In persons aged ≥45 y, the mt-sRNA test had 94% sensitivity for colorectal cancer and 46% for advanced adenomas
The results of the industry-funded study support the use of the multitarget stool RNA (mt-sRNA) test for screening, but better adherence will be needed, and it is unclear whether the new test offers any advantages over current stool DNA testing, an ACP Journal Club commentary said.
An industry-funded study found that a multitarget stool RNA (mt-sRNA) test had 94% sensitivity for detecting colorectal cancer and 46% sensitivity for detecting advanced adenomas versus the reference standard of colonoscopy. Researchers evaluated 8,920 patients ages 45 years and older who had available mt-sRNA test and colonoscopy results (mean age, 55 years; 60% women; 84% White).
The study was published online Oct. 23, 2023, by JAMA. The following commentary by Harvey J. Murff, MD, MPH, was published Feb. 6 in the ACP Journal Club section of Annals of Internal Medicine.
Clinical trials have shown that screening for colorectal cancer reduces disease mortality, yet screening rates remain suboptimal. Home-based strategies could enhance screening rates by being more acceptable to patients. The well-designed study by Barnell and colleagues evaluated the sensitivity and specificity of an mt-sRNA test for detecting colorectal neoplasms. Colonoscopies were not centralized, but the investigators provided detailed colonoscopy quality metrics. The sensitivity and specificity of mt-sRNA were comparable to Cologuard, a stool DNA test already included in screening guidelines. Like Cologuard (Exact Sciences), mt-sRNA had better sensitivity and specificity than FIT [fecal immunochemical test] alone.
A strength of the study was the large number of participants aged 45 to 50 years, a group eligible for screening but with limited screening data. The mt-sRNA test had consistent sensitivities for detecting colorectal cancer and advanced adenoma across all age groups including those aged 45 to 49 years. Although colorectal cancer incidence is increasing in that age group, overall rates of colorectal neoplasms are low, so screening tests are needed to identify appropriate candidates for colonoscopy.
The mt-sRNA test characteristics support use of this method as a screening strategy, but uncertainties exist. Despite receiving reimbursement, >20% of eligible participants either did not send in the test or did not provide sufficient samples for the test. Additional patient education strategies will be needed to improve adherence. Further, it is unclear whether the mt-sRNA strategy offers advantages over current stool DNA testing, and test costs could be a major driver of use. Nevertheless, mt-sRNA testing seems similar to stool DNA screening and may offer another option for patients to help increase colorectal cancer screening rates.