# Multitarget stool RNA test (ColoSense)

Source: https://onco.cc/technologies/multitarget-stool-rna-test/  
OnCo record `multitarget-stool-rna-test` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A home stool test that reads RNA from cells shed by the bowel lining together with a haemoglobin test; approved in the United States in 2024 as an alternative to stool DNA tests for average-risk screening from age 45.

## Summary

What it measures. Like the stool DNA test Cologuard, ColoSense combines a faecal immunochemical test for blood with molecular markers, but the molecular markers are eight messenger RNAs shed by colonic cells rather than DNA methylation and mutation markers. The rationale is that RNA levels change early in adenoma to cancer progression and are less affected by age-related methylation drift, which raises false positives in older people on DNA tests. The result is a single positive or negative call; a positive result leads to colonoscopy.

Evidence and regulatory status. In the CRC-PREVENT study of more than eight thousand average-risk adults, sensitivity for colorectal cancer was in the mid nineties per cent, sensitivity for advanced adenomas around 45 per cent, and specificity in the high eighties, in the same range as the multitarget stool DNA test. The FDA approved ColoSense in May 2024 for adults aged 45 and over at average risk. Its place in guidelines and its coverage in national programmes are still being settled; outside the United States it is not offered.

Who should have it and what changes. Anyone at average risk who is due for screening and will not have a colonoscopy has a choice between an annual faecal immunochemical test, a stool DNA or RNA test every three years, a blood test, or CT colonography. A positive stool RNA result should be followed by colonoscopy; a negative result means repeat in three years. The test costs several hundred dollars, more than a faecal immunochemical test, so its value depends on whether the extra sensitivity for cancer is worth the extra colonoscopies from false positives.

## Fields

- Kind: Technology
- Status: approved
- Last checked: 2026-09-17
- Also known as: ColoSense; mt-sRNA; stool RNA test; Geneoscopy test
- Principle: Stool RNA extraction and quantification of eight transcripts plus a faecal immunochemical test for haemoglobin, combined by an algorithm into a positive or negative screening result.
- Since: 2024
- Strengths: Home collection with no bowel preparation; Cancer sensitivity comparable with stool DNA testing; FDA approved for average-risk screening from age 45
- Limitations: Detects fewer than half of advanced adenomas; More false positives and higher cost than a faecal immunochemical test; United States only so far

## Sources

- Geneoscopy: ColoSense: https://www.geneoscopy.com

## Connected records

- ideas: [Personalised stool-test cut-offs by age, sex and prior results](https://onco.cc/ideas/idea-prev-fit-risk-adapted-thresholds/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/)
- fronts: [Diagnostics & Biomarkers](https://onco.cc/fronts/diagnostics/), [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- technologies: [Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)](https://onco.cc/technologies/colorectal-screening/), [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [Multi-cancer early detection (MCED)](https://onco.cc/technologies/mced/), [RNA sequencing & expression profiling](https://onco.cc/technologies/rna-seq/)
- drugs: [Cologuard](https://onco.cc/drugs/cologuard/), [Cologuard Plus](https://onco.cc/drugs/cologuard-plus/), [Shield](https://onco.cc/drugs/shield/)
- companies: [Exact Sciences (Abbott)](https://onco.cc/companies/exact-sciences/), [Geneoscopy](https://onco.cc/companies/geneoscopy/), [Guardant Health](https://onco.cc/companies/guardant-health/)
- terms: [Faecal immunochemical test (FIT)](https://onco.cc/terms/fit-test/), [Positive predictive value (PPV)](https://onco.cc/terms/ppv/), [Screening](https://onco.cc/terms/screening/)
- trials: [ECLIPSE (Shield blood test)](https://onco.cc/trials/eclipse-shield/)

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