A JNCI decision-modeling study compared noninvasive colorectal cancer screening options using “efficient frontiers” (benefit: life-years or QALYs gained; burden: lifetime colonoscopies/patient hours). Among average-risk adults, biennial or triennial next-generation multitarget stool DNA (ages 45–75) was the only noninvasive strategy consistently on the efficient frontier. Annual FIT was typically near-efficient; multitarget stool RNA was near-efficient at best; and currently available blood-based tests were not efficient under any age/interval scenario.
Sensitivity analyses that added colonoscopy (every 5–10 years) preserved these findings; results assumed 100% adherence and test performance from recent large trials. Authors conclude next-gen stool DNA should be prioritized among noninvasive choices at guideline intervals, with blood-based and stool RNA tests considered lower-priority options unless patients decline more efficient alternatives.