Strategies to boost CRC screening rates and adherence

Address your system's colorectal cancer (CRC) screening gap with the Cologuard® test which has shown increased screening and greater repeat screening adherence.1,2
A healthcare provider reviewing a document with 6 health system leaders around a table.
The Cologuard test increased CRC screening completion by 88.3% over 12 months1
In a cohort of 393 Medicare patients aged 50-85 years who had not completed the recommended CRC screening.1
Prince study design
Multitarget stool DNA tests increases colorectal cancer screening among previously noncompliant Medicare patients1
Prince M, Lester L, Chiniwala R, Berger B. World J Gastroenterol. 2017;23(3):464-471
Study objective
To assess Cologuard test utilization among noncompliant average-risk Medicare patients.
Study design

Researchers conducted a cross-sectional study to examine the use of multitarget stool DNA (mt-sDNA) testing in routine clinical practice among Medicare patients ages 50–85 who were not up-to-date on CRC screening. The study was conducted at USMD Physician Services in Dallas, TX from October 2014 to September 2015.

The researchers reviewed electronic health records to identify mt-sDNA use in patients who had not had a colonoscopy or fecal occult blood test in >10 years and/or >1 year, respectively. Patients who tested positive were advised to have a diagnostic colonoscopy. The most clinically significant lesion was documented on histopathology of biopsies or excisional tissue. Descriptive statistics were used to analyze the data.

Study limitations
This was a relatively small study size from a single health center; findings may not be generalizable to patients not on Medicare or to patients outside of this particular geographic area (Dallas, TX). No formal hypothesis testing was done, therefore unable to determine causality.

References and footnotes

  1. Prince M, Lester L, Chiniwala R, Berger B. Multitarget stool DNA tests increases colorectal cancer screening among previously nonadherent Medicare patients. World J Gastroenterol. 2017;23(3):464-471.
The Cologuard test led to better follow-up rate vs FIT3,4*
Nearly 2 times higher screening rates for follow-up colonoscopy within 6 months of the Cologuard test screening compared with the fecal immunochemical test (FIT)* (85% vs 43%, respectively)4
Finney Rutten study design
Colorectal cancer screening completion: an examination of differences by screening modality1
Finney Rutten LJ, Jacobson DJ, Jenkins GD, et al. Prev Med Rep. 2020;20:101202.
Study objective
To investigate recent population-based patterns in overall and test-specific CRC screening participation in adults ages 50-75 years utilizing comprehensive data resources from the Rochester Epidemiology Project (REP).
Study design

Researchers used the REP research infrastructure to assess CRC screening incidence rates among adults due for screening, ages 50-75 years, living in Olmsted County, Minnesota. Researchers identified 5818 patients who completed CRC screening between January 1, 2016, through December 31, 2018, among an average of 17,604 residents who were due for average-risk CRC screening per year identified in three annual cohorts.

Within the eligible study population, researchers then used the diagnostic indices of the REP to identify completion of CRC screening by the following screening modalities: multitarget stool DNA (mt-sDNA), screening colonoscopy (original indication), computed tomography (CT) colonography, flexible sigmoidoscopy, and fecal occult blood test (FOBT) or FIT.

Study limitations
The authors list a number of limitations to this study, including their use of ICD codes to capture the true incidence of CRC screening rates, wherein patients received screening outside of the participating organizations and/or where coding errors were made in patient records is a limitation of our approach. Another limitation was that the rates reported from the study’s analyses do not represent the screening rates for the entire population since they are focused only on those of average risk during a relatively short time-period (since the mt-sDNA test was not widely available until 2016). The authors pointed out that the small number of positive FIT/FOBT (n=53) may have resulted in an inability to detect significant associations when assessing rate and time to follow-up colonoscopy. Additionally, the authors note that approximately 4% of the population each year was excluded because they did not authorize their medical records to be used for research; therefore, the study authors were not able to examine the impact that insurance status may have on utilization of CRC tests, which vary widely in terms of cost. A related limitation is a lack of data showing socioeconomic status for the study cohorts; choice of screening test may be influenced by cost, particularly among those without health insurance. Another limitation is the limited demographic diversity of the population since the participants for this study originated from Olmsted County, Minnesota, which is less racially diverse, has higher education, and higher incomes than the overall US population.

