Another approach to reducing the high mortality rate of CRC is

to perform an inexpensive and non-invasive screen as part of a standard general physical examination for the appropriate population groups (e.g. persons over 50), which could detect a large fraction of patients who would normally be missed due to non-compliance. Improved fecal tests are being developed, for instance, based on molecular profiling of DNA such as the Exact Science Pre-Gen Plus™ (Berger et al., 2006); however, such tests have not been widely accepted by the medical community, potentially due to the emphasis on home-collection of fecal samples (Woolf, 2004). Yet diagnosing CRC at an early stage is indispensable as the 5-year survival rate is around 90% when caught at the localized SB431542 molecular weight stage (SEER Summary Staging) and drops to 70% with regional metastasis and 12% with distant metastasis (Howlader et al., 2012). Therefore, an early, non-invasive screen for CRC which can complement the colonoscopy is urgently needed. In contrast to fecal based CRC screening, blood testing based on detection of multiple biomarkers provides a minimally-invasive, more patient friendly method of pre-screening for CRC. One such approach is based on detection of aberrant methylation of CpG-islands (CGI-methylation) in freely circulating Small molecule library DNA in blood. Epigenomics is developing

Epi ProColon, a blood-based test based on detection of methylation markers in Septin9 (Toth et al., 2012). Serum proteins and autoantibodies against tumor-associated antigens (TAAs) in blood also comprise a potential source of valuable CRC biomarkers. A 2011 review found 63 studies on the serological diagnosis of CRC with more than 50 TAAs oxyclozanide and other serum protein biomarkers in development (Creeden et al., 2011). Autoantibodies to TAAs have been detected in patient’s blood even in the

early stages of cancer (Chapman et al., 2008). Furthermore, autoantibody biomarkers have several advantages over other serum biomarkers, including long-term stability and “the inherent amplification of signals provided by the host’s own immune system to low levels of tumor-associated antigens in early disease” ( Anderson and LaBaer, 2005 and Storr et al., 2006). However, any single autoantibody biomarker rarely exceeds 15% diagnostic sensitivity ( Zhang et al., 2003, Casiano et al., 2006 and Belousov et al., 2008), thereby highlighting the need to discover and clinically validate large panels or signatures of TAAs, in multiplex, as well as to combine autoantibodies with other serum biomarker types such as circulating proteins, to achieve both sensitive and specific cancer diagnosis. In the genomics realm, highly parallelized and multiplexed bio-assay technologies such as high density DNA microarrays/micro-bead arrays (Fodor et al., 1991, Chee et al., 1996 and Gunderson et al., 2004), massively parallel DNA sequencing (Margulies et al., 2005 and Bentley et al., 2008), microfluidic chips (Dettloff et al.