Service coverage
products

M3CRC

WORLD’S ONLY non-invasive colorectal cancer risk prediction test that detects non-advanced adenoma

Sensitivity in detecting adenomas and early detection of Colorectal Cancer

Colorectal cancer (CRC) has been the commonest and second deadliest cancer in Hong Kong since2013. Most CRCs develop from small polyps (see figure) that are treatable but often undetected.

Various non-invasive tests for CRC are currently available in the market, but they fail to address the need in detecting small polyps for preventative care.

FIT (fecal immunochemical test), the most common of these tests, has a sensitivity of just 7.6% for small polyps. The stool DNA test, one of the newest CRC screening test, similarly only has a sensitivity of 17.2% for small polyps.
(Imperiale, NEJM, 2014)

How does small polyp progress to colorectal cancer?
Illustration adapted from Metagenomic and Metabolomic Analyses Reveal Distinct Stage-specific Phenotypes of the Gut Microbiota in Colorectal Cancer,
by Yachida et al., Nature Medicine, 2019 and Sporadic (Nonhereditary) Colorectal Cancer: Introduction, by Johns Hopkins Colon Cancer Center. https://www.hopkinsmedicine.org/gastroenterology_hepatology/_pdfs/small_large_intestine/sporadic_nonhereditary_colorectal_cancer.pdf

*Small polyp refers to non-advanced adenoma, large polyp refers to advanced-adenoma
Early detection small polyps to avoid the risk of Colorectal Cancer” with “Early Detection and removal of precancerous polyps (adenomas) can prevent CRC and reduce mortality2

The microbiome is closely related to CRC. Intestines that are persistently exposed to a hostile microbial environment have higher risks for CRC. Scientists from The Chinese University of Hong Kong are among the first in the world to identify a series of bad bacteria that are specific to CRC populations. By measuring the levels of these bacteria, we detect CRC and colorectal polyps, including small polyps, at extremely high sensitivity. Through this measurement, we can also compute your gut microbial health, informing dietary adjustments and microbiota modulation to reduce the risk for having CRC.

*Small polyp refers to non-advanced adenoma



Gut Microbiome is Linked to the Development of Colorectal Cancer

We cannot edit our human genome, but we can modulate our gut microbiome to improve health

The gut microbiome dictates human health. In fact, 90% of cell counts in a human body belong tomicrobes, most of which reside in the intestine and interact with human cells. Studies found that:

Only 12-35% of CRC can be explained by hereditary factor4
The gut microbiome of CRC patients is different from that of healthy individuals7
Gut microbiome dysbiosis may promote cancer formation in the colon5



The Features of M3CRC
WORLD’S ONLY non-invasive colorectal cancer risk prediction test that detects non-advanced adenoma

Tailored for Asians
Non-invasive
94% sensitivity for CRC is as robust as colonoscope
Sensitivity for adenoma is superior to currently available non-invasive tests
Dietary recommendations included


How does M3CRC predict risk of having colorectal polyp and cancer?

M3CRC measures the levels of m3 (discovered by the Chinese University of Hong Kong) and the other 3 microbial markers plus hemoglobin in the stool. Using our propriety algorithm, we generate 2 risk indices corresponding to colorectal adenoma and colorectal cancer. Higher risk indices reflect higher risks of having colorectal adenoma and colorectal cancer.

Colorectal Adenoma Risk Index
Colorectal Cancer Risk Index
The Test Journey

The advantages of M3CRC

M3CRC is a world’s only non-invasive colorectal cancer risk prediction test that defects non-advanced adenoma , the sensitivity of CRC is 94% comparable to colonoscopy10 and the specificity is 85%, sensitivity superior to currently available non-invasive test in detecting adenomas. (especially small polyps)11

M3CRC
# Sensitivity detection
CRC
94%
AA
47%
nAA
44%
*at 85% specificity
CRC: colorectal cancer
AA: advanced adenoma
nAA: non-advanced adenoma
#Sample size increased since the publication of Ref. 10. Data on file.



The use of the test
A novel tool for monitoring gut microbial health

A persistently high score indicates a hostile microbial environment that is favorable for the development of CRC.

