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World J Gastroenterol. Mar 28, 2013; 19(12): 1855-1860
Published online Mar 28, 2013. doi: 10.3748/wjg.v19.i12.1855
New strategies for colorectal cancer screening
Maria Di Lena, Elisabetta Travaglio, Donato F Altomare
Maria Di Lena, Elisabetta Travaglio, Donato F Altomare, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, 11-70124 Bari, Italy
Author contributions: Di Lena M, Travaglio E and Altomare DF contributed equally to this paper.
Correspondence to: Donato F Altomare, MD, Professor, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Piazza G Cesare, 11-70124 Bari, Italy. donatofrancesco.altomare@uniba.it
Telephone: +39-8-5592107 Fax: +39-8-5478735
Received: August 21, 2012
Revised: September 30, 2012
Accepted: November 6, 2012
Published online: March 28, 2013

Colorectal cancer (CRC) is still one of the leading causes of cancer-related death in Western countries, despite major improvements in its treatment. The dramatically high social and economic impact of CRC on human health makes the identification of a reliable screening tool of paramount importance. Current screening methods, such as the fecal occult blood test and colonoscopy do not adequately meet the ideal requisites of a screening test because, even if they are effective, they are limited first by too low specificity and sensitivity, or second by high invasiveness, costs and risk. Nowadays extended efforts are made by researchers to look for more reliable and effective screening tests based on a systems biology approach, using biological samples easily available, such as urine, breath, serum and feces. The effectiveness and reliability of several new attempts to screen these patients by non-invasive analysis of their biological samples using genomic (genetic and epigenetic alteration), transcriptomic (miRNA), proteomic (cancer-related antigens, new antibodies against tumor-associated antigens, mutated proteins) and metabolomic (volatile organic metabolites) methods are discussed in this review. Among the most interesting new screening tools, fecal fluorescent long-DNA, fecal miRNA and metabolomic evaluation in breath and/or serum seem to be most promising.

Keywords: Colorectal cancer, Screening, Fecal occult blood test, Systems biology, Metabolomics, Proteomic, microRNA, Volatile organic compounds