Hans J. Nielsen
University of Copenhagen,Denmark
Title: Improvements of colorectal cancer screening by development and implementation blood-based biomarker concepts
Biography
Biography: Hans J. Nielsen
Abstract
Screening concepts for colorectal cancer (CRC) are either under implementation or already implemented in most industrialized countries. The current concept is based on occult human blood in a feces test – FIT screening. Persons with a positive test are offered a subsequent colonoscopy to verify the source of occult blood. The FIT test has an excellent sensitivity of 75% at 90-95% specificity. The compliance is however, only 65%, which leads to a clinical sensitivity of < 50% (0.75 x 0.65). Long story short: >50% of those subjects with an occult bowel neoplasia in the screen relevant populations are not identified. Therefore, development and implementation of improved screening concepts is urgently needed. Once such concept appears to be based on analysis of proteomics, genomics, epigenomics and metabolomics in blood samples and statistically performing various combinations by data fusion. Results of major prospective, clinical studies with focus on subjects referred to colonoscopy due to symptoms attributable to CRC are compelling. In addition, results of retrospective studies have indicated that biomarker profiles may identify subjects at risk of developing primary intra- or extra-colonic malignancy subsequent to colonoscopy with diagnosis of clean colorectum. Collectively, such results have led to validation of the screening concept of blood-based biomarker combinations in large series of subjects undergoing FIT screening. Preliminary results have confirmed the results previously achieved in populations of symptomatic subjects.