Flexible stool collection at home

Please follow this video guide to collect the stool sample.
Caution:

  • Please be reminded to mark down the sample collection date/time on the sample bag;

  • Make sure both tubes are closed tightly and avoid leakage;

  • After the sample collection, return the sample to the Clinic within 24 hours.

FAQ
When Should I take the Test?
When Should I take the Test?
To predict the risk of having colorectal adenoma and colorectal cancer: ≥45 years old. The American Cancer Society (ACS) recommends that adults aged 45 years or above with an average risk of colorectal cancer undergo regular screening. In certain high-risk individuals, including those with a family history of colorectal cancer, any inherited mutations, or other known risk factors, screening is recommended to begin at an earlier age. For stool-based tests, the ACS recommends regular screening every 1-3 years. For more information, please consult your doctor.

For regular monitoring of gut microbial health: Any age M3CRC can inform you of exposure to a hostile microbial environment that can promote colorectal cancer. Anyone can take the test to stay informed about his or her colorectal cancer-related gut microbial health. Please consult your doctor if you are interested in the test.
How does the microbiome relate to colorectal adenoma and colorectal cancer?
How does the microbiome relate to colorectal adenoma and colorectal cancer?
Experiments show that the gut microbiota is involved in colorectal cancer formation and progression. Clinically, patients with colorectal adenoma and colorectal cancer also have a characteristic “CRC microbiome” that is different from the microbiome of healthy people. Certain microbes within the microbiome can secrete toxins, damage DNA, and stimulate inflammation, contributing to adenoma and cancer
How can I improve my gut microbiome?
How can I improve my gut microbiome?
Lifestyle modifications can improve the human gut microbiome. Evidence suggests dietary intervention, weight reduction, and the administration of probiotics, prebiotics, or synbiotics can modulate the gut microbiome. The M3CRC contains a dietary recommendation that is tailored to test results.
What are the scientific evidence behind the test?
What are the scientific evidence behind the test?
The test is based on a clinical study involving over 1,000 colorectal adenoma, colorectal cancer, and control subjects. The test score is significantly elevated in patients with colorectal adenoma and colorectal cancer patients compared with control subjects (p<0.0001)
What is the value proposition of M3CRC risk prediction test?
What is the value proposition of M3CRC risk prediction test?
M3CRC risk prediction test is more sensitive than other commercially available tests at detecting colorectal adenoma and colorectal cancer. At 85% specificity, M3CRC has sensitivities of 40% for non-advanced adenoma 45% for advanced adenoma, and 94% for colorectal cancer. This is respectively a 30%, 20%, and 20% increase in accuracy compared to FIT, a widely used risk prediction test.
Does the M3CRC risk prediction test complement with endoscopy?
Does the M3CRC risk prediction test complement with endoscopy?
Yes. M3CRC can serve as a non-invasive and early step to identify patients who are at higher risk of colorectal adenoma and colorectal cancer, who are otherwise reluctant to perform endoscopy.
How often should I prescribe M3CRC risk prediction test to my patients?
How often should I prescribe M3CRC risk prediction test to my patients?
Based on re-screening practices in Hong Kong and advices of US Centers for Disease Control and Prevention, G-NiiB recommends a follow-up test every year
Can I take the test if I have been on antibiotics?
Can I take the test if I have been on antibiotics?
We recommend a wait of at least one month after any short-term antibiotic use before testing.

Again, this is because it is best to sample at a time that reflects your “normal” gut microbiome
Can I take the test when I am sick or suffer from long-term health conditions?
Can I take the test when I am sick or suffer from long-term health conditions?
Yes, anyone can take our test. Our method of examining your gut bacteria is non-invasive and the initial test can be completed at your home. If you have a medical condition, please consult with a medical professional before making any changes to your diet or lifestyle.

Will medicines interfere with my results?
Will medicines interfere with my results?
Yes. Some medications can change your gut microbiome. However, it is not necessary to stop with long-term medications before taking the test, if these medications are part of your normal diet.

