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Hermann Brenner - One of the best experts on this subject based on the ideXlab platform.
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the effects of different invitation schemes on the use of fecal occult blood tests for Colorectal Cancer Screening systematic review of randomized controlled trials
Cancers, 2021Co-Authors: Laura Fiona Gruner, Michael Hoffmeister, Efrat L Amitay, Thomas Heisser, Feng Guo, Tobias Niedermaier, Anton Gies, Hermann BrennerAbstract:Personal invitations for fecal occult blood tests (nowadays mostly fecal immunochemical tests) are increasingly used to raise their usage for Colorectal Cancer Screening. However, there is a large heterogeneity in applied invitation schemes. We aimed to review evidence for the effectiveness of various invitation schemes. The main outcome was the fecal occult blood test usage rate. A systematic search was performed in Medline and Web of Science (up to 9 July 2020). Randomized controlled trials or cluster-randomized controlled trials were eligible, which reported on general invitations for fecal occult blood test-based Colorectal Cancer Screening sent to the general population at average Colorectal Cancer risk. (PROSPERO 2020 CRD42020169409). Overall, 34 studies were included. Invitations with an attached, i.e., mailed fecal occult blood test consistently increased test usage by 4-19.7% points, compared to other methods of test provision. Likewise, the introduction of advance notification consistently led to a higher usage rate, with an increase of 3.3-10.8% points. Reminders showed positive but varying effects by method. With an increase of 8.5-15.8% points, letter or email reminders were more effective than reminders by phone call or text message (0.6-6.5% points). Inconsistent results were found for financial incentives ((-8.4)-20% points) and for added or changed invitation material ((-3.5)-11.8% points). With 3.5-24.7% points, the strongest increases in use were achieved by multifaceted invitation, implementing multiple components. Any invitation scheme was superior over no invitation. Advance notification, mailing of fecal occult blood test, and reminders were consistently shown to have major, complementary potential to increase participation in fecal occult blood test-based Colorectal Cancer Screening settings.
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direct comparison of diagnostic performance of 9 quantitative fecal immunochemical tests for Colorectal Cancer Screening
Gastroenterology, 2018Co-Authors: Anton Gies, Katarina Cuk, Petra Schrotzking, Hermann BrennerAbstract:Background & Aims A variety of fecal immunochemical tests (FITs) for hemoglobin (Hb) are used in Colorectal Cancer Screening. It is unclear to what extent differences in reported sensitivities and specificities reflect true heterogeneity in test performance or differences in study populations or varying pre-analytical conditions. We directly compared the sensitivity and specificity values with which 9 quantitative (laboratory-based and point-of-care) FITs detected advanced neoplasms (AN) in a single Colorectal Cancer Screening study. Methods Pre-colonoscopy stool samples were obtained from participants of Screening colonoscopy in Germany from 2005 through 2010 and frozen at –80°C until analysis. The stool samples were thawed, homogenized, and used for 9 different quantitative FITs in parallel. Colonoscopy and histology reports were collected from all participants and evaluated by 2 independent, trained research assistants who were blinded to the test results. Comparative evaluations of diagnostic performance for AN were made at preset manufacturers′ thresholds (range, 2.0–17.0 μg Hb/g feces), at a uniform threshold (15 μg Hb/g feces), and at adjusted thresholds yielding defined levels of specificity (99%, 97%, and 93%). Results Of the 1667 participants who fulfilled the inclusion criteria, all cases with AN (n = 216) and 300 randomly selected individuals without AN were included in the analysis. Sensitivities and specificities for AN varied widely when we used the preset thresholds (21.8%–46.3% and 85.7%–97.7%, respectively) or the uniform threshold (16.2%–34.3% and 94.0%–98.0%, respectively). Adjusting thresholds to yield a specificity of 99%, 97%, or 93% resulted in almost equal sensitivities for detection of AN (14.4%–18.5%, 21.3%–23.6%, and 30.1%–35.2%, respectively) and almost equal positivity rates (2.8%–3.4%, 5.8%–6.1%, and 10.1%–10.9%, respectively). Conclusions Apparent heterogeneity in diagnostic performance of quantitative FITs can be overcome to a large extent by adjusting thresholds to yield defined levels of specificity or positivity rates. Rather than simply using thresholds recommended by the manufacturer, Screening programs should choose thresholds based on intended levels of specificity and manageable positivity rates.
