Triage May Improve Selection to Colonoscopy and Reduce the Number of Unnecessary Colonoscopies

SIMPLE SUMMARY: Presently, constraints on colonoscopy capacity appear to be associated with inclusion of screening by direct colonoscopy or follow-up colonoscopy subsequent to a positive result of a feces-based screening concept. It is well known, however, that only a minority of the subjects with a positive feces test are diagnosed with bowel neoplasia at the subsequent follow-up colonoscopy. Therefore, a proposed Triage test concept, which includes (1) age of the subject; (2) concentration of occult blood in a feces test; (3) combinations of blood-based, cancer-associated biomarkers, may improve selection to follow-up colonoscopy in screening for bowel cancer. Thereby, the number of unnecessary colonoscopies may be reduced significantly, which may improve the national healthcare budgets, and indeed spare many subjects for the colonic examination, which is not free from adverse effects. Current research may identify and validate the optimal Triage screening concept. ABSTRACT: Implementation of population screening for colorectal cancer by direct colonoscopy or follow-up colonoscopy after a positive fecal blood test has challenged the overall capacity of bowel examinations. Certain countries are facing serious colonoscopy capacity constraints, which have led to waiting lists and long time latency of follow-up examinations. Various options for improvement are considered, including increased cut-off values of the fecal blood tests. Results from major clinical studies of blood-based, cancer-associated biomarkers have, however, led to focus on a Triage concept for improved selection to colonoscopy. The Triage test may include subject age, concentration of hemoglobin in a feces test and a combination of certain blood-based cancer-associated biomarkers. Recent results have indicated that Triage may reduce the requirements for colonoscopy by around 30%. Such results may be advantageous for the capacity, the healthcare budgets and in particular, the subjects, who do not need an unnecessary, unpleasant and risk-associated bowel examination.