Use of NCCN Guidelines, Other Guidelines, and Biomarkers for Colorectal Cancer Screening

Restricted access

Colorectal cancer (CRC) remains a common cancer and significant public health burden. CRC-related mortality is declining, partly due to the early detection of CRC through robust screening. NCCN has established the NCCN Guidelines for CRC Screening to help healthcare providers make appropriate screening recommendations according to the patient's risk of developing CRC. This review describes the evolution of CRC screening guidelines for average-risk individuals, discusses the role of NCCN Guidelines for CRC Screening in cancer prevention, and comments on the current and emerging use of biomarkers for CRC screening.

Correspondence: Christina D. Williams, PhD, MPH, Durham VA Medical Center, 508 Fulton Street (152), Durham, NC 27705. E-mail: Christina.Williams4@va.gov
  • 1.

    American Cancer Society. Cancer Facts & Figures 2016. Available at: http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf. Accessed July 28, 2016.

    • Search Google Scholar
    • Export Citation
  • 2.

    Provenzale D, Gupta S, Ahnen DJ. Colorectal Cancer Screening, version 1.2016. National Comprehensive Cancer Network. Accessed July 27, 2016. To view the most recent version of these guidelines, visit NCCN.org.

    • Search Google Scholar
    • Export Citation
  • 3.

    Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin 2014;64:104117.

  • 4.

    Provenzale D, Jasperson K, Ahnen DJ. Colorectal Cancer Screening, version 1.2015. J Natl Compr Canc Netw 2015;13:959968; quiz 968.

  • 5.

    Jensen CD, Corley DA, Quinn VP. Fecal immunochemical test program performance over 4 rounds of annual screening: a retrospective cohort study. Ann Intern Med 2016;164:456463.

    • Search Google Scholar
    • Export Citation
  • 6.

    Levin B, Lieberman DA, McFarland B. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology 2008;134:15701595.

    • Search Google Scholar
    • Export Citation
  • 7.

    Whitlock EP, Lin JS, Liles E. Screening for colorectal cancer: a targeted, updated systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2008;149:638658.

    • Search Google Scholar
    • Export Citation
  • 8.

    Byers T, Levin B, Rothenberger D. American Cancer Society guidelines for screening and surveillance for early detection of colorectal polyps and cancer: update 1997. American Cancer Society Detection and Treatment Advisory Group on Colorectal Cancer. CA Cancer J Clin 1997;47:154160.

    • Search Google Scholar
    • Export Citation
  • 9.

    Rex DK, Johnson DA, Anderson JC. American College of Gastroenterology guidelines for colorectal cancer screening 2008. Am J Gastroenterol 2009;104:739750.

    • Search Google Scholar
    • Export Citation
  • 10.

    Lieberman DA, Rex DK, Winawer SJ. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012;143:844857.

    • Search Google Scholar
    • Export Citation
  • 11.

    Lin JS, Piper MA, Perdue LA. Screening for colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2016;315:25762594.

    • Search Google Scholar
    • Export Citation
  • 12.

    Bibbins-Domingo K, Grossman DC, Curry SJ. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA 2016;315:25642575.

    • Search Google Scholar
    • Export Citation
  • 13.

    Ransohoff DF, Sox HC. Clinical practice guidelines for colorectal cancer screening: new recommendations and new challenges. JAMA 2016;315:25292531.

    • Search Google Scholar
    • Export Citation
  • 14.

    Inadomi JM, Vijan S, Janz NK. Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies. Arch Inter Med 2012;172:575582.

    • Search Google Scholar
    • Export Citation
  • 15.

    Berger BM, Parton MA, Levin B. USPSTF colorectal cancer screening guidelines: an extended look at multi-year interval testing. Am J Manag Care 2016;22:e7781.

    • Search Google Scholar
    • Export Citation
  • 16.

    Meester RG, Doubeni CA, Zauber AG. Public health impact of achieving 80% colorectal cancer screening rates in the United States by 2018. Cancer 2015;121:22812285.

    • Search Google Scholar
    • Export Citation
  • 17.

    Klabunde CN, Zheng Y, Quinn VP. Influence of age and comorbidity on colorectal cancer screening in the elderly. Am J Prev Med 2016;51:e6775

  • 18.