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cost effectiveness of Colorectal Cancer Screening
Epidemiologic Reviews, 2011Co-Authors: Iris Lansdorpvogelaar, Amy B Knudsen, Hermann BrennerAbstract:Colorectal Cancer is an important public health problem. Several Screening methods have been shown to be effective in reducing Colorectal Cancer mortality. The objective of this review was to assess the cost-effectiveness of the different Colorectal Cancer Screening methods and to determine the preferred method from a cost-effectiveness point of view. Five databases (MEDLINE, EMBASE, the Cost-Effectiveness Analysis Registry, the British National Health Service Economic Evaluation Database, and the lists of technology assessments of the Centers for Medicare and Medicaid Services) were searched for cost-effectiveness analyses published in English between January 1993 and December 2009. Fifty-five publications relating to 32 unique cost-effectiveness models were identified. All studies found that Colorectal Cancer Screening was cost-effective or even cost-saving compared with no Screening. However, the studies disagreed as to which Screening method was most effective or had the best incremental cost-effectiveness ratio for a given willingness to pay per life-year gained. There was agreement among studies that the newly developed Screening tests of stool DNA testing, computed tomographic colonography, and capsule endoscopy were not yet cost-effective compared with the established Screening options.
Iris Lansdorpvogelaar - One of the best experts on this subject based on the ideXlab platform.
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cost effectiveness and budget impact analyses of a Colorectal Cancer Screening programme in a high adenoma prevalence scenario using miscan colon microsimulation model
BMC Cancer, 2018Co-Authors: Arantzazu Arrospide, Isabel Idigoras, Harry J De Koning, Myriam Sotogordoa, Jose Miguel Martinezllorente, Isabel Portillo, Eunate Aranaarri, Oliver Ibarrondo, Miriam P Van Der Meulen, Iris LansdorpvogelaarAbstract:The Basque Colorectal Cancer Screening Programme began in 2009 and the implementation has been complete since 2013. Faecal immunological testing was used for Screening in individuals between 50 and 69 years old. Colorectal Cancer in Basque country is characterized by unusual epidemiological features given that Colorectal Cancer incidence is similar to other European countries while adenoma prevalence is higher. The object of our study was to economically evaluate the programme via cost-effectiveness and budget impact analyses with microsimulation models. We applied the Microsimulation Screening Analysis (MISCAN)-Colon model to predict trends in Colorectal Cancer incidence and mortality and to quantify the short- and long-term effects and costs of the Basque Colorectal Cancer Screening Programme. The model was calibrated to the Basque demographics in 2008 and age-specific Colorectal Cancer incidence data in the Basque Cancer Registry from 2005 to 2008 before the Screening begun. The model was also calibrated to the high adenoma prevalence observed for the Basque population in a previously published study. The multi-cohort approach used in the model included all the cohorts in the programme during 30 years of implementation, with lifetime follow-up. Unit costs were obtained from the Basque Health Service and both cost-effectiveness analysis and budget impact analysis were carried out. The goodness-of-fit of the model adaptation to observed programme data was evidence of validation. In the cost-effectiveness analysis, the savings from treatment were larger than the added costs due to Screening. Thus, the Basque programme was dominant compared to no Screening, as life expectancy increased by 29.3 days per person. The savings in the budget analysis appeared 10 years after the complete implementation of the programme. The average annual budget was €73.4 million from year 2023 onwards. This economic evaluation showed a Screening intervention with a major health gain that also produced net savings when a long follow-up was used to capture the late economic benefit. The number of colonoscopies required was high but remain within the capacity of the Basque Health Service. So far in Europe, no other population Colorectal Cancer Screening programme has been evaluated by budget impact analysis.
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cost effectiveness of Colorectal Cancer Screening
Epidemiologic Reviews, 2011Co-Authors: Iris Lansdorpvogelaar, Amy B Knudsen, Hermann BrennerAbstract:Colorectal Cancer is an important public health problem. Several Screening methods have been shown to be effective in reducing Colorectal Cancer mortality. The objective of this review was to assess the cost-effectiveness of the different Colorectal Cancer Screening methods and to determine the preferred method from a cost-effectiveness point of view. Five databases (MEDLINE, EMBASE, the Cost-Effectiveness Analysis Registry, the British National Health Service Economic Evaluation Database, and the lists of technology assessments of the Centers for Medicare and Medicaid Services) were searched for cost-effectiveness analyses published in English between January 1993 and December 2009. Fifty-five publications relating to 32 unique cost-effectiveness models were identified. All studies found that Colorectal Cancer Screening was cost-effective or even cost-saving compared with no Screening. However, the studies disagreed as to which Screening method was most effective or had the best incremental cost-effectiveness ratio for a given willingness to pay per life-year gained. There was agreement among studies that the newly developed Screening tests of stool DNA testing, computed tomographic colonography, and capsule endoscopy were not yet cost-effective compared with the established Screening options.
