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David A. Ahlquist, Daniel J. Sargent, Charles L. Loprinzi, Theodore R. Levin, Douglas K. Rex, Dennis J. Ahnen, Kandice Knigge, M. Peter Lance, Lawrence J. Burgart, Stanley R. Hamilton, James E. Allison, Michael J. Lawson, Mary E. Devens, Jonathan J. Harrington, Shauna L. Hillman; Stool DNA and Occult Blood Testing for Screen Detection of Colorectal Neoplasia. Annals of Internal Medicine. 2008 Oct;149(7):441-450.

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Articles | 7 October 2008

Stool DNA and Occult Blood Testing for Screen Detection of Colorectal Neoplasia

David A. Ahlquist, MD; Daniel J. Sargent, PhD; Charles L. Loprinzi, MD; Theodore R. Levin, MD; Douglas K. Rex, MD; Dennis J. Ahnen, MD; Kandice Knigge, MD; M. Peter Lance, MD; Lawrence J. Burgart, MD; Stanley R. Hamilton, MD; James E. Allison, MD; Michael J. Lawson, MD; Mary E. Devens; Jonathan J. Harrington; and Shauna L. Hillman, MS

[+] Article and Author Information

From the Mayo Clinic, Rochester, Minnesota; Kaiser Permanente, Oakland and Sacramento, California; University of Indiana, Indianapolis, Indiana; University of Colorado Health Sciences Center, Denver, Colorado; University of Portland, Portland, Oregon; University of Arizona Health Science Center, Tucson, Arizona; Abbott Northwestern Hospital, Minneapolis, Minnesota, and University of Texas, Houston, Texas.

Acknowledgment: The authors thank EXACT Sciences for performance of all genetic assays on tissue and stools and Beckman Coulter for provision of Hemoccult and HemoccultSensa cards at no cost; Sara Linker Nord for management at coordination center; Kelli Burger for statistical support; Jacalyn McCormick for secretarial support; H. Samuel Wieand, PhD (University of Pittsburgh), for statistical consulting; and Jane Milburn for assistance on protocol development. The authors also thank the physicians and study coordinators at the participating medical centers for their support (Appendix).

Grant Support: By grants UO1 CA 89389 and UO1 CA 37404 from the National Institutes of Health.

Potential Financial Conflicts of Interest:Consultancies: D.J. Ahnen (EXACT Sciences), J.E. Allison (Fujirebio, Quidel). Stock ownership or options (other than mutual funds): J.E. Allison (IntelligeneScan). Grants received: T.R. Levin (EXACT Sciences), M.P. Lance (National Institutes of Health), M.J. Lawson (EXACT Sciences). The Mayo Clinic is a minor equity investor in EXACT Sciences.

Reproducible Research Statement:Study protocol, statistical code, and data set: Available from Ms. Devens (devens@mayo.edu).

Requests for Single Reprints: David A. Ahlquist, MD, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905; e-mail, ahlquist.david@mayo.edu.

Current Author Addresses: Drs. Ahlquist, Sargent, and Loprinzi; Ms. Devens; Mr. Harrington; and Ms. Hillman: Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905.

Dr. Levin: Kaiser Permanente, 3505 Broadway, 12th Floor, Oakland, CA 94611-5714.

Dr. Rex: University of Indiana, Division of Gastroenterology/Hepatology, 550 North University Boulevard, UH 4100, Indianapolis, IN 46202.

Dr. Ahnen: University of Colorado Health Sciences Center, Denver VAMC 111E, 1055 Clermont Street, Denver, CO 80220.

Dr. Knigge: Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, PV-310, Division of Gastroenterology, Portland, OR 97239.

Dr. Lance: University of Arizona Health Science Center, 1515 North Campbell Avenue, Room 2964, PO Box 245028, Tucson, AZ 85724-5024.

Dr. Burgart: Hospital Pathology Associates, PA, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN 55407.

Dr. Hamilton: University of Texas, Box 85, Room GI.3754, 1515 Holcombe Boulevard, Houston, TX 77030-4095.

