대변 및 혈액 기반 검사를 이용한 비침습적 대장암 선별 검사: 근거, 타당성 및 형평성 고려 사항

Haocheng Wang; Ruilan Chen; Yao Ying; Junyao Shi; Min Wang

doi:10.3791/70478

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리뷰 논문

대변 및 혈액 기반 검사를 이용한 비침습적 대장암 선별 검사: 근거, 타당성 및 형평성 고려 사항

143 조회수

⸱

DOI:

10.3791/70478

⸱

2026년 9월 18일

Haocheng Wang¹ , Ruilan Chen² , Yao Ying³ , Junyao Shi³ , Min Wang⁴

¹Colorectal Cancer Center, Department of General Surgery, West China Hospital of Sichuan, ²Department of General Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, ³Department of General Surgery, Zhujiang Hospital, Southern Medical University, ⁴Hospital of Chengdu University of Traditional Chinese Medicine

이 논문에서

요약

본 리뷰에서는 대변 및 혈액 기반의 대장암 선별 검사를 평가하고, 검사 성능, 순응도, 추적 관찰 역량 및 형평성이 구현 과정에 어떻게 반영되어야 하는지 설명합니다.

초록

대장암(CRC)은 전 세계적으로 암 발생 및 사망의 주요 원인으로 남아 있습니다. 대장내시경은 많은 자원이 소모되며 참여율이 완벽하지 않기 때문에, 비침습적 선별 검사는 인구 수준의 예방에 있어 핵심적인 역할을 합니다. 본 리뷰는 분변 잠혈 검사(FIT), 멀티오믹스 대변 DNA-FIT(mt-sDNA-FIT), 멀티오믹스 대변 RNA-FIT(mt-sRNA-FIT) 및 혈액 기반 분석법에 관한 최신 증거를 종합하며, 특히 평균 위험군인 무증상 개인의 선별 검사, 암 검출과 진행성 전암 병변 검출의 구분, 그리고 검사 성능을 공중 보건 혜택으로 전환하는 데 필요한 운영 요구 사항에 중점을 둡니다. FIT는 저렴하고 반복 가능하며 체계적인 선별 검사 증거에 의해 뒷받침되므로, 많은 프로그램에서 가장 확장 가능한 1차 선택지로 남아 있습니다. FIT의 성능은 헤모글로빈 임계값, 샘플링 및 취급, 병변의 생물학적 특성, 반복적인 준수 여부, 그리고 양성 결과 후의 대장내시경 완료 여부에 따라 달라집니다. 분자 대변 분석법은 일반적으로 대장암 및 진행성 전암 병변에 대한 1회 적용 민감도를 향상시키지만, 특이도를 낮추고 비용과 대장내시경 수요를 증가시킵니다. 혈액 기반 분석법은 대변 검사나 대장내시경을 거부하는 사람들의 수용성을 높일 수 있으나, 현재의 증거에 따르면 진행성 전암 병변의 검출률이 낮아 대변 기반 전략의 직접적인 대체제로 사용될 때 예방적 가치가 제한적입니다. 구현 장벽은 초대, 검사 접근성, 검체 반환, 실험실 처리, 결과 통보, 진단적 대장내시경, 병리 진단, 치료 접근성 및 등록 추적을 포함하여 선별 검사 경로 전반에서 발생합니다. 향후 발전 방향은 위험 적응형 선별 검사, 검증된 분자 및 멀티오믹스 바이오마커, 인공지능 보조 분류 및 공평한 프로그램 설계를 우선시해야 합니다. 가장 타당한 전략은 단일 분석법의 보편적 채택이 아니라, 선별 검사 방법을 인구 집단의 위험도, 환자의 수용성 및 시스템 역량에 맞추는 자원 층화 경로를 구축하는 것입니다.

서론

대장암(CRC)은 많은 사례가 수년에 걸쳐 감지 가능한 선종-암 또는 톱니상 신생물 경로를 통해 발생하기 때문에 가장 예방 가능한 주요 암 중 하나입니다. 전 세계 암 감시 추정치에 따르면 2022년에 190만 건 이상의 신규 대장암 사례와 90만 명 이상의 대장암 사망자가 발생했으며, 이로 인해 대장암은 전 세계적으로 암 관련 이환율 및 사망률의 주요 원인 중 하나가 되었습니다¹. 예측에 따르면 인구 성장, 인구 고령화, 생활 습관 변화, 비만, 식이 노출 및 예방 서비스에 대한 불평등한 접근성으로 인해 절대적인 부담은 계속 증가할 것으로 보입니다¹^,². 이러한 추세는 내시경 역량이 제한적이거나, 일차 의료 체계가 분절되어 있거나, 조직적 검진 참여율이 낮은 보건 의료 시스템에서 특히 중요합니다.

