Surreal illustration of a path to colon health guided by a blood drop.

Nu.Q™ Triage Test: A Smarter Approach to Colorectal Cancer Screening

Rhea Morgan monogram
Rhea Morgan in Health & Wellness October 2026 • 4 min read.

"Reduce unnecessary colonoscopies and improve early detection with this innovative blood test."


Colorectal cancer (CRC) screening is crucial for early detection and improved outcomes. However, widespread adoption of stool-based CRC screening programs is straining colonoscopy resources. Many individuals who test positive through initial screening methods may not actually have advanced adenomas or cancer, leading to unnecessary colonoscopies.

To address this challenge, researchers have developed the Nu.Q™ Colorectal Cancer Screening Triage Test, a blood test designed to refine the screening process. The goal? To reduce the number of unnecessary colonoscopies performed on individuals who are at low risk of screen-relevant neoplasia (no findings or low-risk adenomas) while maintaining high sensitivity for detecting CRC.

This article will delve into the details of the Nu.Q™ Triage Test, exploring its methodology, performance results, and potential impact on colorectal cancer screening programs. We'll examine how this innovative test can help optimize resource allocation, improve patient experience, and enhance the overall effectiveness of CRC screening.

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How Screening Methods Are Received

A systematic review by Omar Ali examined the acceptability of alternative colorectal cancer screening technologies compared with faecal immunochemical testing (FIT) and/or colonoscopy. The listed source identifies those established methods as the comparators, but its supplied information does not report which alternatives were more acceptable or quantify the limitations of FIT or colonoscopy.

From Polyp Detection to Organized Screening

The history of colorectal cancer (CRC) screening traces back to observations at a London hospital and an internist’s office in Ohio: CRC can arise from a premalignant polyp, and detecting cancer at an earlier stage is associated with better outcomes. Most CRCs follow a normal-mucosa-to-polyp-to-cancer sequence, making polyps and cancers detectable by endoscopy and creating an opportunity for early detection and prevention. Organized screening also developed at a national level: the Czech Republic’s National CRC Screening Program had been running for more than 13 years when the 2014 review was published.

How Does the Nu.Q™ Triage Test Work?

Surreal illustration of a path to colon health guided by a blood drop.

The Nu.Q™ Triage Test analyzes circulating nucleosomes in the blood. These nucleosomes contain methylated DNA, which can be indicative of cancerous or precancerous conditions. The test uses a proprietary algorithm to assess the risk of an individual having screen-relevant neoplasia.

In a study of 1961 FIT positive individuals, researchers applied the Nu.Q™ Triage Test and compared its recommendations (colonoscopy or no colonoscopy) to actual colonoscopy findings. This allowed them to evaluate the test's accuracy in identifying low-risk individuals who could safely avoid colonoscopy.

  • The Nu.Q™ Triage test is designed to reduce un-necessary colonoscopies by ≥ 20% whilst maintaining sensitivity for CRC ≥ 90%.
  • The study utilized blinded serum samples from 1961 FIT positive individuals (>200ng/mL).
  • Circulating nucleosomes containing methylated DNA are normalized using Nu.Q™ immunoassays.
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Research Focuses on FIT Sensitivity and Triage

The Nature subject page notes that early CRC detection significantly improves clinical outcomes, while the widely used faecal immunochemical test (FIT) has suboptimal sensitivity. The supplied description of the Nu.Q™ Colorectal Cancer Screening Triage Test presents it as a blood test intended to refine screening by reducing unnecessary colonoscopies among people at low risk of screen-relevant neoplasia, including those with no findings or low-risk adenomas, while maintaining high sensitivity for CRC. The listed material does not provide performance figures for this proposed approach.

Potential Effect of Blood-Based Screening

A 2024 study titled “Effectiveness and Cost-Effectiveness of Colorectal Cancer” reports that a blood-based colorectal cancer screening test may increase screening participation. The supplied source description does not identify the test or provide comparative participation, effectiveness, or cost-effectiveness figures, so it supports only this potential effect.

