Use of blood-based biomarkers for early diagnosis and surveillance of colorectal cancer

Abstract

Early screening for colorectal cancer (CRC) holds the key to combat and control the increasing global burden of CRC morbidity and mortality. However, the current available screening modalities are severely inadequate because of their high cost and cumbersome preparatory procedures that ultimately lead to a low participation rate. People simply do not like to have colonoscopies. It would be ideal, therefore, to develop an alternative modality based on blood biomarkers as the first line screening test. This will allow for the differentiation of the general population from high risk individuals. Colonoscopy would then become the secondary test, to further screen the high risk segment of the population. This will encourage participation and therefore help to reach the goal of early detection and thereby reduce the anticipated increasing global CRC incidence rate. A blood-based screening test is an appealing alternative as it is non-invasive and poses minimal risk to patients. It is easy to perform, can be repeated at shorter intervals, and therefore would likely lead to a much higher participation rate. This review surveys various blood-based test strategies currently under investigation, discusses the potency of what is available, and assesses how new technology may contribute to future test design.

Keywords: Biological markers; Blood; Colonoscopy; Colorectal neoplasms; DNA methylation; Early detection of cancer; High-throughput nucleotide sequencing; Long non-coding RNA; Loss of heterozygosity; Mass spectrometry; Messenger RNA; MicroRNA; Microarray analysis; Microsatellite instability; Real-time polymerase chain reaction.