Dr. Allison: Kaiser Permanente, 3505 Broadway, 7th Floor, Oakland, CA 94611-5714.

Dr. Lawson: Kaiser Permanente, 2025 Morse Avenue, 2nd Floor, Sacramento, CA 95825-2112.

Author Contributions: Conception and design: D.A. Ahlquist, D.J. Sargent, C.L. Loprinzi, T.R. Levin, K. Knigge, M.P. Lance, J.E. Allison, M.E. Devens, S.L. Hillman.

Analysis and interpretation of the data: D.A. Ahlquist, D.J. Sargent, D.K. Rex, D.J. Ahnen, K. Knigge, M.P. Lance, L.J. Burgart, S.R. Hamilton, J.E. Allison, J.J. Harrington, S.L. Hillman.

Drafting of the article: D.A. Ahlquist, D.J. Sargent.

Critical revision of the article for important intellectual content: D.A. Ahlquist, D.J. Sargent, C.L. Loprinzi, T.R. Levin, D.K. Rex, D.J. Ahnen, M.P. Lance, J.E. Allison, M.J. Lawson.

Final approval of the article: D.A. Ahlquist, D.J. Sargent, T.R. Levin, D.K. Rex, D.J. Ahnen, M.P. Lance, S.R. Hamilton, J.E. Allison, M.J. Lawson.

Provision of study materials or patients: D.A. Ahlquist, D.J. Sargent, T.R. Levin, D.K. Rex, D.J. Ahnen, M.P. Lance, M.E. Devens.

Statistical expertise: D.J. Sargent, S.L. Hillman.

Obtaining of funding: D.A. Ahlquist, D.J. Sargent, C.L. Loprinzi, M.P. Lance, M.E. Devens.

Administrative, technical, or logistic support: D.A. Ahlquist, D.J. Sargent, C.L. Loprinzi, D.K. Rex, D.J. Ahnen, K. Knigge, S.R. Hamilton, M.E. Devens, J.J. Harrington, S.L. Hillman.

Collection and assembly of data: D.J. Sargent, T.R. Levin, D.K. Rex, D.J. Ahnen, K. Knigge, M.P. Lance, L.J. Burgart, M.J. Lawson, M.E. Devens, J.J. Harrington, S.L. Hillman.

Ann Intern Med. 2008;149(7):441-450. doi:10.7326/0003-4819-149-7-200810070-00004

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Table 1 lists the genes used in our test panels and defines several key terms.

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Figure 1.

Study flow diagram.

Grahic Jump Location

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Figure 2.

Stool DNA versus occult blood testing for detection of screen-relevant neoplasia (curable-stage colorectal cancer, high-grade dysplasia, and adenomas ≥1 cm) (n = 142).

Sensitivity is plotted for Hemoccult and HemoccultSensa with 1, 2, and 3 stools per patient and with stool DNA test 2 (SDT-2) on a single stool per patient. Vertical lines represent 95% CIs. * P < 0.001 versus Hemoccult or HemoccultSensa.

Grahic Jump Location

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AAM 2010;304:1493-1495.

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BMJ 2010;341:c5893-c1494.

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Summary for Patients

Stool DNA and Occult Blood Testing to Screen for Colorectal Neoplasia

The summary below is from the full report titled “Stool DNA and Occult Blood Testing for Screen Detection of Colorectal Neoplasia.” It is in the 7 October 2008 issue of Annals of Internal Medicine (volume 149, pages 441-450). The authors are D.A. Ahlquist, D.J. Sargent, C.L. Loprinzi, T.R. Levin, D.K. Rex, D.J. Ahnen, K. Knigge, M.P. Lance, L.J. Burgart, S.R. Hamilton, J.E. Allison, M.J. Lawson, M.E. Devens, J.J. Harrington, and S.L. Hillman.

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Stool DNA and Occult Blood Testing for Screen Detection of Colorectal Neoplasia

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Study flow diagram.

Stool DNA versus occult blood testing for detection of screen-relevant neoplasia (curable-stage colorectal cancer, high-grade dysplasia, and adenomas ≥1 cm) (n = 142).

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