스크리닝은 완전한 경로로서 작동할 때만 임상적 가치가 있습니다. 검사는 CRC 또는 임상적으로 중요한 전구 병변이 있는 사람을 식별하고, 결과를 효과적으로 전달하며, 적시에 진단적 대장내시경, 조직 병리학적 검사, 치료 및 종단적 레지스트리 추적으로 이어져야 합니다. 대장내시경은 많은 전구 병변을 식별하고 생검 및 제거할 수 있기 때문에 결정적인 진단 및 치료 절차로 남아 있습니다. 그럼에도 불구하고, 이는 침습적이고 비용이 많이 들며, 숙련된 인력과 고품질의 장 정결 상태에 의존하며, 일부 개인에게는 수용도가 낮습니다. 결과적으로, 특히 스크리닝을 최신 상태로 유지하지 않은 평균 위험 성인들 사이에서 도달 범위를 넓히기 위해 인구 기반 프로그램은 비침습적인 분변 또는 혈액 기반 스크리닝 검사에 점점 더 의존하고 있습니다³^,⁴^,⁵.

본 리뷰는 주로 평균 위험군의 무증상 인구 스크리닝에 중점을 둡니다. 증상 기반의 진단적 선별(triage), 용종 절제술 후 추적 관찰, 그리고 유전성 또는 고위험군 상태에서의 스크리닝은 해석을 명확히 하기 위해 필요한 경우에만 논의합니다. 검사 성능과 임상적 함의가 상황에 따라 다르기 때문에 이러한 구분이 필수적입니다. 증상 기반 환자의 긴급 대장내시경 우선순위를 정하기 위해 사용되는 FIT 임계값은 조직화된 무증상 스크리닝 프로그램의 반복 FIT 전략과 동일하게 해석될 수 없습니다. 마찬가지로, 평균 위험군 코호트에서 평가된 분자 진단법은 의도된 사용 대상 인구에 대해 별도의 검증이 이루어지지 않는 한 추적 관찰 대상군으로 일반화해서는 안 됩니다³^,⁶^,⁷.

비침습적 대장암(CRC) 선별 검사 기술이 빠르게 확장되었습니다. FIT는 대변 내 인간 헤모글로빈을 검출합니다. 분자 대변 검사는 분변 헤모글로빈과 DNA, RNA, 메틸화 또는 기타 신생물 관련 신호를 결합하여 분석합니다. 혈액 기반 분석법은 순환 무세포 DNA, 메틸화 패턴, 프래그먼토믹(fragmentomic) 특성 또는 기타 종양 유래 신호를 평가합니다. 이러한 플랫폼들은 생물학적 표적, 분석 전 단계의 취약성, 비용, 특이도, 검사 간격 가정 및 대장내시경 수요에 미치는 영향 면에서 차이가 있습니다. 따라서 과학적으로 유용한 비교를 위해서는 CRC 검출과 진행성 전암성 병변 검출을 구분해야 하며, 진단 정확도와 실행 가능성을 모두 평가해야 합니다⁸^,⁹^,¹⁰^,¹¹^,¹²^,¹³^,¹⁴^,¹⁵^,¹⁶^,¹⁷.

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리뷰 및 관점

Evidence sources and review approach

A narrative evidence review was performed to summarize clinically relevant literature on validated and emerging non-invasive CRC screening tests. PubMed, Embase, Scopus, Web of Science, regulatory documents, major guideline statements, and high-impact review articles were consulted for literature published primarily from 2017 through June 2026, while seminal earlier studies were retained when they established pivotal evidence of diagnostic performance or provided guideline context. Search concepts included colorectal cancer screening, fecal immunochemical test, stool DNA, stool RNA, circulating tumor DNA, methylated SEPT9, cell-free DNA, blood-based screening, advanced adenoma, advanced precancerous lesion, adherence, colonoscopy follow-up, equity, cost-effectiveness, polygenic risk score, microbiome, multi-omics, and artificial intelligence. Figure 1 summarizes the screening pathway and interpretation framework used throughout this review. A modality-specific evidence framework is provided in Table 1.

