Comparing Colorectal Cancer Screening Test Performance and Prep Option

In this episode, ‘Comparing Colorectal Cancer Screening Test Performance and Prep Options,’ the panelists review the performance characteristics of available colorectal cancer screening modalities, including colonoscopy, FIT, multi-target stool DNA, RNA-based tests, and blood-based assays. The faculty compare sensitivity and specificity across tests, emphasizing that colonoscopy remains the most sensitive and uniquely therapeutic option. They highlight variability in FIT performance depending on assay type and cutoff thresholds, underscoring the importance of understanding which test is being used. Advances in next-generation stool DNA testing are discussed, with improved sensitivity and specificity compared to earlier versions. The conversation also addresses practical considerations such as bowel preparation options, patient adherence, and tailoring prep regimens to comorbidities to optimize both safety and diagnostic quality.

The next episode in this series, ‘Overcoming Barriers and Advancing Precision in Colorectal Cancer Screening,’ features expert faculty reviewing the barriers to colorectal cancer screening uptake, the evolving role of blood- and DNA-based testing, and the ongoing discussions around precision risk stratification and potentially lowering the screening age amid rising early-onset disease globally.

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Clinicians share practical tips to boost colorectal screening, comparing colonoscopy and stool tests while addressing fears.

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Comparing Colorectal Cancer Screening Test Performance and Prep Options

Shared Decision-Making in Colorectal Cancer Screening 

In’ Shared Decision-Making in Colorectal Cancer Screening’, the panelists focus on practical strategies for engaging patients in colorectal cancer screening conversations and improving screening uptake. The faculty discuss how to present screening options—colonoscopy, stool-based testing, and other modalities—by outlining the risks, benefits, and trade-offs of each approach. Emphasis is placed on shared decision-making, addressing patient concerns about invasiveness, preparation, and potential complications while reinforcing the importance of early detection and cancer prevention. The speakers also highlight the role of stool DNA testing and FIT in average-risk patients and clarify expectations for follow-up colonoscopy after a positive result. Finally, the discussion underscores the importance of high-quality colonoscopy reporting and appropriate follow-through to ensure effective colorectal cancer prevention.

Our next episode, ’Colorectal Cancer Screening Modalities and Implementation Strategies,’ further explores the expanding range of colorectal cancer screening options, including FIT, stool DNA/RNA tests, and emerging blood-based assays. The panelists highlight the performance characteristics, intervals, and appropriate use for each screening option. The discussion emphasizes patient-centered selection, the necessity of colonoscopy for symptomatic or high-risk individuals, and the importance of tracking, follow-up, and updated surveillance intervals to ensure timely and effective screening.

Doctors share tactics to boost colorectal screening: compare colonoscopy vs stool tests, address fears, and prevent cancer before symptoms.

Shared Decision-Making in Colorectal Cancer Screening

Shara Bialo, MD, is the senior medical director of T1D immunology at Sanofi.

T1D Screening is Effective but Underused Among Patients With No Disease History, With Shara Bialo, MD

 screening can effectively predict the disease before the first symptoms appear; however, despite its efficacy, many patients are not offered screening and are only diagnosed after the first symptoms have appeared.

T1D is an inherited disease, and often a family history is the primary impetus for investigation and diagnosis. Relatives of patients with T1D have a roughly 15-fold greater risk of disease compared to those without a relative with T1D. However, roughly 90% of all patients who will present with new T1D do not have a positive family history.

“T1D gets a lot of attention for its metabolic consequences, but we’re starting to shift the focus a bit earlier to its true autoimmune roots, which is this underlying, silent disease evolution that doesn’t really call our attention until it’s clinically obvious,” Shara Bialo, MD, senior medical director of T1D immunology at Sanofi, told 

 in an exclusive interview. “However, it turns out that you can detect it months to years before clinical signs and symptoms emerge – and you do that through screening for T1D.”