    Joseph DA, King JB, Miller JW, Richardson LC. Prevalence of colorectal cancer screening among adults—behavioral risk factor surveillance system, United States, 2010. MMWR Suppl 2012;61:5156.

    • Search Google Scholar
    • Export Citation
  • 19.

    Stanley SL, King JB, Thomas CC, Richardson LC. Factors associated with never being screened for colorectal cancer. J Community Health 2013;38:3139.

    • Search Google Scholar
    • Export Citation
  • 20.

    Cyhaniuk A, Coombes ME. Longitudinal adherence to colorectal cancer screening guidelines. Am J Manag Care 2016;22:105111.

  • 21.

    van Roessel P, Rouse RV, Wren SM. Care within a Veterans Hospital – earlier detection of colon cancer. Surg Endosc 2007;21:14341440.

  • 22.

    Shapiro JA, Klabunde CN, Thompson TD. Patterns of colorectal cancer test use, including CT colonography, in the 2010 National Health Interview Survey. Cancer Epidemiol Biomarkers Prev 2012;21:895904.

    • Search Google Scholar
    • Export Citation
  • 23.

    Gupta S, Tong LY, Allison JE. Screening for colorectal cancer in a safety-net health care system: access to care is critical and has implications for screening policy. Cancer Epidemiol Biomarkers Prev 2009;18:23732379.

    • Search Google Scholar
    • Export Citation
  • 24.

    El-Haddad B, Dong F, Kallail KJ. Association of marital status and colorectal cancer screening participation in the USA. Colorectal Dis 2015;17:O108114.

    • Search Google Scholar
    • Export Citation
  • 25.

    Sidransky D, Tokino T, Hamilton SR. Identification of ras oncogene mutations in the stool of patients with curable colorectal tumors. Science 1992;256:102105.

    • Search Google Scholar
    • Export Citation
  • 26.

    Okugawa Y, Grady WM, Goel A. Epigenetic alterations in colorectal cancer: emerging biomarkers. Gastroenterology 2015;149:12041225.

  • 27.

    Dickinson BT, Kisiel J, Ahlquist DA, Grady WM. Molecular markers for colorectal cancer screening. Gut 2015;64:14851494.

  • 28.

    Shah R, Jones E, Vidart V. Biomarkers for early detection of colorectal cancer and polyps: systematic review. Cancer Epidemiol Biomarkers Prev 2014;23:17121728.

    • Search Google Scholar
    • Export Citation
  • 29.

    Pepe MS, Alonzo TA. Comparing disease screening tests when true disease status is ascertained only for screen positives. Biostatistics 2001;2:249260.

    • Search Google Scholar
    • Export Citation
  • 30.

    Muller HM, Oberwalder M, Fiegl H. Methylation changes in faecal DNA: a marker for colorectal cancer screening? Lancet 2004;363:12831285.

  • 31.

    Huang Z, Li L, Wang J. Hypermethylation of SFRP2 as a potential marker for stool-based detection of colorectal cancer and precancerous lesions. Dig Dis Sci 2007;52:22872291.

    • Search Google Scholar
    • Export Citation
  • 32.

    Chen WD, Han ZJ, Skoletsky J. Detection in fecal DNA of colon cancer-specific methylation of the nonexpressed vimentin gene. J Natl Cancer Inst 2005;97:11241132.

    • Search Google Scholar
    • Export Citation
  • 33.

    Glockner SC, Dhir M, Yi JM. Methylation of TFPI2 in stool DNA: a potential novel biomarker for the detection of colorectal cancer. Cancer Res 2009;69:46914699.

    • Search Google Scholar
    • Export Citation
  • 34.

    Hellebrekers DM, Lentjes MH, van den Bosch SM. GATA4 and GATA5 are potential tumor suppressors and biomarkers in colorectal cancer. Clin Cancer Res 2009;15:39903997.

    • Search Google Scholar
    • Export Citation
  • 35.

    Lee BB, Lee EJ, Jung EH. Aberrant methylation of APC, MGMT, RASSF2A, and Wif-1 genes in plasma as a biomarker for early detection of colorectal cancer. Clin Cancer Res 2009;15:61856191.

    • Search Google Scholar
    • Export Citation
  • 36.

