New research shows a colonoscopy following a positive mt-sDNA test was commonly linked to colorectal cancer and colorectal neoplasia when compared to colonoscopies alone.

A team, led by Joseph C. Anderson, MD, Geisel School of Medicine at Dartmouth, Hanover Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center NH Colonoscopy Registry, investigated colonoscopy outcomes and quality after positive mt-sDNA tests in the population-based New Hampshire Colonoscopy Registry.

Overall, positive mt-sDNA tests were significantly more likely to have colorectal cancer or advanced noncancerous neoplasia than the colonoscopy-only cohort.

In an interview with HCPLive®, Anderson explained how the results could impact cancer screenings moving forward, particularly for an older population.

HCPLive: Can you tell me what the main takeaway from this study?

Anderson: I think what this study shows is that the use of stool tests can be helpful in enriching a population that’s attending colonoscopy so that when you perform the colonoscopy, you’re more likely to do it for a purpose of preventing cancer finding something, because that’s really how we prevent cancer.

We prevent cancer, through the detection of polyps and the removal of those polyps. So what this study demonstrates is that the use of tests stool based tests can be useful in increasing the yield of those colonoscopies.

And in particular, the stool DNA tests, because of the fact that it has the methylated markers can be very useful in enriching the colonoscopy findings with serrated polyps.

Other implications of the study are that we need more real world data like this so that we can say, what should be the expected yield of these tests.

When you do a colonoscopy and average risk individuals, what should you be finding in those individuals? Well, this data will help with the stool DNA as well as fit to show what you should be expecting on colonoscopy, and people who have positive tests.

HCPLive: How do you take the results of this study and implement it into the field so there is real-world clinical impact?

Anderson: Well, I think the best way to do that is to publish it. We’ve submitted that so I think that’s the best way to get those findings. I think the message is essentially, that two-fold. One is that, that we’re providing benchmarks for, for the yield of positive tests, when you do a colonoscopy.

In other words, what you should expect to find abnormal detection rates are important because they tell you whether or not you as an endoscopists are doing your job.

Well, the abnormal detection rate for colonoscopy certainly has gone up now. But our studies seem to suggest that maybe in the 30s is reasonable and if you’re FIT positive, well, maybe that might actually be 45.

The other potential implication is that since there is this higher yield of serrated polyps when you use the stool DNA, because of the methylated markers, that potentially individuals who are at risk for severed lesions might benefit from screening.

Like people who smoke for example. It’s been shown that smoking is very much correlated with serrated polyps. So those individuals might have a higher yield if you use the stool DNA. So those are some of the implications.

HCPLive: When talking about screening methods and different risk factors, how important is to continue to update the guidance over time?

Anderson: I think it’s very important. It’s an ever-changing field, so it makes it kind of exciting to study. The tests themselves change, the ability of endoscopists to detect lesions change as well. In other words, if you look at the data we presented in the past, in abstract form at other meetings that have shown that serrated polyp detection is really dramatically increased.

And so I think updating the data is extremely important. And that’s why I think these data are very timely, and current, we hope to get them in in press in the next few months in actual print.

I will say that if you look at the abnormal detection rate, for example, 20% was what was the expected just several years ago. Now it’s much higher, and now we know we expect people to get to 25% and our data seems to suggest that 30% might be what the benchmark is.

HCPLive: In this sample of 52,000 individuals, the average age was 66.5. How concerning is it that the population is aging and we might be in a situation we’re going to have more patients with more serious illnesses?

Anderson: The idea how, what when do you recommend sort of not screening or, or doing surveillance, and there were tools that can be used looking at age expectancy, the patient’s preferences, and what they’ve had previously, certainly a colonoscopy last year, gives you a lot of protection if it’s done with quality.

The other point is as people get older alternative type of tests for screening might be beneficial in terms of not having to put people through colonoscopies. So stool based tests, are something that can be quite attractive with regards to that, and maybe being able to call out those individuals who really, truly need the colonoscopy.

And certainly, as we get older, there are more serrated cancers. So something like this stool DNA based tests might be something that is helpful in this older population.

HCPLive: Is there anything in this study that surprised you?

Anderson: I think biologically I really find these tests because they’re biologically based. I do think that finding the fact that this difference in sensitivity seemed to make sense in terms of how you look at how to take tests restructured, but also, the fact that there was a higher yield to show to polyps in the stool DNA is something that I think we expected to find.

Certainly being able to examine these data in a real world setting. And that’s what the registry is great for the new him for calling out the registry is your provides real world data. That’s really timely, as you pointed out, where we’re collecting data at this moment. So we can look at changes and that sort of thing.

The study was important to support what our hypothesis was.


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