T1D screening is typically conducted via a blood test, which is then investigated for autoantibodies created by the immune system to destroy insulin-producing cells. The presence of ≥2 diabetes-related antibodies warrants a diagnosis, although clinicians frequently corroborate this data by examining blood sugar levels.

Among the positive impacts of screening for T1D is the avoidance of diabetic ketoacidosis (DKA), a devastating and potentially life-threatening complication affecting longevity, morbidity, and quality of life. Previous trials have highlighted the efficacy of various methods of reducing the rate of DKA; among these, T1D screening and follow-up reduced the rate of DKA by 20%.

Low utilization of T1D screening is not due to limited access or high cost – most methods are free. Only a small number of patients are aware of the opportunity to predict T1D. Many clinicians have long been pushing for general population screening for T1D, which would help prevent major conditions such as DKA. However, logistical challenges, such as working with primary care physicians and optimizing cost-effectiveness, still prevent screening from being generalized to the full population.

Bialo discusses how patient awareness can be improved, suggesting that healthcare providers and clinicians emphasize the value of predicting and potentially forestalling the disease.

“Brief conversations can really make a meaningful difference for patients and their families, and it could start with simply knowing that screening exists,” Bialo said. “It’s okay for it to be a slow rollout, but over time, we should make our way to general population screening. We’ve been missing the vast majority of individuals who could be helped because we’ve kept our area of focus too narrow, but there’s definitely a chance to start somewhere.”

Editors’ Note: Bialo reports no relevant disclosures.

Sims EK, Besser REJ, Dayan C, et al. Screening for Type 1 Diabetes in the General Population: A Status Report and Perspective. Diabetes. 2022;71(4):610-623. 

Centers for Disease Control and Prevention. Screening for type 1 diabetes. Centers for Disease Control and Prevention. February 23, 2026. Accessed March 12, 2026. 

https://www.cdc.gov/diabetes/diabetes-testing/screening-type-1-diabetes.html#cdc_generic_section_3-how-screening-works

Bialo discusses her perspective on the importance of T1D screening and its capacity to reduce the risk of disease progression and eventual complications later in life.

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Sayantani Sindher, MD, is a clinical associate professor at the Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine.

Dupilumab Improves Desensitization Outcomes in OIT, With Sayantani Sindher, MD

2026 American Academy of Allergy, Asthma & Immunology (AAAAI)

 annual meeting in Philadelphia, found that adding dupilumab to omalizumab-facilitated 

improved desensitization outcomes and reduced gastrointestinal adverse events.

However, it did not significantly increase sustained unresponsiveness. This begs the question: How should clinicians counsel patients about expectations for desensitization versus sustained responsiveness?

“I'm always trying to figure out how to apply sustained unresponsiveness data to the patient sitting in front of me,” investigator Sayantani Sindher, MD, clinical associate professor of medicine at Stanford University, told 

during the meeting. “When you have a patient in front of you as an individual, it's really hard to [figure] out, ‘Okay, are you going to be someone who will achieve sustained unresponsiveness versus not? ‘ In my outpatient care, I don't take them off of [therapy for] a long period of time. If they do miss many days or months of treatment, I will bring them back in and do observed dosing to get them right back on track. Until we have biomarkers available that can predict sustained unresponsiveness, it is not something I'm able to readily apply in my outpatient clinical care practice.”

The randomized COMBINE trial enrolled 108 individuals with multiple food allergies (peanut plus 1 or 2 additional allergens) and investigated whether dupilumab could improve outcomes during omalizumab-assisted OIT. Participants first received omalizumab for 8 weeks, after which they received OIT with either dupilumab or placebo from weeks 8 through 32. All therapies were discontinued at week 32, and sustained unresponsiveness was evaluated at week 44 using double-blind, placebo-controlled food challenges.

