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The Nuances of Noninvasive Screening for Colorectal Cancer, with Fola May, MD, PhD
May describes differences between colorectal cancer screening tests and which might be right for patients based on their preferences and values.
As colorectal cancer screening options expand, patients are faced with more choices than ever before—each with different strengths, limitations, and implications for care. While the growing menu of tests increases accessibility, understanding the nuances between them is essential for informed decision-making.
“Fundamentally, these tests are different,” Fola May, MD, PhD, an associate professor at the David Geffen School of Medicine and associate director of the UCLA Kaiser Permanente Center for Health Equity, told HCPLive, emphasizing that the decision should be tailored to the patient’s preferences.
Despite the emergence of several new noninvasive tests, colonoscopy remains the most comprehensive screening tool, offering both preventive and diagnostic benefits by allowing physicians to find and remove precancerous polyps and detect cancers directly. For those unable or unwilling to undergo colonoscopy, stool-based tests like FIT and FIT-DNA can also detect cancer and, to a lesser extent, precancerous lesions.
The latest development in noninvasive colorectal cancer screening is the emergence of blood-based tests, the first of which was approved by the FDA in 2024.1 While they may be easier to access, May was careful to note key limitations to these tests, at least in their current formation, including their lack of sensitivity for precancerous lesions.
“If you're picking a blood based test, you're accepting that that test will likely miss a precancerous polyp and will mostly be looking for cancers, usually stage 2 and beyond,” May said. “Everyone has different preferences. I let patients decide what's best for them. To me, it's very important that they understand those nuances of the test.”
May goes on to emphasize that noninvasive tests are intended for average-risk individuals and not those with a family history or high-risk conditions such as inflammatory bowel disease or polyposis syndromes, additionally noting these patients should start screening earlier.
Editors’ note: May has relevant disclosures with Kimberly-Clark, Medtronic, Takeda, Freenome, Geneoscopy, and Exact Sciences.