The results from the study demonstrated the potential of the Nu.Q™ Triage Test to significantly reduce the number of unnecessary colonoscopies. In the training set, the test identified a low-risk subset of 477 individuals (25%) for whom colonoscopy could be avoided while still detecting a high percentage of CRCs and High-Risk Adenomas (HRA). A potential reduction of 28.6% in colonoscopies was achieved in the validation set. The study also established high intra laboratory reproducibility.

The Future of Colorectal Cancer Screening

The Nu.Q™ Triage Test represents a promising step forward in colorectal cancer screening. By refining the selection process for colonoscopy, this test can help alleviate the strain on healthcare resources, reduce patient burden, and potentially improve overall screening effectiveness.

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Accuracy Benchmarks and Nu.Q’s Intended Role

A 2026 meta-analysis of FIT and colonoscopy for CRC screening reports colonoscopy sensitivity of approximately 97%, specificity of approximately 100%, and a receiver operating characteristic value of 0.99, supporting its role as the reference standard. Separately, a report on the CE-marked Nu.Q™ Colorectal Cancer Screening Test describes a design goal of reducing unnecessary colonoscopies by at least 20% while maintaining CRC sensitivity of at least 90%, and says it reports triage-test performance by disease stage and adenoma risk category, as well as intra-laboratory reproducibility. These figures describe different tests and purposes; the supplied material does not establish a direct head-to-head comparison.

Triage and the Colonoscopy Referral Pathway

A Volition announcement dated September 6, 2016 described a pathway in which patients with a positive FIT could receive the blood-based Nu.Q Triage test, with colonoscopy referral depending on the combined test results; it said this could potentially reduce referrals by 25%. In February 2017, VolitionRx reported that results presented at the World Congress of GI Endoscopy (ENDO 2017) in Hyderabad, India, from a prospective trial confirmed prior results showing fewer total colonoscopy referrals while maintaining high sensitivity for cancer detection. A separate 2026 study describes evaluating the effectiveness and patient experience of a nurse-led telephone triage service for access to second-level CRC screening, but the supplied description gives no outcome findings.

While further research and real-world implementation studies are needed, the initial results suggest that the Nu.Q™ Triage Test could play a significant role in optimizing colorectal cancer screening strategies. Combining a single, age-adjusted NuQ® blood score with FIT score could improve performance relative to an increased FIT threshold.

As screening programs continue to evolve, innovative approaches like the Nu.Q™ Triage Test will be essential for ensuring that resources are used efficiently and that individuals at the highest risk of colorectal cancer are identified and treated promptly. Screening throughput and overall detection of screen relevant neoplasia could therefore be increased where colonoscopy capacity is a limiting factor.

Blood-marker results beside FIT benchmarks

  • 0.74; 0.23; approximately 0.95A systematic review reported pooled FIT sensitivity of 0.74 for CRC and 0.23 for advanced adenoma, with specificity of about 0.95 for both.[1]
  • 0.79; 0.94; 95%Another FIT meta-analysis estimated CRC sensitivity at 0.79 and specificity at 0.94; its overall diagnostic accuracy estimate was 95%.[2]

How blood testing fits alongside FIT and care pathways

FIT was introduced for low-risk symptom triage in primary care, with evidence also growing for its use in high-risk symptoms meeting NICE criteria. A blood triage test is framed as a possible additional way for GPs to manage presenting patients when endoscopy resources are limited, including amid rising early-onset CRC.[3]

A review describes methylated Septin 9 testing as approved for screening in some regions for people who decline other methods. It notes that its lower discriminatory performance than other screening methods might be offset by greater willingness to have blood drawn than to use stool testing or colonoscopy.[1]

A separate blood-test evaluation met its specified acceptance criteria for CRC sensitivity and advanced-neoplasia specificity, but reported low sensitivity for advanced precancerous lesions. Manufacturer sponsorship and limited laboratory-analysis detail constrain how fully those results can be assessed.[4]

Survey respondents identified convenience, time saved, comfort, and familiarity as influences on screening participation. These preferences may help explain why a blood-based option could matter to participation, but they do not establish that this particular triage test changes uptake.[5]