The evidence was interpreted by study type rather than pooled across heterogeneous designs. Diagnostic accuracy studies, screening program evaluations, randomized screening invitation trials, cost-effectiveness models, adherence studies, regulatory summaries, and implementation reports address different questions. Accuracy studies describe test performance against colonoscopy or another reference standard; program studies estimate real-world effectiveness only when test completion and follow-up colonoscopy occur; economic models depend heavily on assumptions about interval, adherence, payer perspective, and colonoscopy costs. Because of this heterogeneity, the manuscript avoids pooled estimates and presents representative performance results only when they are tied to the specific assay, population, and reference standard⁵^,¹³^,¹⁸^,¹⁹^,²⁰^,²¹^,²².

Studies in symptomatic diagnostic pathways were not combined with average-risk screening studies. Symptomatic cohorts have higher pretest probability, different referral thresholds, and different downstream consequences. Likewise, studies in high-risk or surveillance populations were treated separately because previous adenomas, inflammatory bowel disease, hereditary syndromes, or a strong family history change both baseline risk and acceptable follow-up strategy. The practical interpretation used throughout this review is that test performance must be linked to intended use, screening interval, adherence, and capacity for colonoscopy after a positive result.

Global burden and public health context

The public health rationale for CRC screening is strongest when the burden of preventable disease is high and when the screening pathway can be delivered reliably. Global Cancer Observatory estimates and global cancer reports show substantial CRC incidence and mortality across regions, but burden alone does not determine the best screening test. A high-burden country with limited colonoscopy capacity may obtain greater public health benefit from high-adherence FIT outreach than from an expensive molecular test that generates more positive results than the system can evaluate. Conversely, in settings where stool collection is a major barrier to participation and colonoscopy capacity is sufficient, offering additional validated options may increase screening completion³^,⁴^,⁵.

Program organization is as important as test selection. Data from global cancer-screening program repository indicate that cancer-screening program data are incomplete in many countries, particularly for pathway indicators such as invitation coverage, participation, positivity, diagnostic follow-up, and treatment linkage²³. These gaps limit the ability to compare assay strategies across regions. Screening policy should therefore be based on pathway bottlenecks: identifying eligible adults, delivering the test, returning or processing the sample, communicating results, ensuring colonoscopy after a positive result, and tracking outcomes. Without these steps, even highly sensitive tests may not reduce CRC incidence or mortality.

Randomized and programmatic evidence reinforces the distinction between test efficacy and program effectiveness. The randomized colorectal cancer screening trial showed that invitation to repeated FIT screening achieved higher participation than invitation to one-time colonoscopy and was non-inferior for CRC mortality at 10 years in intention-to-screen analysis, whereas per-protocol findings favored completed colonoscopy⁵. Observational data from organized screening programs also associate FIT-based programs with reductions in CRC mortality and shifts toward earlier-stage disease²⁴^,²⁵^,²⁶. These findings support FIT as a practical population strategy while also emphasizing that repeated participation and follow-up colonoscopy are indispensable.

Fecal immunochemical testing

FIT is the foundation of most scalable non-invasive CRC screening programs. It uses antibodies specific for human globin and therefore avoids dietary restrictions required by older guaiac-based fecal occult blood tests. FIT is inexpensive, can be mailed to participants, quantified, and repeated annually or biennially. Its major limitation is biological: bleeding from neoplastic lesions is intermittent, and advanced adenomas may bleed less consistently than established cancers. Consequently, FIT generally performs better for CRC than for advanced precancerous lesions⁸^,⁹^,²⁶.

FIT performance varies for several reasons. First, positivity thresholds determine the balance between sensitivity and the demand for colonoscopy. Lower fecal hemoglobin cutoffs detect more disease but increase false positives and require more diagnostic colonoscopies. Higher thresholds preserve colonoscopy capacity but miss more lesions. Second, sample stability and handling affect the measured hemoglobin, especially when transport is delayed or when temperatures are high. Third, one-sample and two-sample strategies differ in positivity and detection. Fourth, lesion location, stage, sex, age, medication use, and baseline risk influence fecal hemoglobin concentration and, therefore, sensitivity⁸^,⁹^,¹⁰^,²⁶.

Analytically, FIT depends on the preservation of human globin in the collection buffer. Delayed return, heat exposure, inadequate sampling, and stool heterogeneity can reduce measurable hemoglobin, whereas non-neoplastic lower gastrointestinal bleeding can contribute to positive FIT results in the absence of CRC or advanced precancerous lesions. These limitations explain why thresholds, kit instructions, transport windows, and laboratory quality control are determinants of screening performance rather than minor technical details⁸^,⁹.