Although the trial’s primary endpoint, sustained unresponsiveness to ≥1043 mg of peanut protein, was not statistically different between groups, results suggested potential benefits with dupilumab. Sustained unresponsiveness was achieved in 39% of patients receiving omalizumab plus OIT and 55% of those receiving dupilumab plus OIT (

Secondary findings showed improvements in desensitization and tolerability with the addition of dupilumab. By week 32, 92% of patients receiving dupilumab tolerated the highest tested allergen dose (4043 mg) during food challenge compared with 63% of those receiving OIT without dupilumab (adjusted 

 =.013). Investigators also reported fewer gastrointestinal symptoms and treatment withdrawals in the dupilumab group.

Despite encouraging signals, Sindher emphasized that translating combination biologic strategies into routine practice requires consideration of real-world factors such as insurance coverage and drug costs.

“In clinical trials, we have funding to obtain the drugs. In the outpatient world, it all goes through insurance, and access is a big deal,” Sindher said. “The cost of it is… something we have to think through before… we start using it.”

Future analyses of the COMBINE trial are exploring immune mechanisms underlying treatment responses, including assessments of B cells, T cells, and basophil activation. Sindher said these efforts may help identify patient subgroups most likely to benefit from combination biologic approaches and inform more personalized strategies for managing food allergy.

“What we need is a much better understanding of why it works,” Sindher said. “Who is the population it works best for, and also who is the population it doesn't work for? Once we have better predictive biomarkers or algorithms that help us phenotypically cluster these patients, it'll be really hard to know when to use these biologics…Many of our food allergic kids and adults also have many other atopic conditions [such as asthma, eczema, seasonal allergies, eosinophilic esophagitis] …Having different biologics approved for some of these indications that may also help for food allergy would really help us address multiple atopic conditions with just one drug.”

A relevant disclosure for Sindher includes Genentech USA.

Sindher S, Long A, Garcia-llorett M, et al. The addition of dupilumab enhances desensitization and reduces gastrointestinal symptoms in omalizumab-facilitated multi-allergen oral immunotherapy in the COMBINE trial. 

Journal of Allergy and Clinical Immunology

doi:https://doi.org/10.1016/j.jaci.2025.12.917

Sindher S. Dupilumab Reduces GI Symptoms During Multi-Allergen OIT, With Sayantani Sindher, MD. HCPLive. Accessed on March 12, 2026. Published on March 5, 2026. 

https://www.hcplive.com/view/dupilumab-reduces-gi-symptoms-multi-allergen-oit-sayantani-sindher-md

Data presented at AAAAI 2026 showed that adding dupilumab to omalizumab-facilitated oral immunotherapy improved desensitization and reduced gastrointestinal adverse events.

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Abigail Brooks is an assistant managing editor for 

She joined MJH Life Sciences in August 2023 shortly after graduating from Monmouth University where she earned her BA in Communication with a concentration in Public Relations/Journalism and later an MA in Interactive Digital Media. She enjoys traveling, running, and reading books. She can be reached at abrooks@mjhlifesciences.com.

 remains one of the most common yet underrecognized chronic conditions in the United States. Affecting an estimated 35–36 million individuals, the disease often progresses silently, leaving many patients unaware of their condition until significant kidney damage has occurred.

At a recent clinical forum examining challenges in CKD identification and management, Muthiah Vaduganathan, MD, MPH, codirector of the Center for Cardiometabolic Implementation Science at Brigham and Women’s Hospital, and clinicians across nephrology and cardiovascular medicine discussed the persistent gap between disease prevalence and clinical awareness.

The conversation focused on improving early detection, refining risk stratification, and integrating newer therapies into practice while navigating workforce constraints and evolving care models. Experts emphasized that recent therapeutic advances can only influence outcomes if CKD is identified earlier in its course.

A central theme of the discussion was the striking lack of patient awareness surrounding CKD. Despite affecting tens of millions of Americans, only a small fraction of patients know they have the disease. Because CKD often produces few symptoms in its early stages and screening practices remain inconsistent, many patients are first identified after kidney function has already declined significantly. Disparities in diagnosis and awareness also persist, particularly among younger individuals, women, and certain racial and ethnic populations.

