Stool-Based CRC Surveillance May Reduce Need for Colonoscopies
Stool-based tests for colorectal cancer (CRC), particularly fecal immunochemical tests (FITs), may provide a viable alternative to colonoscopy surveillance in selected populations, with the potential to lessen both patient burden and health care system demand, investigators reported in Gastroenterology.
Researchers who conducted the cross-sectional observational MOCCAS study, evaluated the potential of stool-based tests to reduce the burden of colonoscopy-based CRC surveillance for individuals aged 50 to 75 years. The aim was to identify whether multitarget stool DNA testing and FITs could offer effective alternatives to colonoscopy by focusing surveillance efforts on individuals at higher risk of advanced neoplasia.
Participants included individuals with surveillance indications, categorized by prior polypectomy, history of CRC, or familial CRC risk. Prior to bowel preparation, stool samples were collected for a multitarget stool DNA test and two FITs. A total of 3453 individuals completed all stool tests and colonoscopy. Of these, 2226 had undergone previous polypectomy, 1003 had a history of CRC, and 224 were identified with a familial CRC risk.
The multitarget stool DNA test demonstrated an area under the receiver operating characteristic curve (AUC) of 0.72 (95% CI, 0.69–0.75) for detecting advanced neoplasia. In comparison, the OC-SENSOR and FOB-Gold FITs showed lower AUCs of 0.61 (95% CI, 0.58–0.64) and 0.59 (95% CI, 0.56–0.61), respectively. To evaluate long-term outcomes specifically for the postpolypectomy subgroup—considered the most prevalent surveillance indication and associated with relatively low CRC risk—the Adenoma and Serrated Pathway to Colorectal Cancer (ASCCA) model was used. Stool-based surveillance strategies were adjusted for test positivity thresholds to match or exceed the effectiveness of colonoscopy-based strategies.
Simulations showed that stool-based surveillance for postpolypectomy individuals could reduce the number of colonoscopies by 15% to 41%, depending on the strategy. These reductions were associated with a lifetime requirement of 5.6 to 9.5 stool tests per individual. While multitarget stool DNA–based surveillance offered effectiveness comparable to colonoscopy, it incurred higher costs. In contrast, FIT-based strategies were both effective and cost-saving.
Reference
Carvalho B, de Klaver W, van Wifferen F, et al. Stool-based testing for post-polypectomy colorectal cancer surveillance safely reduces colonoscopies: the MOCCAS study. Gastroenterology. 2025;168(1):121–135
