Freenome, a privately held biotech company, presented new research at the American College of Gastroenterology (ACG) annual meeting that underscores their commitment to improving colorectal cancer (CRC) screening. In two separate presentations, Freenome examines the benefits and burdens of detecting and removing adenomas, and the barriers to CRC screening among different age groups.

Freenome is developing a CRC screening test using a routine blood draw to detect cancer in its earliest stages.

PREEMPT CRC, Freenome's multi-center clinical study on colorectal cancer, is in the final stages of enrollment. The study leverages a novel hybrid model that includes both virtual and traditional recruitment to reach underserved communities and ensure a diverse and representative population. With an estimated enrollment of more than 25,000, PREEMPT CRC represents the largest registrational study to date for a CRC screening test for asymptomatic, average risk adults in the United States.

Detection and removal of adenomas have different benefits and burdens depending on their size
While the benefits of the early detection of CRC are widely accepted, the risks and benefits of detecting and removing small and medium adenomas is still debated. For this new study,^[1] Freenome utilized its CRC-MAPS™ model to examine burden-to-benefit ratios across different adenoma size groups for a hypothetical blood-based CRC screening test.

The findings showed that improvements to test performance metrics, such as specificity and sensitivity for CRC or adenomas, had different impacts on the number of colonoscopies expected ("burden") and clinical outcomes ("benefits"). Further, the burden-to-benefit ratios differed by adenoma size and were far less favorable for small adenomas than for medium and large adenomas.

"This study underscores that detection and removal of all adenomas - let alone non-adenomatous polyps - may not offer an acceptable tradeoff since gains in clinical benefits come with a disproportionately greater increase in colonoscopy burden," said Girish Putcha, M.D., Ph.D., and chief medical officer at Freenome.

Multiple barriers to CRC screening exist, especially for younger age groups
In May, the United States Preventive Services Task Force (USPSTF) expanded their recommendation for CRC screening to include all adults ages 45 to 75.^[2]

Despite evidence of increasing CRC incidence rates in young adults, CRC screening rates continue to be lower for younger adults. To better understand CRC screening barriers among younger age groups, Freenome performed an analysis on a subset of data from a recent systematic literature review.

The analysis^[3] showed that younger ages reported lower adherence (43%) to CRC screening compared to older ages (57%). The most common barriers co-occurring with younger age adults included patient-level factors, such as education and socioeconomic status, and provider-level factors, like the absence of a regular care provider.

The findings underscored that optimizing screening adherence, especially among younger populations for whom screening is now recommended, will likely require targeted interventions and strategies to address barriers.

"We've prioritized understanding and meeting the needs of patients, providers, regulators and payers from the outset," said Mike Nolan, chief executive officer of Freenome. "We are driven to help all communities with our blood-based CRC screening test."