Improving outcomes therefore begins with more consistent detection. Panelists highlighted the underuse of urine albumin-to-creatinine ratio (UACR) testing as a key contributor to missed diagnoses. While estimated glomerular filtration rate (eGFR) is commonly included in routine laboratory panels, albuminuria testing is obtained far less consistently. Yet albuminuria is a critical biomarker of kidney damage and a strong predictor of both CKD progression and cardiovascular risk.

Several experts described efforts to reframe albuminuria testing as an early warning signal for kidney disease. When paired with eGFR, UACR can help clinicians identify patients earlier and better assess their risk of progression. Expanding the routine use of these tests was widely viewed as one of the most practical steps toward improving early CKD detection.

The forum also examined evolving referral patterns to nephrology. Some clinicians reported increased referrals from primary care, particularly from advanced practice providers, though referrals remain inconsistent. In many cases, patients are referred late in the disease course—sometimes only when kidney failure is imminent or dialysis planning is required—limiting opportunities to slow progression.

At the same time, experts acknowledged a practical reality: the nephrology workforce cannot manage every patient with early-stage CKD. With diabetes, hypertension, and cardiovascular disease continuing to rise, the population at risk for kidney disease is expanding rapidly. As a result, more effective triage and risk stratification are needed to ensure nephrology resources are directed toward patients most likely to benefit from specialist care.

Rather than relying solely on eGFR thresholds, panelists emphasized a more nuanced approach to referral decisions. Factors such as albuminuria levels, rate of kidney function decline, structural abnormalities, and underlying disease etiology can help determine which patients require specialist involvement. Many individuals with stable kidney function and minimal albuminuria may be appropriately managed in primary care with careful monitoring and risk factor control.

Strengthening collaboration between primary care clinicians and nephrologists will be essential for making these models work. Education around CKD biomarkers and referral criteria can help clinicians better identify which patients require specialist care and which can be safely managed in the community.

Recent advances in CKD therapeutics have added urgency to improving early detection. Over the past several years, therapies such as sodium-glucose cotransporter 2 inhibitors and nonsteroidal mineralocorticoid receptor antagonists have demonstrated the ability to slow CKD progression while reducing cardiovascular risk. Dapagliflozin and empagliflozin, as assessed in the DAPA-CKD and EMPA-KIDNEY trials, respectively, represent a major shift in CKD care, moving the field closer to disease modification rather than simply managing complications.

However, the benefits of these therapies depend heavily on early identification. If CKD remains undetected until advanced stages, opportunities to meaningfully alter disease trajectory may already be lost.

For clinicians, the message from the forum was clear: the tools to change CKD outcomes now exist, but realizing their full potential will require earlier recognition and a healthcare system capable of moving kidney care further upstream.

US Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023. May 15, 2024. Accessed March 12, 2026. 

https://www.cdc.gov/kidney-disease/php/data-research/index.html

American Kidney Fund. Risk factors for kidney disease. Accessed March 12, 2026. 

https://www.kidneyfund.org/all-about-kidneys/risk-factors

Campbell P. Dapagliflozin (Farxiga) Receives Historic FDA Approval for Chronic Kidney Disease. HCPLive. April 30, 2021. Accessed March 12, 2026. 

https://www.hcplive.com/view/dapagliflozin-farxiga-receives-historic-fda-approval-for-chronic-kidney-disease

Campbell P. Empagliflozin (Jardiance) Receives CKD Approval from US FDA. HCPLive. September 22, 2023. Accessed March 12, 2026. 

https://www.hcplive.com/view/empagliflozin-jardiance-receives-ckd-approval-from-us-fda

Articles

Chronic kidney disease affects 35–36 million Americans yet frequently goes unrecognized until late, reflecting limited patient awareness and inconsistent screening. Underuse of urine albumin-to-creatinine ratio testing, despite routine eGFR reporting, drives missed early diagnosis and inadequate risk stratification. Referral to nephrology often occurs near kidney failure, while workforce limitations necessitate better triage models that incorporate albuminuria, trajectory of decline, etiology, and structural findings. Therapeutic advances—particularly SGLT2 inhibitors and nonsteroidal MRAs—heighten urgency to shift kidney care upstream.

