Table 1.

Summary of the efficacy, cost effectiveness, and patient adherence of CRC screening modalities

Screening method	Specificity	Sensitivity	Adherence	Lifetime number of tests needed per 1000 individuals screened**	Cost-effectiveness
Stool-based strategies recommended by the USPSTF
High-sensitivity guaiac fecal occult blood test (HSgFOBT)	96–98% for CRC [1••]	50–75% for CRC [1••]	40–67% [55, 62]	Annual testing: 21,612 [4••]	Lower cost compared to colonoscopy [63]
Fecal immunochemical test (FIT)	94% for CRC [1••]	74% for CRC [1••]	31–73% [47, 64, 65]	Annual testing: 21,094 [4••]	Lower cost compared to CT colonography, colonoscopy, capsule endoscopy and mt-sDNA [11, 66]
Multi-target stool DNA (mt-sDNA) test	85% for CRC [1••]	93% for CRC [1••]	~75% [17]	Annual testing: 16,224 Q3y: 8,855 [5•]	Higher cost compared to FIT [22, 66]
Direct visualization techniques recommended by the USPSTF
Computed tomography (CT) colonography	94% for adenomas ≥10 mm [1••]	89% for adenomas ≥10 mm [1••]	30–34% [67, 68]	Q5y: 6,609 [4••, 5•]	Lower cost compared to colonoscopy [69]
Flexible sigmoidoscopy	83–94% for proximal colon advanced neoplasms [70]	90–100% for distal colon CRC [3••]	27% [67]	Q5y: 6,563 [5•]	Lower cost compared to colonoscopy [30]
Colonoscopy	89% for adenomas ≥10 mm [1••]	18–100% for CRC [1••]	22–38% [55, 67, 68, 71]	Q10y: 4,248 [5•]	Higher cost compared to stool screening and other direct visualization tests [11]
Emerging technologies (not currently USPSTF recommended)
Colon capsule endoscopy	91% for advanced neoplasia ≥10 mm [4••]	77% for advanced neoplasia ≥10 mm [4••]	80–90% after positive FIT [63]	Q5y: 2,736 colonoscopies/1,000 people, Q10y: 2,173 colonoscopies/1,000 people [66]	Approximately twice the cost of colonoscopy [40]
Liquid biopsy—methylated DNA (Epi ProColon)	79% for CRC [41]	68% for CRC [41]	83% [71]	Not known	Projected to have similar costs to mt-sDNA [72]
Liquid biopsy—methylated DNA (TriMeth)	99% for CRC [42••]	80% for CRC [42••]	Not known	Not known	Not known
Liquid biopsy—miRNA	26% for CRC [43]	85% for CRC [43]	Not known	Not known	Not known
Stool-based microbiome tests	78% for CRC [48]	62-78% for CRC [48]	Not known	Not known	Not known
Urine-based screening tests	80-96% for CRC [49, 51]	80-100% for CRC [49, 51]	Not known	Not known	Not known

**Tests include high-sensitivity guaiac fecal occult blood test (HSgFOBT), fecal immunochemical test (FIT), multi-target stool DNA (mt-sDNA)-FIT, CT colonography, flexible sigmoidoscopy, and colonoscopy and accounts for additional colonoscopies required for positive results from other screening modalities. Estimate is based on CISNET modeling study assuming 100% adherence and screening starting at age 45 years. Estimates from Davidson, KW, et al. [4••]

“Not known”: No data available

Abbreviations: USPSTF United States Preventive Services Task Force, CRC colorectal cancer, Q3y every 3 years, Q5y every 5 years, Q10y every 10 years