Breath test: a new diagnostic tool for colorectal cancer?

• DOI: 10.2217/crc.13.9
• Publication Date: 2013-04-02T16:58:37Z
• Authors: Donato F Altomare; Maria Di Lena; Elisabetta Travaglio
• Keywords: Colorectal Cancer; 0303 health sciences; 03 medical and health sciences; breath test; Volatile organic compound; metabolomic; 3. Good health

1Department of Emergency & Organ Transplantation, University ‘Aldo Moro’ of Bari, Bari, Italy *Author for correspondence: Tel.: [phone]; Fax: [phone]; [e-mail] The medical literature is full of studies aiming to detect reliable biomarkers for a certain type of cancer, but this goal is rarely achieved and the great enthusiasm of the researchers is usually frustrated by the disappointing outcomes obtained [1]. Nevertheless, screening to identify a disease or a predisease condition in apparently healthy subjects is a central issue in national healthcare systems, because it can allow detection of a disease in an early phase or even prevent the disease itself. This, in turn, decreases morbidity and mortality, and consequently may have a great economic and social impact. This is particularly true for colorectal cancer, which is the second most common (third in women) cause of cancer death in western countries [2], and that recognizes a pre-disease condition in the adenomatous colonic polyps [3]. There is evidence in the literature to suggest that colorectal cancer diagnosed in its early stage can be cured in a significantly higher proportion of patients [4] and colonic polyps can be endoscopically removed, leading to true cancer prevention. Nowadays, colorectal cancer screening is performed by an immunochemical test based on the identification of human hemoglobin in feces (fecal occult blood test [FOBT]). This test has been proven to be effective in reducing colon cancerrelated mortality [5,6], but its low sensitivity and specificity makes the FOBT a poorly reliable screening tool [7]. Furthermore, the unpleasant material used contributes to decrease patients’ compliance and increases patients’ reluctance to adhere to the screening program. Limitation of false-positive tests is essential to avoid useless, risky and expensive colonoscopies (the risk of complications is reportedly between 0.5 and 1.9% [8]), and the psychological consequences of a false-positive result [9]. Limitation of false-negative tests is even more important because it can prevent asymptomatic cancer or adenomas from going undetected. Metabolomics is a relatively new branch of the systems biology that deals with the ‘metabolome’, represented by the small molecules resulting from the final cell “...if confirmed on a larger sample of patients, the test could be proposed as a new screening tool with higher sensitivity and specificity compared with the traditional fecal occult blood test...” EDITORIAL