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evaluating test strategies for Colorectal Cancer Screening a decision analysis for the u s preventive services task force
Annals of Internal Medicine, 2008Co-Authors: Ann G Zauber, Iris Lansdorpvogelaar, Amy B Knudsen, Janneke Wilschut, Marjolein Van Ballegooijen, Karen M KuntzAbstract:Despite recent declines in both incidence and mortality (1), Colorectal Cancer remains the second most common cause of Cancer death in the United States (2). Screening for Colorectal Cancer reduces mortality by allowing physicians to detect Cancer at earlier, more treatable stages, as well as to identify and remove adenomatous polyps (asymptomatic benign precursor lesions that may lead to Colorectal Cancer). Many tests are available for Screening, such as fecal occult blood tests (FOBTs), flexible sigmoidoscopy, and colonoscopy. Screening with FOBT (Hemoccult II, Beckman Coulter, Fullerton, California) has been shown to reduce Colorectal Cancer mortality by 15% to 33% in randomized, controlled trials (3--5), and Screening with more sensitive FOBTs, flexible sigmoidoscopy, colonoscopy, or combinations of these tests may reduce the burden of Colorectal Cancer even more (6, 7). In the absence of adequate clinical trial data on several recommended Screening strategies, microsimulation modeling can provide guidance on the risks, benefits, and testing resources required for different Screening strategies to reduce the burden of Colorectal Cancer. In July 2002, the U.S. Preventive Services Task Force (USPSTF) concluded that there was sufficient evidence to recommend strongly that all average-risk adults 50 years of age and older should be offered Colorectal Cancer Screening (8). However, the logistics of Screening, such as the type of Screening test, Screening interval, and age at which to stop Screening, were not evaluated in terms of the balance of benefits and potential harms. The USPSTF has again addressed recommendations for Colorectal Cancer Screening with a systematic review of the evidence (9) on Screening tests. For this assessment, the USPSTF requested a decision analysis to project expected outcomes of various strategies for Colorectal Cancer Screening. Two independent microsimulation modeling groups from the Cancer Intervention and Surveillance Modeling Network (CISNET), funded by the National Cancer Institute, used a comparative modeling approach to compare life-years gained relative to resource use of different strategies for Colorectal Cancer Screening.
Oliver Ibarrondo - One of the best experts on this subject based on the ideXlab platform.
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cost effectiveness and budget impact analyses of a Colorectal Cancer Screening programme in a high adenoma prevalence scenario using miscan colon microsimulation model
BMC Cancer, 2018Co-Authors: Arantzazu Arrospide, Isabel Idigoras, Javier Mar, Harry J De Koning, Miriam P Van Der Meulen, Myriam Sotogordoa, Jose Miguel Martinezllorente, Isabel Portillo, Eunate Aranaarri, Oliver IbarrondoAbstract:The Basque Colorectal Cancer Screening Programme began in 2009 and the implementation has been complete since 2013. Faecal immunological testing was used for Screening in individuals between 50 and 69 years old. Colorectal Cancer in Basque country is characterized by unusual epidemiological features given that Colorectal Cancer incidence is similar to other European countries while adenoma prevalence is higher. The object of our study was to economically evaluate the programme via cost-effectiveness and budget impact analyses with microsimulation models. We applied the Microsimulation Screening Analysis (MISCAN)-Colon model to predict trends in Colorectal Cancer incidence and mortality and to quantify the short- and long-term effects and costs of the Basque Colorectal Cancer Screening Programme. The model was calibrated to the Basque demographics in 2008 and age-specific Colorectal Cancer incidence data in the Basque Cancer Registry from 2005 to 2008 before the Screening begun. The model was also calibrated to the high adenoma prevalence observed for the Basque population in a previously published study. The multi-cohort approach used in the model included all the cohorts in the programme during 30 years of implementation, with lifetime follow-up. Unit costs were obtained from the Basque Health Service and both cost-effectiveness analysis and budget impact analysis were carried out. The goodness-of-fit of the model adaptation to observed programme data was evidence of validation. In the cost-effectiveness analysis, the savings from treatment were larger than the added costs due to Screening. Thus, the Basque programme was dominant compared to no Screening, as life expectancy increased by 29.3 days per person. The savings in the budget analysis appeared 10 years after the complete implementation of the programme. The average annual budget was €73.4 million from year 2023 onwards. This economic evaluation showed a Screening intervention with a major health gain that also produced net savings when a long follow-up was used to capture the late economic benefit. The number of colonoscopies required was high but remain within the capacity of the Basque Health Service. So far in Europe, no other population Colorectal Cancer Screening programme has been evaluated by budget impact analysis.
