Page 41 - DIGITAL e-Book RCPH 2026

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1 REGIONAL CONFERENCE onon Organised by: :
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PRECISION HEALTH
P P R E C I S I O N H E A L T H
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Several blood-based tests show promise for CRC screening: Methylated SEPT9 (mSEPT9) :
FDA-approved DNA marker. Cell-Free DNA (cfDNA) : Detects 83% of colorectal cancers with 89.6%
specificity. MicroRNAs (miRNAs) : Emerging stable biomarkers with high sensitivity. Volatile Organic
Compounds (VOCs) : Urinary and exhaled VOCs show potential for non-invasive screening. However,
blood-based tests demonstrate suboptimal sensitivity for advanced adenomas and early-stage cancers
(13.2%), limiting their current application as standalone screening tools. Their high cost (>$1,000 per
test) also restricts accessibility in resource-limited regions.
Key Success Factors:
Successful CRC screening programs require three pillars:
Accessibility: Organized mass screening programs with public health campaigns.
FIT Sensitivity: Appropriate test calibration and quality assurance.
Compliance : Ensuring participants complete the full screening pathway.
Thailand's organized population screening in Lampang Province (2010-2011) exemplifies this model:
63% FIT uptake, 1.1% positivity rate, and 72% colonoscopy compliance yielded 3.7% cancer detection
among positive cases.
Future Directions: The next decade of CRC screening will integrate multiple technologies: two-step
screening strategies tailored to resource availability, AI-augmented endoscopy for quality
standardization, and refined blood-based biomarkers as they mature. Blood-based tests may
complement but not replace colonoscopy in the foreseeable future, particularly in identifying individuals
at higher risk for neoplastic disease.
Conclusion: Effective CRC screening in resource-limited countries requires pragmatic, multi-modal
approaches. Clinical risk stratification combined with quantitative FIT efficiently triages patients for
colonoscopy, while AI technologies optimize detection quality and enhance clinician performance.
Although blood-based biomarkers and advanced molecular testing show considerable promise, their
clinical maturity and cost-effectiveness remain in developmental stages, necessitating continued
reliance on proven screening methodologies coupled with technological innovation.