Dr Shaukat reviews new alternatives for noninvasive colon cancer screening, including 2 stool-based and 1 blood-based test. 

Aasma Shaukat, MD, is professor of medicine and population health at the NYU-Grossman School of Medicine and a physician at the New York Harbor Veterans Administration Medical Center in New York City.

Hello, my name is Aasma Shaukat, I'm a professor of medicine at NYU Grossman School of Medicine and a physician at the New York Harbor VA in New York also. I'm very excited to be speaking to you today about colon cancer screening, some of the updates in noninvasive colorectal cancer strategies and other guideline-related updates.

So one of the first few updates is now average risk screening for men and women in the US is recommended to initiate at age 45. Over the last few years we've had accumulating data that colorectal cancer screening rates in individuals 50 and older, both men and women, have been declining steadily. However, we are seeing an uptick in incidents of colorectal cancer in men and women ages 20 to 49. This and many other pieces of evidence have led all the guideline bodies, including American College of Gastroenterology, the US Preventive Services Task Force to lower the screening age to begin at 45. This is now covered by Medicare and all commercial payers. So hopefully everybody is starting to discuss screening with their patients at 45 and not having any barriers to getting that screening covered.

In terms of screening modalities, we have several options and what's really exciting is that there are 3 new noninvasive testing options that I'll talk about. So currently our screening options are either colonoscopy, which is the most frequently done procedure in the US for screening for colon cancer and is very sensitive and specific for colorectal cancer detection as well as detection of precancerous lesions. Our other 2 screening modalities are stool-based, either a fecal immunochemical test or FIT or the multitarget stool DNA test. A FIT is done every year and a Cologuard test is done every 3 years.

The important thing to remember is that these tests are a 2-step process, meaning after the initial test, if that test is positive or abnormal, our patients need a colonoscopy to complete that screening cascade. And that colonoscopy is now considered a screening colonoscopy, so our patients need not worry about having a copay or shared costs.

The 3 new tests that I wanted to highlight are, one is a multitarget stool RNA test. It's by Geneoscopy, and the pivotal study was done in almost 8000 average-risk individuals undergoing colonoscopy. The test ranks pretty high in sensitivity and specificity. The second test is a Cologuard 2.0 called Cologuard Plus. This is a multitarget stool DNA test with advances in the technology used for detection. And this test also has high sensitivity and specificity for colorectal cancer. And the third and most exciting development is a novel blood-based test. So this test is by Guardant, it's called SHIELD, and the test was also approved based on a pivotal study with almost 8000 individuals, and it was clinically validated against screening colonoscopy. The test performance is about 80% sensitivity for colorectal cancer detection and almost 90 % specificity for colorectal cancer. The test is FDA approved as of May this year and it's also Medicare approved. So very soon labs near you might be offering this test.

How to choose these tests? Remember adherence is the most important thing. The best test is the one that the patient is willing to complete and complete both steps in case of a noninvasive test. So again, think of offering your patients choices and they might opt for a colonoscopy or one of these noninvasive tests. So that decision-making process should be shared between the providers and our patients and let's maximize adherence and get it above 80%, which is our national goal. Thank you very much.