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cost effectiveness and budget impact analyses of a Colorectal Cancer Screening programme in a high adenoma prevalence scenario using miscan colon microsimulation model
BMC Cancer, 2018Co-Authors: Arantzazu Arrospide, Isabel Idigoras, Harry J De Koning, Myriam Sotogordoa, Jose Miguel Martinezllorente, Isabel Portillo, Eunate Aranaarri, Oliver Ibarrondo, Miriam P Van Der Meulen, Iris LansdorpvogelaarAbstract:The Basque Colorectal Cancer Screening Programme began in 2009 and the implementation has been complete since 2013. Faecal immunological testing was used for Screening in individuals between 50 and 69 years old. Colorectal Cancer in Basque country is characterized by unusual epidemiological features given that Colorectal Cancer incidence is similar to other European countries while adenoma prevalence is higher. The object of our study was to economically evaluate the programme via cost-effectiveness and budget impact analyses with microsimulation models. We applied the Microsimulation Screening Analysis (MISCAN)-Colon model to predict trends in Colorectal Cancer incidence and mortality and to quantify the short- and long-term effects and costs of the Basque Colorectal Cancer Screening Programme. The model was calibrated to the Basque demographics in 2008 and age-specific Colorectal Cancer incidence data in the Basque Cancer Registry from 2005 to 2008 before the Screening begun. The model was also calibrated to the high adenoma prevalence observed for the Basque population in a previously published study. The multi-cohort approach used in the model included all the cohorts in the programme during 30 years of implementation, with lifetime follow-up. Unit costs were obtained from the Basque Health Service and both cost-effectiveness analysis and budget impact analysis were carried out. The goodness-of-fit of the model adaptation to observed programme data was evidence of validation. In the cost-effectiveness analysis, the savings from treatment were larger than the added costs due to Screening. Thus, the Basque programme was dominant compared to no Screening, as life expectancy increased by 29.3 days per person. The savings in the budget analysis appeared 10 years after the complete implementation of the programme. The average annual budget was €73.4 million from year 2023 onwards. This economic evaluation showed a Screening intervention with a major health gain that also produced net savings when a long follow-up was used to capture the late economic benefit. The number of colonoscopies required was high but remain within the capacity of the Basque Health Service. So far in Europe, no other population Colorectal Cancer Screening programme has been evaluated by budget impact analysis.
Arantzazu Arrospide - One of the best experts on this subject based on the ideXlab platform.
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cost effectiveness and budget impact analyses of a Colorectal Cancer Screening programme in a high adenoma prevalence scenario using miscan colon microsimulation model
BMC Cancer, 2018Co-Authors: Arantzazu Arrospide, Isabel Idigoras, Javier Mar, Harry J De Koning, Miriam P Van Der Meulen, Myriam Sotogordoa, Jose Miguel Martinezllorente, Isabel Portillo, Eunate Aranaarri, Oliver IbarrondoAbstract:The Basque Colorectal Cancer Screening Programme began in 2009 and the implementation has been complete since 2013. Faecal immunological testing was used for Screening in individuals between 50 and 69 years old. Colorectal Cancer in Basque country is characterized by unusual epidemiological features given that Colorectal Cancer incidence is similar to other European countries while adenoma prevalence is higher. The object of our study was to economically evaluate the programme via cost-effectiveness and budget impact analyses with microsimulation models. We applied the Microsimulation Screening Analysis (MISCAN)-Colon model to predict trends in Colorectal Cancer incidence and mortality and to quantify the short- and long-term effects and costs of the Basque Colorectal Cancer Screening Programme. The model was calibrated to the Basque demographics in 2008 and age-specific Colorectal Cancer incidence data in the Basque Cancer Registry from 2005 to 2008 before the Screening begun. The model was also calibrated to the high adenoma prevalence observed for the Basque population in a previously published study. The multi-cohort approach used in the model included all the cohorts in the programme during 30 years of implementation, with lifetime follow-up. Unit costs were obtained from the Basque Health Service and both cost-effectiveness analysis and budget impact analysis were carried out. The goodness-of-fit of the model adaptation to observed programme data was evidence of validation. In the cost-effectiveness analysis, the savings from treatment were larger than the added costs due to Screening. Thus, the Basque programme was dominant compared to no Screening, as life expectancy increased by 29.3 days per person. The savings in the budget analysis appeared 10 years after the complete implementation of the programme. The average annual budget was €73.4 million from year 2023 onwards. This economic evaluation showed a Screening intervention with a major health gain that also produced net savings when a long follow-up was used to capture the late economic benefit. The number of colonoscopies required was high but remain within the capacity of the Basque Health Service. So far in Europe, no other population Colorectal Cancer Screening programme has been evaluated by budget impact analysis.
