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Colorectal cancer (CRC) is the second most common cause of cancer death in the western world. An effective screening program leading to early detection of disease would severely reduce the mortality of CRC. Alterations in the gut microbiota have been linked to CRC, but the potential of microbial markers for use in CRC screening has been largely unstudied. We used a nested case–control study of 238 study subjects to explore the use of microbial markers for  clbA+  bacteria harboring the  pks  pathogenicity island,  afa‐C+  diffusely adherent  Escherichia coli  harboring the  afa‐1  operon, and  Fusobacterium nucleatum  in stool as potential screening markers for CRC. We found that individual markers for  clbA+  bacteria and  F. nucleatum  were more abundant in stool of patients with CRC, and could predict cancer with a relatively high specificity (81.5% and 76.9%, respectively) and with a sensitivity of 56.4% and 69.2%, respectively. In a combined test of  clbA+  bacteria and  F. nucleatum , CRC was detected with a specificity of 63.1% and a sensitivity of 84.6%. Our findings support a potential value of microbial factors in stool as putative noninvasive biomarkers for CRC detection. We propose that microbial markers may represent an important future screening strategy for CRC, selecting patients with a “high‐risk” microbial pattern to other further diagnostic procedures such as colonoscopy.

Cancer‐associated fecal microbial markers in colorectal cancer detection