Methods

Performance

Advantages

Drawbacks

Stool/blood-based tests

FIT^a (stool)

79% sensitivity

94% specificity

Noninvasive; Nocomplications; Home-based test.

Positive results require colonoscopy; test repeated annually; low sensitivity for advanced adenomas; insensitive to serrated lesions.

MT-sDNA (stool)

92% sensitivity

87% specificity

Noninvasive with no complications;

Home-based test; better sensitivity for late-stage adenomas and lesions than FIT alone.

Positive results need colonoscopy; repeat every 3 years; more expensive than FIT alone. Concerns for false positive.

Septin-9 (blood)

48% sensitivity

91% specificity

Minimally invasive; no complications; test can be added to usual blood draw.

Low sensitivity for CRC. Requires colonoscopy for positive results.

Visual tests

Colonoscopy

100% detection

Both diagnostic and therapeutic; can detect cancers and precursor polyps.

Depends on the skill of operator; bowel preparation and sedation necessary; Risk of complications < 0.1%.

Flexible sigmoidoscopy

90% - 100% sensitivity for distal CRC

Less invasive than colonoscopy; low risk of complications.

Colonoscopy needed for positive results; Need to repeat every 5 - 10 years; enema preparation is a pre-requisite.

CT colonography

90% - 100% for CRC; variable sensitivity for polyps and poor sensitivity for lesions.

Less invasive than colonoscopy; sedation not required; lower risk of complications than colonoscopy.

Colonoscopy for positive results; bowel preparation is necessary; trained radiologists are inadequate across USA.

Colon capsule

81% sensitivity

93% specificity for polyps ≥ 6 mm

Minimally invasive. Does not require sedation; newer generation tests are home-based.

Colonoscopy needed for positive results; Requires bowel preparation.