Experts discuss gaps in CKD detection, the role of albuminuria testing, and the need for earlier, risk-based care to improve outcomes.

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The HCPLive nephrology page is a resource for medical news and expert insights on kidney disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in nephrology, and more.

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Improving Early Detection of CKD in an Evolving Cardio-Kidney-Metabolic Era

Mary K Roberts, PhD is a Post Doctoral Researcher at the Leverhulme Centre for Demographic Science at the University of Oxford.

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Crisis Point: The Cause and Calamity, Neighborhood Disadvantage and Kidney Disease

Wood discussed the potential of BTK inhibition for peanut allergy and beyond.

Remibrutinib Enables Peanut Tolerance in as Little as 1 Week, With Robert Wood, MD

Tatyana Kushner, MD, is an associate professor of medicine in the division of gastroenterology and hepatology at Weill Cornell Medicine.

Kushner discusses the global burden of hepatitis D, gaps in testing, and emerging therapies reshaping the treatment landscape.

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New Momentum in Hepatitis D Research and Treatment, With Tatyana Kushner, MD

Mark G. Lebwohl, MD, the dean for Clinical Therapeutics at the Icahn School of Medicine at Mount Sinai,

At AAAAI 2026, Lebwohl discussed REMIX trial data showing oral remibrutinib reduced CSU symptoms within 12 hours and improved disease control.

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Remibrutinib Shows Rapid Symptom Relief in CSU, With Mark Lebwohl, MD

Melissa Wallach, MD, is a pediatrician at K. Hovnanian Children’s Hospital, Hackensack Meridian Jersey Shore University Medical Center.

Tozzi and Wallach discuss ways to omit artificial sweeteners and added sugars from children’s diets and minimize risk for T2D and MASLD later in life.

Type 2 Diabetes

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Sugar-Sweetened Beverages in Childhood Increases Diabetes, MASLD Risk, With Melissa Wallach, MD, and Meghan Tozzi, MD

Victoria Johnson joined the MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and now HCPLive. You can reach her at vjohnson@mjhlifesciences.com

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Eosinophils, Exacerbations, and Endpoints: Biologic Therapy Selection in COPD and Asthma

Experts discuss the clinical significance of the updated international CSU guidelines, which for the first time incorporate 3 step-up therapy options.

Overview of the New International CSU Guidelines and Expanded Treatment 

Nicole Negbenebor, MD, is a clinical assistant professor of dermatology and the director of the Skin of Color Clinic for the University of Iowa, as well as a Skin of Color Society (SOCS) member.

In this segment of the latest Skin of Color Savvy podcast, Nicole Negbenebor, MD, highlights her experiences as director of a Skin of Color Clinic.

Discussing Work as the Director of a Skin of Color Clinic in Dermatology

Experts discuss the goal of complete symptom control in CSU and the practical limitations of achieving complete control of disease.

Treatment Goals, Disease Control Targets, and the Role of Patient-Reported Outcome Measures 

Matthew Krantz, MD, from Vanderbilt University Medical Center

This HCPLive Five captures 5 interviews conducted on-site at AAAAI 2026.

Latest News

Comparing Colorectal Cancer Screening Test Performance and Prep Options

Shared Decision-Making in Colorectal Cancer Screening

T1D Screening is Effective but Underused Among Patients With No Disease History, With Shara Bialo, MD

Dupilumab Improves Desensitization Outcomes in OIT, With Sayantani Sindher, MD

Improving Early Detection of CKD in an Evolving Cardio-Kidney-Metabolic Era