The distinction between screening and symptomatic triage is central. In average-risk screening, FIT is a repeated population intervention designed to reduce future CRC incidence and mortality through early detection and removal of precursor lesions. In symptomatic pathways, FIT is a triage tool used to prioritize colonoscopy among patients with possible CRC symptoms. Guidelines for symptomatic FIT use define specific thresholds and referral actions, but those thresholds should not be transferred directly to asymptomatic screening programs⁷.

The effectiveness of FIT also depends on behavior and system design. Annual or biennial testing only prevents disease when individuals complete testing repeatedly and when positive results are followed by a colonoscopy. Failure to undergo colonoscopy after a positive FIT substantially increases the risk of death from CRC¹⁰. Effective FIT programs therefore, require accurate registries, mailed or in-clinic kit distribution, clear instructions, reminders, laboratory quality control, rapid reporting of results, navigation for abnormal results, and sufficient colonoscopy capacity. In lower-resource settings, calibrating the positivity threshold may be necessary to align detection with available endoscopy services rather than overwhelming the system.

FIT remains attractive for low- and middle-resource because it is comparatively inexpensive and operationally flexible. However, a low-cost test can still fail if the pathway lacks postal systems, laboratory infrastructure, electronic recall, patient navigation, or affordable colonoscopy. FIT should therefore be viewed not simply as a test but as a program component whose value depends on repeated adherence and diagnostic completion.

Multi-omics stool DNA-FIT, multitarget stool RNA–FIT, and other molecular stool assays

Molecular stool assays attempt to improve detection by measuring biomarkers shed by neoplastic cells into stool. The original mt-sDNA-FIT platform combined fecal hemoglobin with DNA methylation markers, KRAS mutations, and additional assay components. In its pivotal average-risk screening study, mt-sDNA-FIT achieved higher sensitivity than FIT for CRC and advanced precancerous lesions, although specificity was lower¹². A next-generation mt-sDNA-FIT assay reported 93.9% sensitivity for CRC, 43.4% sensitivity for advanced precancerous lesions, and 90.6% specificity for advanced neoplasia in a large average-risk screening population; in the same study, FIT showed lower sensitivity for both CRC and advanced precancerous lesions at the evaluated threshold¹³.

Multitarget stool RNA–FIT assays represent another molecular strategy. In a large average-risk study, an mt-sRNA-FIT assay reported high sensitivity for stage I–III CRC and moderate sensitivity for advanced adenomas, with lower specificity than FIT¹⁴. RNA-based markers may capture active cellular processes and complement hemoglobin measurements, but they require careful stabilization, extraction, and assay reproducibility, as well as consideration of laboratory workflow. These requirements distinguish molecular stool assays from point-of-care or basic laboratory FIT and affect implementation in lower-resource settings.

For stool DNA- and RNA-based assays, the analytical challenge is not only marker selection but also preservation and recovery of tumor-derived material from a heterogeneous stool specimen. Neoplastic DNA or RNA is mixed with bacterial nucleic acid, digestive products, non-neoplastic epithelial DNA, and hemoglobin; marker degradation, heterogeneous shedding, variable extraction efficiency, and algorithmic thresholds can therefore influence positivity. False-positive findings may arise when hemoglobin or molecular signals reflect non-advanced lesions, benign bleeding, inflammatory change, background methylation, or analytical variation near the cutoff. Reproducible use requires standardized collection devices, stabilizing chemistry, extraction protocols, locked classifiers, laboratory quality control, and external validation rather than extrapolation from one platform to another¹²^,¹³^,¹⁴^,¹⁵^,¹⁶^,¹⁷^,²¹.

The central trade-off for molecular stool testing is that improved sensitivity is not automatically superior at the population level. Lower specificity increases the number of people referred for colonoscopy. In a high-resource setting, this may be acceptable if the system can provide a timely diagnostic evaluation. In a setting with limited endoscopy capacity, lower specificity can delay colonoscopy for people at the highest risk and increase opportunity costs. Cost-effectiveness, therefore, depends on screening interval, adherence assumptions, test price, colonoscopy cost, complication rates, prevalence, willingness-to-pay thresholds, and the health system's ability to manage positive results¹⁸^,¹⁹^,²⁷.

