Adherence
Studies have indicated that adherence with multi-target stool DNA (mt-sDNA) testing is high,1,2,7 even among previously non-adherenta patients.2 Up to 40% of patients using mt-sDNA have reported screening for the first time, and nearly 1 in 4 of these appear to be overdue to initiate screening by 10 years or more.3 Studies also suggest that adherence with a follow-up colonoscopy is high after a positive mt-sDNA result,3,4 and significantly higher than in those screened with fecal immunochemical (FIT) or guaiac fecal occult blood tests (FOBT).4 Modeling has suggested that at adherence rates of 65-70% or higher for mt-sDNA, deaths averted would be equal to or exceed those of colonoscopy.5
One-year adherence to mt-sDNA screening was 71.1-88.3% in studied populations (Medicare, one population previously non-adherent)1,2
96.1% of patients with a positive mt-sDNA result were adherent with follow-up colonoscopy (Medicare, previously non-adherent)2
84.9% of patients with a positive mt-sDNA result vs 42.6% of those with a positive FIT/FOBT result adhered to a follow-up colonoscopy within 6 months (average risk population)4
ADHERENCE TO mt-sDNA SCREENING IN A NATIONAL SAMPLE OF MEDICARE PATIENTS (N=368,494)1,b
- Nearly three-quarters of the Medicare cohort beneficiaries adhered with an mt-sDNA order for CRC screening1
- Cross-sectional adherence rates were similar across patient age group, Medicare coverage type, and patient gender1
- Cumulative adherence rates increased more rapidly at 30 and 60 days, followed by more gradual increases at 90, and 180 days1
FOLLOW UP COLONOSCOPY RATES AFTER A POSITIVE STOOL TEST4,c
| Positive result n (%) |
6-month follow-up colonoscopy rate |
|
| mt-sDNA | 322 (12.2%) | 84.9% |
| FIT/FOBT | 53 (18.7%) | 42.6% |
| P-value for 6mo follow-up |
0.0002 | |
In this study of 5818 adults ages 50-75, adherence with a follow-up colonoscopy within 6 months after a positive mt-sDNA (84.9% ) was significantly higher compared with those with a positive FIT/FOBT (42.6%)4
CASE STUDY OF ADHERENCE WITH mt-sDNA SCREENING AND FOLLOW-UP DIAGNOSTIC COLONOSCOPY IN A LOCALIZED SAMPLE OF AVERAGE RISK, PREVIOUSLY NON-ADHERENTa MEDICARE PATIENTS (N=393)2,d
- 88.3% of previously non-adherenta patients were compliant with mt-sDNA over 12 months2
- 96.1% of patients with a positive mt-sDNA result were adherent with follow-up colonoscopy2
- mt-sDNA had a PPV of 51.0% for any advanced colorectal neoplasiae and 81.6% for any colorectal neoplasia2
TOP REASONS FOR LACK OF FOLLOW-UP POST-POSITIVE FIT OR mt-sDNA6,f
|
FIT (n=164) n (%) |
mt-sDNA (n=92) n (%) |
|
| System Barriers: | ||
|
48 (29.3) | 11 (12.0) |
|
5 (3.0) | 17 (18.5) |
| Provider level Barriers: | ||
|
3 (1.8) | 0 (0.0) |
|
0 (0.0) | 7 (7.6) |
|
39 (23.8) | 1 (1.1) |
|
24 (14.6) | 1 (1.1) |
|
8 (4.9) | 11 (12.0) |
| Patient Level Barriers: | ||
|
8 (4.9) | 8 (8.7) |
|
4 (2.5) | 15 (16.3) |
|
42 (25.6) | 26 (28.3) |
- Even when screening occurs, there are further barriers to appropriate follow-up6
- Only 46.7% of FIT positive and 71.5% of mt-sDNA positive patients underwent a follow-up colonoscopy within six months of a positive result6
- After a positive screening test, barriers to follow-up care were reported on the patient, provider, and system levels6
Learn more about the full Indications/Contraindications for the mt-sDNA test.
Please see complete prescribing information for Cologuard in the Cologuard Clinician Brochure
References
1 Weiser E, Parks PD, Swartz RK, et al. Cross-sectional adherence with the multi-target stool DNA test for colorectal cancer screening: real-world data from a large cohort of older adults. J Med Screen. 2021;28(1):18-24.
2 Prince M, Lester L, Chiniwala R, Berger B. Multitarget stool DNA tests increases colorectal cancer screening among previously noncompliant Medicare patients. World J Gastroenterol. 2017;23(3):464-471.
3 Eckmann JD, Ebner DW, Bering J, et al. Multitarget stool DNA screening in clinical practice: High positive predictive value for colorectal neoplasia regardless of exposure to previous colonoscopy. Am J Gastroenterol. 2020;115(4):608-615.
4 Finney Rutten LJ, Jacobson DJ, Jenkins GD, et al. Colorectal cancer screening completion: An examination of differences by screening modality. Prev Med Rep. 2020 Sep 11;20:101202.
5 D’Andrea E, Ahnen DJ, Sussman DA, Najafzadeh M. Quantifying the impact of adherence to screening strategies on colorectal cancer incidence and mortality. Cancer Med. 2020;9(2):824-836.
6 Cooper GS, Grimes A, Werner J, et al. Barriers to follow-up colonoscopy after positive FIT or multitarget stool DNA testing. J Am Board Fam Med. 2021;34(1):61-69.
7 Miller-Wilson LA, Finney Rutten LJ, Van Thomme J, Ozbay, AB, Limburg PJ. Cross‑sectional adherence with the multi‑target stool DNA test for colorectal cancer screening in a large, nationally insured cohort. Int J of Colorectal Dis. 2021;s00384-021-03956-0.
Footnotes
a Non-adherence with CRC screening recommendations was defined as >10 years since last colonoscopy and/or >1 year since last FOBT
b Retrospective study of aggregate laboratory data as part of ongoing laboratory quality management processes and in compliance with the HIPAA. N=368,494. Age=65-85.
c Population-based, retrospective study using the Rochester Epidemiology Project research medical records data linkage infrastructure. N=5,818. Age=50-75.
d A retrospective, cross-sectional electronic health record- based review of records based in a primary care office was conducted from October 2014 until September 2015. 393 subjects were recruited. Age=50-85.
e Advanced adenoma: colorectal adenoma or sessile serrated adenoma/polyp ≥1.0 cm in diameter, or adenoma with high-grade dysplasia or ≥25% villous component, of any size
f Retrospective ambulatory EMR-based cohort study (n=631) in a large health care system in the Midwest evaluated the frequency of follow-up colonoscopy post-positive mt-sDNA or FIT and identified reasons for lack of colonoscopy follow-up (Jan 2016 – Jun 2018).
Last updated: 04/22/2023