Faecal occult blood testing (FOBT) is used as a population based method to identify people over the age of 50 years with colorectal cancer.   Fortunately, the majority of patients with a positive FOBT do not have colorectal cancer and only about 5% are diagnosed with CRC and 30% with polyps after colonoscopy.  Colonoscopy is not without risk and even in the most experienced hands there is a morbidity associated with this procedure.

Recently, a highly sensitive and specific assay has been developed that utilises circulating tumour DNA (ctDNA) for the identification of patients with colorectal cancer.  This approach has been shown to have a significantly better specificity and sensitivity than any other screening procedure and has the potential to significantly reduce costs and increase bowel cancer screening compliance using a much less invasive strategy than currently applied.

The project aims to assess the presence or absence of circulating tumour DNA that is specific for colorectal cancer and correlate these findings with those from FOBT testing.  At present there is published evidence demonstrating highly correlative data between ctDNA and the presence of colorectal cancer in patients with later stage disease.  It remains to be determined if patients with early stage disease can be reliably identified and compared to those with FOBT screened patients who do not have disease.

The project will provide much needed specificity in colonoscopy screening and reduce a large number of unnecessary interventions that carry a morbidity risk in otherwise healthy individuals.  By identifying those patients who actually need a colonoscopy, improved screening compliance is expected as it will be undertaken on patients who actually need it thereby improving the speed of access and consequent treatment.



Dr Peter Pockney, Laureate Prof Rodney Scott

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