Molecular stool testing for colorectal cancer Improving screening and surveillance strategies

Colorectal cancer (CRC) is a highly prevalent disease and chances of survival are dependent on CRC stage at diagnosis. Unfortunately, symptoms often only arise at late stages of the disease. Therefore, CRC screening and surveillance strategies have been introduced. The introduction of these strategies has helped to reduce the global burden of CRC. This because CRC is more often detected at an early and curable stage, or even prevented due to the detection and resection of its advanced precursor lesions. Nevertheless, the benefit-to-harm ratio of these strategies can be improved.
In this thesis several opportunities to improve the benefit-to-harm ratio of CRC screening and post-polypectomy surveillance were investigated. The studies focused on non-invasive strategies based on molecular stool testing for CRC. One important milestone was the development and prospective validation of a new non-invasive molecular stool test for CRC screening, the multitarget fecal immunochemical test (mtFIT).
The results of this thesis pave the way towards an increased benefit-to-harm ratio of CRC screening and surveillance, by presenting different strategies with potential to be implemented in CRC screening or post-polypectomy surveillance.