What evidence would clarify Nu.QTM triage

  • Would a blood-marker triage strategy retain its performance when tested prospectively in screening settings, rather than in observational or other settings? Such directly relevant validation is important for moving biomarkers toward clinical implementation.[1]
  • Would a blood test change participation in an actual screening program, and would any change reflect convenience or comfort rather than familiarity with existing options? The reported survey preferences do not answer that outcome question.[5]
FIT
Faecal immunochemical testing[3]

Sources

  1. Risk-Predictive and Diagnostic Biomarkers for Colorectal Cancer; a Systematic Review of Studies Using Pre-Diagnostic Blood Samples Collected in Prospective Cohorts and Screening Settings (pmc.ncbi.nlm.nih.gov)
  2. Accuracy of fecal immunochemical tests for colorectal cancer: systematic review and meta-analysis. (pubmed.ncbi.nlm.nih.gov)
  3. A novel blood based triage test for colorectal cancer in primary care: a pilot study (pmc.ncbi.nlm.nih.gov)
  4. Diagnostic performance of a circulating tumor DNA‐based blood test compared to fecal immunochemical test in colorectal cancer screening (pmc.ncbi.nlm.nih.gov)
  5. "Rescue" of Nonparticipants in Colorectal Cancer Screening: A Randomized Controlled Trial of Three Noninvasive Test Options. (pubmed.ncbi.nlm.nih.gov)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

Everything You Need To Know

1

What is the Nu.Q™ Triage Test, and how does it work?

The Nu.Q™ Triage Test is a blood test designed to refine the process of colorectal cancer (CRC) screening. It works by analyzing circulating nucleosomes in the blood, which contain methylated DNA that can indicate cancerous or precancerous conditions. The test then uses a proprietary algorithm to assess an individual's risk of screen-relevant neoplasia, helping to identify those who may not need an immediate colonoscopy.

2

Why is the Nu.Q™ Triage Test important for colorectal cancer screening?

The significance of the Nu.Q™ Triage Test lies in its ability to reduce unnecessary colonoscopies while maintaining high accuracy in detecting colorectal cancer. Widespread adoption of stool-based screening programs has strained colonoscopy resources. Many individuals testing positive via initial screening do not have advanced adenomas or cancer. This test addresses that by refining the screening process, optimizing resource allocation, improving patient experience, and enhancing the overall effectiveness of CRC screening.

3

How does the Nu.Q™ Triage Test analyze blood samples?

The Nu.Q™ Triage Test analyzes circulating nucleosomes in the blood. These nucleosomes contain methylated DNA, which may indicate cancerous or precancerous conditions. The test employs a proprietary algorithm to assess an individual's risk of having screen-relevant neoplasia. The study examined the Nu.Q™ Triage Test with FIT positive individuals, comparing its recommendations (colonoscopy or no colonoscopy) to actual colonoscopy findings. The Nu.Q™ Triage test aims to reduce unnecessary colonoscopies by ≥ 20% while maintaining sensitivity for CRC ≥ 90%.

4

What were the key findings of the study on the Nu.Q™ Triage Test?

The study results demonstrated the potential of the Nu.Q™ Triage Test to significantly reduce unnecessary colonoscopies. It identified a low-risk subset of individuals for whom colonoscopy could be avoided while still detecting a high percentage of CRCs and High-Risk Adenomas (HRA). The test achieved a potential reduction in colonoscopies in the validation set. It also established high intra-laboratory reproducibility.

5

What are the potential implications of using the Nu.Q™ Triage Test for patients and healthcare systems?

The implications of the Nu.Q™ Triage Test are far-reaching. By refining the selection process for colonoscopy, this test can alleviate the strain on healthcare resources. This could lead to reduced waiting times for those who genuinely need colonoscopies. Furthermore, it reduces patient burden by avoiding unnecessary procedures, improving the overall screening experience. This approach contributes to more effective CRC screening, ultimately leading to better patient outcomes.

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