Molecular stool tests are most appropriate when patients prefer non-invasive testing, when adherence to repeated FIT is poor, or when higher single-application sensitivity justifies the added cost and the demand for colonoscopy. They are less appropriate as universal first-line tests when budgets are limited, colonoscopy backlogs are substantial, or laboratory infrastructure is unavailable. Because assay platforms differ in biomarker composition, collection kits, algorithms, positivity thresholds, and interval recommendations, evidence should be interpreted assay-by- assay rather than generalized across all stool molecular tests¹²^,¹³^,¹⁴^,²¹.

Blood-based assays

Blood-based CRC screening assays are attractive because blood collection can occur during routine clinical encounters and may be more acceptable to people who decline stool collection or colonoscopy. Current platforms evaluate cell-free DNA, methylation signals, tumor-derived genomic alterations, and fragmentomic features. The public health promise is increased participation among unscreened people; the principal concern is whether improved completion rates compensate for lower detection of advanced precancerous lesions²²^,²⁸^,²⁹^,³⁰.

The prospective average-risk colorectal cancer screening study of a cell-free DNA-based blood test in an average-risk screening population reported 83.1% sensitivity for CRC, 89.6% specificity for advanced neoplasia, and 13.2% sensitivity for advanced precancerous lesions²². The FDA executive summary emphasizes that positive results require colonoscopy and that a negative blood test does not exclude CRC or advanced precancerous lesions²⁸. These figures illustrate the key limitation: current blood tests can detect many established cancers but detect far fewer removable precancerous lesions than prevention-oriented stool molecular assays or colonoscopy.

The biological limitation of blood-based screening is most evident for advanced precancerous lesions. These lesions are usually smaller, often remain confined to the mucosa, and may shed very small quantities of altered DNA into plasma compared with invasive cancers. Any weak precursor-derived signal is diluted by abundant non-neoplastic cell-free DNA, and specificity-preserving thresholds may further reduce precursor sensitivity. Therefore, acceptable cancer sensitivity in a blood-based assay should not be interpreted as evidence of equivalent prevention potential, because prevention depends heavily on detecting and removing advanced precancerous lesions before invasion¹⁷^,²²^,²⁷^,²⁸^,³¹.

Methylated SEPT9 and other plasma methylation approaches provided early proof of concept for blood-based CRC detection, but their performance on precancerous lesions and their screening impact have been limited²⁹^,³⁰. Newer blood-based approaches may improve detection by combining methylation, cfDNA fragmentation, protein markers, and machine-learning classifiers. However, broad implementation should be based on prospective studies conducted in the intended-use population, longitudinal interval-cancer data, follow-up colonoscopy completion, and cost-effectiveness under realistic adherence assumptions¹⁸^,¹⁹^,³¹.

Blood-based assays should therefore be framed as adjuncts or alternatives for people who would otherwise remain unscreened, rather than direct replacements for FIT, mt-sDNA-FIT, mt-sRNA-FIT, or colonoscopy. Their most defensible role is in shared decision-making when patients decline or do not complete preferred stool-based or visual-examination options. As with stool tests, a positive blood test is not diagnostic; it must trigger a colonoscopy to complete the screening process³^,⁴.

Equity and implementation across the screening pathway

Equity should be analyzed across the full screening pathway rather than described only by country income category. Barriers may occur during eligibility identification, invitation, health-literacy–appropriate communication, test delivery, stool-sample collection and return, access to phlebotomy, laboratory processing, result notification, follow-up colonoscopy, pathology, treatment, and surveillance. Each barrier has different solutions. Low invitation coverage may require registries and primary-care outreach. Low sample return may require simplified kits, reminders, community health workers, or navigation. Low colonoscopy completion may require transportation support, scheduling assistance, insurance coverage, and capacity planning¹⁰^,²³^,³²^,³³^,³⁴^,³⁵^,³⁶. Table 2 summarizes pathway barriers, supporting evidence types, and practical implications for test selection.

Regional and resource-level recommendations should follow bottleneck diagnosis. Where colonoscopy capacity is the limiting factor, high-specificity strategies, FIT threshold calibration, and risk stratification may be more important than maximizing single-test sensitivity. Where participation is the limiting factor, offering more acceptable tests, mailed outreach, culturally adapted messaging, and navigation may generate larger gains than changing the assay alone. Where laboratory capacity is the limiting factor, FIT may be more feasible than molecular stool or blood assays. Where treatment access is limited, screening expansion must be coordinated with oncology, surgery, pathology, and palliative care capacity.

