comparing DNA Testing and FIT for the Detection of Colorectal Cancer and Advanced Colorectal Neoplasia.,Results,Multitarget DNA testing detected clinically significant lesions more efficiently than FIT.,Conclusions,A stool test combining altered human DNA and fecal hemoglobin showed higher sensitivity than a commercial FIT for both CRC and advanced precancerous lesions, although with lower specificity.,Translational Research,Aug. 12, 2014FDA Approves CologuardFirst and Only Stool DNA Noninvasive Colorectal Cancer Screening TestReceived a proposed cove-rage memorandum from the Centers for Me