    Leung WK, To KF, Man EP. Detection of hypermethylated DNA or cyclooxygenase-2 messenger RNA in fecal samples of patients with colorectal cancer or polyps. Am J Gastroenterol 2007;102:10701076.

    • Search Google Scholar
    • Export Citation
  • 37.

    Lidgard GP, Domanico MJ, Bruinsma JJ. Clinical performance of an automated stool DNA assay for detection of colorectal neoplasia. Clini Gastroenterol Hepatol 2013;11:13131318.

    • Search Google Scholar
    • Export Citation
  • 38.

    Melotte V, Lentjes MH, van den Bosch SM. N-Myc downstream-regulated gene 4 (NDRG4): a candidate tumor suppressor gene and potential biomarker for colorectal cancer. J Natl Cancer Inst 2009;101:916927.

    • Search Google Scholar
    • Export Citation
  • 39.

    Petko Z, Ghiassi M, Shuber A. Aberrantly methylated CDKN2A, MGMT, and MLH1 in colon polyps and in fecal DNA from patients with colorectal polyps. Clin Cancer Res 2005;11:12031209.

    • Search Google Scholar
    • Export Citation
  • 40.

    Wang DR, Tang D. Hypermethylated SFRP2 gene in fecal DNA is a high potential biomarker for colorectal cancer noninvasive screening. World J Gastroenterol 2008;14:524531.

    • Search Google Scholar
    • Export Citation
  • 41.

    Imperiale TF, Ransohoff DF, Itzkowitz SH. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med 2014;370:12871297.

  • 42.

    Wong IH, Lo YM, Zhang J. Detection of aberrant p16 methylation in the plasma and serum of liver cancer patients. Cancer Res 1999;59:7173.

  • 43.

    Esteller M, Sanchez-Cespedes M, Rosell R. Detection of aberrant promoter hypermethylation of tumor suppressor genes in serum DNA from non-small cell lung cancer patients. Cancer Res 1999;59:6770.

    • Search Google Scholar
    • Export Citation
  • 44.

    Silva JM, Dominguez G, Villanueva MJ. Aberrant DNA methylation of the p16INK4a gene in plasma DNA of breast cancer patients. Br J Cancer 1999;80:12621264.

    • Search Google Scholar
    • Export Citation
  • 45.

    Lofton-Day C, Model F, Devos T. DNA methylation biomarkers for blood-based colorectal cancer screening. Clin Chem 2008;54:414423.

  • 46.

    Church TR, Wandell M, Lofton-Day C. Prospective evaluation of methylated SEPT9 in plasma for detection of asymptomatic colorectal cancer. Gut 2014;63:317325.

    • Search Google Scholar
    • Export Citation
  • 47.

    Jin P, Kang Q, Wang X. Performance of a second-generation methylated SEPT9 test in detecting colorectal neoplasm. J Gastroenterol Hepatol 2015;30:830833.

    • Search Google Scholar
    • Export Citation
  • 48.

    Ebert MP, Model F, Mooney S. Aristaless-like homeobox-4 gene methylation is a potential marker for colorectal adenocarcinomas. Gastroenterology 2006;131:14181430.

    • Search Google Scholar
    • Export Citation
  • 49.

    Leung WK, To KF, Man EP. Quantitative detection of promoter hypermethylation in multiple genes in the serum of patients with colorectal cancer. Am J Gastroenterol 2005;100:22742279.

    • Search Google Scholar
    • Export Citation
  • 50.

    Wallner M, Herbst A, Behrens A. Methylation of serum DNA is an independent prognostic marker in colorectal cancer. Clin Cancer Res 2006;12:73477352.

    • Search Google Scholar
    • Export Citation
  • 51.

    Herbst A, Rahmig K, Stieber P. Methylation of NEUROG1 in serum is a sensitive marker for the detection of early colorectal cancer. Am J Gastroenterol 2011;106:11101118.

    • Search Google Scholar
    • Export Citation
  • 52.

    Li M, Chen WD, Papadopoulos N. Sensitive digital quantification of DNA methylation in clinical samples. Nat Biotechnol 2009;27:858863.

  • 53.

    Mansour H. Cell-free nucleic acids as noninvasive biomarkers for colorectal cancer detection. Front Genet 2014;5:182.

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 315 276 33
PDF Downloads 68 64 9
EPUB Downloads 0 0 0