Recent implementation studies illustrate the heterogeneity of barriers. Rural populations and younger adults may have lower FIT completion unless programs simplify distribution and return³². FIT-positive and population-based studies from Bahrain, Hainan, and Taiwan further show that demographic characteristics, fecal hemoglobin concentration, screening history, and program organization influence positivity, follow-up, and detection³³^,³⁴^,³⁵. During health-system disruptions, such as the COVID-19 pandemic, completion of diagnostic colonoscopy after a positive non-invasive test may decline, threatening the effectiveness of screening even when test access remains available³⁶.

Assay selection must also consider affordability and opportunity cost. A high-cost test may be clinically attractive for selected patients but can reduce total coverage if it consumes resources that could otherwise fund broader FIT outreach, colonoscopy capacity, or navigation. In contrast, a lower-cost test may be insufficient if participation remains low. The key equity question is therefore not which test has the highest single-application sensitivity, but which pathway produces the greatest number of completed, timely, and equitable screening episodes per available resource.

Future CRC screening will likely become more risk-adapted. Risk-adapted screening can combine age, sex, family history, prior screening history, lifestyle factors, fecal hemoglobin concentration, comorbidity, and polygenic risk scores (PRSs) to determine screening age, interval, test modality, and referral threshold. PRSs have shown potential to identify individuals whose CRC risk differs substantially from age-based averages in the general population, but implementation requires calibration across ancestry groups, transparent communication, privacy safeguards, and evidence that risk stratification improves outcomes rather than widening inequity³⁷^,³⁸^,³⁹.

Microbiome and multi-omics approaches may improve non-invasive detection by integrating microbial species, microbial metabolites, host-derived methylation markers, RNA transcripts, proteins, and fecal hemoglobin. CRC-associated microbiome changes are detectable in stool and may help distinguish adenomas or early cancers from normal colonoscopy findings, but reproducibility across diet, geography, antibiotic exposure, sample processing, and sequencing pipelines remains a major challenge³⁷^,⁴⁰^,⁴¹. Multi-omics algorithms should be benchmarked against clinically meaningful endpoints, especially advanced precancerous lesions and interval cancers, rather than only established cancer.

Artificial intelligence may contribute at several points in the pathway. Prediction models could prioritize outreach, identify people unlikely to return kits, personalize reminders, interpret multivariable risk scores, or assist colonoscopy quality assurance. Early work using routinely available blood-count data and machine learning suggests that risk stratification may capture some CRC cases, but such models are not substitutes for validated screening tests and require prospective external validation before program deployment³⁷^,⁴². AI tools should be evaluated for calibration, bias, explainability, clinical utility, and effects on completed screening, not only discrimination metrics.

The most important evidence gaps are longitudinal and implementation-oriented. New tests should report not only cross-sectional sensitivity and specificity but also repeated-round adherence, interval cancer rates, detection of advanced precancerous lesions, demand for colonoscopy, false-positive burden, false-negative outcomes, patient acceptability, cost, equity effects, and feasibility in lower-resource settings. Comparative-effectiveness studies should model realistic adherence because a moderately sensitive test that many people complete may outperform a more sensitive test with poor uptake. Regulatory approval and market availability are not sufficient evidence of population-level benefit.

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결론

비침습적 CRC 선별 검사는 생물학적 성능과 경로의 실행 가능성 모두를 통해 평가되어야 합니다. FIT는 저렴하고 반복 가능하며, 프로그램 참여와 CRC 사망률 감소 사이의 연관성을 입증하는 근거가 뒷받침되기 때문에 많은 체계적 프로그램에서 가장 확장 가능한 옵션으로 남아 있습니다. 분자 대변 검사는 CRC 및 진행성 전암성 병변의 단회 적용 검출률을 향상시키지만, 낮은 특이도, 높은 비용, 그리고 대장 내시경에 대한 더 높은 수요라는 점이 지역적 자원과 함께 고려되어야 합니다. 혈액 기반 검사는 대변 검사나 대장 내시경을 거부하는 개인들의 참여를 확대할 수 있으나, 현재의 분석법은 진행성 전암성 병변에 대한 민감도가 낮으므로, 예방 중심의 전략을 직접적으로 대체하기보다는 검사를 받지 않은 사람들을 위한 보조 수단이나 대안으로 배치되어야 합니다.

가장 타당한 구현 접근 방식은 자원 층화 경로(resource-stratified pathway)입니다. 프로그램은 먼저 주요 병목 구...

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공개 사항

저자들은 이해 상충 관계가 없음을 밝힙니다.

감사의 글

연구비 지원 성명: 본 연구는 사천성 자연과학재단(지원 번호 2024NSFSC0718)의 지원을 받아 수행되었습니다.

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