References and footnotes

  1. Finney Rutten LJ, Jacobson DJ, Jenkins GD, et al. Colorectal cancer screening completion: an examination of differences by screening modality. Prev Med Rep. 2020;20:101202.
The Cologuard test led to faster colonoscopy follow-up vs FIT3*
for patients initially screened with the Cologuard test compared with FIT* (86 vs 127 days on average, respectively)3
Austin study design
Patterns of initial colorectal cancer screenings after turning 50 years old and follow-up rates of colonoscopy after positive stool-based testing among the average-risk population1
Austin G, Kowalkowski H, Guo Y, et al. Curr Med Res Opin. 2023;39(1):47-61.
Study objective
To examine initial screening rates after turning 50 years old; and to assess rates of follow-up colonoscopy after a positive stool-based test.
Study design

Researchers used de-identified administrative claims data from January 1, 2006, to June 30, 2020, for commercially insured and Medicare Advantage enrollees. To examine initial screening rates, the index year was the year enrollees turned 50. Rates of CRC screening during and after the index year were captured.

To assess rates of follow-up colonoscopy, the index date was the claim date of a FIT or multitarget stool DNA test (mt-sDNA) where linked lab data indicated a positive test result. Rates and time to follow-up colonoscopy after a positive stool-based test were assessed.  

Study limitations
One of the limitations of the study was related to using administrative claims data. The authors noted that the limitation involved the data collected in that the age of the enrollees was calculated as of January 1st of the year, since in the de-identified data, only a member’s birth year was made available; enrollees who were becoming age 50 at the beginning of the year versus towards the end of the year may exhibit different patterns. Another limitation was that FIT utilization may be underestimated as some FIT tests available through various programs may not generate a claim; the authors pointed out that is also important to note that only 15% of FIT test results were available for this study, and data from enrollees with a positive and available FIT test result may not be generalizable to the entire population of enrollees who receive a FIT positive test.

References and footnotes

  1. Austin G, Kowalkowski H, Guo Y, et al. Pattern of initial colorectal cancer screening after turning 50 years old and follow-up rates of colonoscopy after positive stool-based testing among the average-risk population. Curr Med Opin. 2023;39(1):47-61.
Help increase CRC adherence support with a Cologuard test
Internal data showed 4 out of 5 eligible patients were adherent after becoming eligible for Cologuard test rescreening.2†
The Cologuard® test box sitting at the edge of a bathroom sink.
Learn how incorporating the Cologuard test may increase your system's screening rates
Health system experiences with the Cologuard test
Discover how your electronic health record (EHR) can enable optimized workflows

References and footnotes

  1. 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.
  2. Data on file. Exact Sciences Corporation. Madison, WI.
  3. Austin G, Kowalkowski H, Guo Y, et al. Pattern of initial colorectal cancer screening after turning 50 years old and follow-up rates of colonoscopy after positive stool-based testing among the average-risk population. Curr Med Opin. 2023;39(1):47-61.
  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;20:101202.
  5. OC FIT-CHEK, Polymedco, Inc.
  6. Based on patients who completed screening within 90 days of receiving Cologuard test kits for their second CRC screening from October 2020 to December 2021.2

Indications and Important Risk Information

The Cologuard® test is intended for the qualitative detection of colorectal neoplasia associated DNA markers and for the presence of occult hemoglobin in human stool. A positive result may indicate the presence of colorectal cancer (CRC) or advanced adenoma (AA) and should be followed by colonoscopy. The Cologuard test is indicated to screen adults of either sex, 45 years or older, who are at typical average risk for CRC. The Cologuard test is not a replacement for diagnostic colonoscopy or surveillance colonoscopy in high-risk individuals.

The Cologuard test is not for high-risk individuals, including patients with a personal history of colorectal cancer and adenomas; have had a positive result from another colorectal cancer screening method within the last 6 months; have been diagnosed with a condition associated with high risk for colorectal cancer such as IBD, chronic ulcerative colitis, Crohn’s disease; or have a family history of colorectal cancer, or certain hereditary syndromes.

Positive Cologuard results should be referred to colonoscopy. A negative Cologuard test result does not guarantee absence of cancer or advanced adenoma. Following a negative result, patients should continue participating in a screening program at an interval and with a method appropriate for the individual patient.

False positives and false negatives do occur. In a clinical study, 13% of patients without colorectal cancer or advanced adenomas received a positive result (false positive) and 8% of patients with cancer received a negative result (false negative). The clinical validation study was conducted in patients 50 years of age and older. Cologuard test performance in patients ages 45 to 49 years was estimated by sub-group analysis of near-age groups.

Cologuard test performance when used for repeat testing has not been evaluated or established. Rx only