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Sir, We read with great interest the article by Haug et al (2008) and would like to complement them for such interesting clinical work. Their study further supports the previous smaller studies in patients with more-than-average risk of harbouring colorectal cancer (CRC) (Shastri et al, 2006, 2008), in which the suboptimal performances of faecal pyruvate kinase M2 (M2-PK) for detecting the precursors for CRC (the colorectal adenomas) have already been demonstrated. However, we have certain comments to make about this study:  We agree with the authors of the study (Haug et al, 2008) that faecal M2-PK has poor test characteristics (especially low sensitivity and specificity) in distinguishing between patients having colorectal adenomas or no clinical findings at colonoscopy. This has also been reported in a previous prospective study (Mulder et al, 2007). This knowledge further consolidates the case for not recommending faecal M2-PK as a biomarker for CRC screening, as detecting and removing the precursors of CRC is one of the major aims of any CRC screening modality.

Faecal tumour pyruvate kinase M2: not a good marker for the detection of colorectal adenomas