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cost effectiveness and budget impact analyses of a Colorectal Cancer Screening programme in a high adenoma prevalence scenario using miscan colon microsimulation model
BMC Cancer, 2018Co-Authors: Arantzazu Arrospide, Isabel Idigoras, Harry J De Koning, Myriam Sotogordoa, Jose Miguel Martinezllorente, Isabel Portillo, Eunate Aranaarri, Oliver Ibarrondo, Miriam P Van Der Meulen, Iris LansdorpvogelaarAbstract:The Basque Colorectal Cancer Screening Programme began in 2009 and the implementation has been complete since 2013. Faecal immunological testing was used for Screening in individuals between 50 and 69 years old. Colorectal Cancer in Basque country is characterized by unusual epidemiological features given that Colorectal Cancer incidence is similar to other European countries while adenoma prevalence is higher. The object of our study was to economically evaluate the programme via cost-effectiveness and budget impact analyses with microsimulation models. We applied the Microsimulation Screening Analysis (MISCAN)-Colon model to predict trends in Colorectal Cancer incidence and mortality and to quantify the short- and long-term effects and costs of the Basque Colorectal Cancer Screening Programme. The model was calibrated to the Basque demographics in 2008 and age-specific Colorectal Cancer incidence data in the Basque Cancer Registry from 2005 to 2008 before the Screening begun. The model was also calibrated to the high adenoma prevalence observed for the Basque population in a previously published study. The multi-cohort approach used in the model included all the cohorts in the programme during 30 years of implementation, with lifetime follow-up. Unit costs were obtained from the Basque Health Service and both cost-effectiveness analysis and budget impact analysis were carried out. The goodness-of-fit of the model adaptation to observed programme data was evidence of validation. In the cost-effectiveness analysis, the savings from treatment were larger than the added costs due to Screening. Thus, the Basque programme was dominant compared to no Screening, as life expectancy increased by 29.3 days per person. The savings in the budget analysis appeared 10 years after the complete implementation of the programme. The average annual budget was €73.4 million from year 2023 onwards. This economic evaluation showed a Screening intervention with a major health gain that also produced net savings when a long follow-up was used to capture the late economic benefit. The number of colonoscopies required was high but remain within the capacity of the Basque Health Service. So far in Europe, no other population Colorectal Cancer Screening programme has been evaluated by budget impact analysis.
Barry M Berger - One of the best experts on this subject based on the ideXlab platform.
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cross sectional adherence with the multi target stool dna test for Colorectal Cancer Screening real world data from a large cohort of older adults
Journal of Medical Screening, 2021Co-Authors: Emily Weiser, Philip D Parks, Rebecca Swartz, Jack Van Thomme, Philip T Lavin, Paul J Limburg, Barry M BergerAbstract:ObjectiveTo determine cross-sectional adherence with the multi-target stool DNA test used for Colorectal Cancer Screening in a large, fully insured Medicare population.MethodsAll patients aged 65–8...