If in doubt, consult our customer support.
References
  • C Allemani, T Matsuda, V Di Carlo, R Harewood, M Matz, M Niksic, A Bonaventure, M Valkov, CJ Johnson, J Esteve, OJ Ogunbiyi, ESG Azevedo, WQ Chen, S Eser, G Engholm, CA Stiller, A Monnereau, RR Woods, O Visser, GH Lim, J Aitken, HK Weir, MP Coleman, and CW Group, Global surveillance of trends in cancer survival 2000 14 (CONCORD 3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population based registries in 71 countries. Lancet, 2018 .39 110125 ): p. 1023 1075

  • JJ Sung, SC Ng, FK Chan, HM Chiu, HS Kim, T Matsuda, SS Ng, JY Lau, S Zheng, S Adler, N Reddy, KG Yeoh, KK Tsoi, JY Ching, EJ Kuipers, L Rabeneck, GP Young, RJ Steele, D Lieberman, KL Goh, and G Asia Pacific Working, An updated Asia Pacific Consensus Recommendations on colorectal cancer screening. Gut, 2015. 64(1): p. 121-32.

  • Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2020 and the ACS website (January 2020).

  • SH Wong and J Yu, Gut microbiota in colorectal cancer: mechanisms of action and clinical applications. Nat Rev Gastroenterol Hepatol, 2019. 16(11): p. 690-704.

  • SH Wong, L Zhao, X Zhang, G Nakatsu, J Han, W Xu, X Xiao, TNY Kwong, H Tsoi, WKK Wu, B Zeng, FKL Chan, JJY Sung, H Wei, and J Yu, Gavage of Fecal Samples From Patients With Colorectal Cancer Promotes Intestinal Carcinogenesis in Germ-Free and Conventional Mice. Gastroenterology, 2017. 153(6): p. 1621-1633 e6.

  • G Nakatsu, X Li, H Zhou, J Sheng, SH Wong, WK Wu, SC Ng, H Tsoi, Y Dong, N Zhang, Y He, Q Kang, L Cao, K Wang, J Zhang, Q Liang, J Yu, and JJ Sung, Gut mucosal microbiome across stages of colorectal carcinogenesis. Nat Commun, 2015. 6: p.8727.

  • Z Dai, OO Coker, G Nakatsu, WKK Wu, L Zhao, Z Chen, FKL Chan, K Kristiansen, JJY Sung, SH Wong, and J Yu, Multi-cohort analysis of colorectal cancer metagenome identified altered bacteria across populations and universal bacterial markers. Microbiome, 2018. 6(1): p. 70.

  • J Yu, Q Feng, SH Wong, D Zhang, QY Liang, Y Qin, L Tang, H Zhao, J Stenvang, Y Li, X Wang, X Xu, N Chen, WK Wu, J Al-Aama, HJ Nielsen, P Kiilerich, BA Jensen, TO Yau, Z Lan, H Jia, J Li, L Xiao, TY Lam, SC Ng, AS Cheng, VW Wong, FK Chan, X Xu, H Yang, L Madsen, C Datz, H Tilg, J Wang, N Brunner, K Kristiansen, M Arumugam, JJ Sung, andJ Wang, Metagenomic analysis of faecal microbiome as a tool towards targeted noninvasive biomarkers for colorectal cancer. Gut, 2017. 66(1): p. 70-78.

  • Q Liang, J Chiu, Y Chen, Y Huang, A Higashimori, J Fang, H Brim, H Ashktorab, SC Ng, SSM Ng, S Zheng, FKL Chan, JJY Sung, and J Yu, Fecal Bacteria Act as Novel Biomarkers for Noninvasive Diagnosis of Colorectal Cancer. Clin Cancer Res, 2017. 23(8):p. 2061-2070.

  • JQ Liang, T Li, G Nakatsu, YX Chen, TO Yau, E Chu, S Wong, CH Szeto, SC Ng, FKL Chan, JY Fang, JJY Sung, and J Yu, A novel faecal Lachnoclostridium marker for the noninvasive diagnosis of colorectal adenoma and cancer. Gut, 2019.

  • TF Imperiale, DF Ransohoff, SH Itzkowitz, TR Levin, P Lavin, GP Lidgard, DA Ahlquist, and BM Berger. Multitarget Stool DNA Testing for Colorectal-Cancer Screening. The New England Journal of Medicine, 2014.

Disclaimer

G-NiiB® CRCcore is not a diagnostic test. The test result should be interpreted with caution. Precise screening interval for this follow-up has not been established. This information in this leaflet is only for reference. This leaflet is not intended to serve as a substitute for professional medical help or advice. If you have any question regarding the above information, always seek advice from your doctor.