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specificity of the multi target stool dna test for Colorectal Cancer Screening in average risk 45 49 year olds a cross sectional study
Cancer Prevention Research, 2021Co-Authors: Thomas F Imperiale, Steven H Itzkowitz, Barry M Berger, John B Kisiel, Bradley Scheu, Emma Kate Duimstra, Sandra Statz, Paul J LimburgAbstract:High-specificity Colorectal Cancer Screening is desirable to triage patients <50 years for colonoscopy; however, most endorsed Colorectal Cancer Screening tests have not been rigorously evaluated in younger populations. This prospective cross-sectional study determined the specificity of the multitarget stool DNA (mt-sDNA) test in an average-risk Screening population of 45 to 49 year-olds. Specificity was the primary outcome and was measured in participants without Colorectal Cancer or advanced preCancerous lesions [APL- advanced adenomas (AA), and sessile serrated lesions ≥10 mm], and in the subgroup of participants with negative colonoscopic findings. APL sensitivity was a secondary outcome. The evaluable cohort included those who completed the study without protocol deviations and had a usable mt-sDNA test. Of 983 enrolled participants, 816 formed the evaluable cohort, with a mean age of 47.8 (SD, 1.5) years; 47.7% were women. No participants had Colorectal Cancer, 49 had APL, 253 had nonadvanced adenomas (NAA), and 514 had negative colonoscopic findings. mt-sDNA test specificity was 95.2% (95% CI, 93.4-96.6) in participants with NAA or negative findings [96.3% (confidence interval (CI), 94.3%-97.8%)] in those with negative findings, and did not differ by sex (P = 0.75) or race (P = 0.36) in participants with NAA or negative findings. Sensitivity for APL was 32.7% (CI, 19.9-47.5%), with most APL (83.7%) measuring 10-19 mm and none having high-grade dysplasia. The area under the ROC curve for discriminating between APL and lesser findings was 0.72 (CI, 0.64-0.81). mt-sDNA's high specificity would help minimize risk from unnecessary diagnostic procedures in this age group. This study shows that mt-sDNA has high specificity among average-risk 45 to 49-year olds, supporting its use as a noninvasive option for Colorectal Cancer Screening. PREVENTION RELEVANCE: This study shows that mt-sDNA has high specificity among average-risk 45-49 year olds, supporting its use as a non-invasive option for Colorectal Cancer Screening.
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multitarget stool dna testing for Colorectal Cancer Screening
The New England Journal of Medicine, 2014Co-Authors: Thomas F Imperiale, David A Ahlquist, Steven H Itzkowitz, Philip T Lavin, David F Ransohoff, Theodore R Levin, Graham P Lidgard, Barry M BergerAbstract:Background An accurate, noninvasive test could improve the effectiveness of Colorectal-Cancer Screening. Methods We compared a noninvasive, multitarget stool DNA test with a fecal immunochemical test (FIT) in persons at average risk for Colorectal Cancer. The DNA test includes quantitative molecular assays for KRAS mutations, aberrant NDRG4 and BMP3 methylation, and β-actin, plus a hemoglobin immunoassay. Results were generated with the use of a logistic-regression algorithm, with values of 183 or more considered to be positive. FIT values of more than 100 ng of hemoglobin per milliliter of buffer were considered to be positive. Tests were processed independently of colonoscopic findings. Results Of the 9989 participants who could be evaluated, 65 (0.7%) had Colorectal Cancer and 757 (7.6%) had advanced preCancerous lesions (advanced adenomas or sessile serrated polyps measuring ≥1 cm in the greatest dimension) on colonoscopy. The sensitivity for detecting Colorectal Cancer was 92.3% with DNA testing and 73.8% with FIT (P = 0.002). The sensitivity for detecting advanced preCancerous lesions was 42.4% with DNA testing and 23.8% with FIT (P<0.001). The rate of detection of polyps with high-grade dysplasia was 69.2% with DNA testing and 46.2% with FIT (P = 0.004); the rates of detection of serrated sessile polyps measuring 1 cm or more were 42.4% and 5.1%, respectively (P<0.001). Specificities with DNA testing and FIT were 86.6% and 94.9%, respectively, among participants with nonadvanced or negative findings (P<0.001) and 89.8% and 96.4%, respectively, among those with negative results on colonoscopy (P<0.001). The numbers of persons who would need to be screened to detect one Cancer were 154 with colonoscopy, 166 with DNA testing, and 208 with FIT. Conclusions In asymptomatic persons at average risk for Colorectal Cancer, multitarget stool DNA testing detected significantly more Cancers than did FIT but had more false positive results. (Funded by Exact Sciences; ClinicalTrials.gov number, NCT01397747.)