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.
71% of eligible patients adhered to screening when offered the Cologuard test1
In a study to examine adherence to multi-target stool DNA testing for colorectal cancer screening in the United States.1
Le study design

Adherence to multi-target stool DNA testing for colorectal cancer screening in the United States1

Le QA, Greene M, Gohil S, et al.
Study objective
To examine the adherence rate to mt-sDNA testing among new users across different health payors and subgroups and to explore the sociodemographic factors associated with patient adherence to mt-sDNA screening. The primary outcome of interest for this study was adherence to the mt-sDNA test, defined as the percentage of eligible participants successfully returning a valid non-empty test kit within 365 days of initial shipment date.
Study design

Aggregated laboratory data from Exact Sciences Laboratories LLC (ESL) was analyzed retrospectively. The study cohort included individuals aged 45 to 85, covered by commercial insurance, Medicare, or Medicaid, who received the mt-sDNA test kit via a point-of-care order for the first time from ESL between January 1, 2023, and June 1, 2023. Individuals were excluded if they were not first-time users of mt-sDNA testing, were not covered by Medicare, Medicare advantage, or Medicaid, were aged younger than 45 or older than 85, had orders that were not point-of-care, had canceled orders other than those that expired, or had major missing information on important patient characteristics. 1,557,915 patients met the study criteria. Baseline characteristics, overall and by payor type, were summarized via descriptive statistics.

Study limitations
The authors noted several limitations to this study. Data on race, ethnicity, and preferred language were minimal which hindered a comprehensive analysis of racial and ethnic disparities in adherence rates. Analysis was restricted to only those patient and provider variables that were available within the existing laboratory data at the time and because risk status for mt-sDNA testing was based on providers’ clinical evaluations, off-label test usage cannot be ruled out. The relatively short timeframe of the studies focus may not have captured variations in adherence that could emerge over extended periods and the lack of a comparative analysis with alternative screening methods limited context on relative adherence rates. Additionally, potential biases related to distribution of test kits or variations in patient follow-up practices across different healthcare settings were not considered.
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)3
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 the 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.
The Cologuard test led to faster colonoscopy follow-up vs FIT4*  
For patients initially screened with the Cologuard test compared with FIT2*   (86 vs 127 days on average, respectively)4
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 the de-identified data provided only a member’s birth year; enrollees who were becoming age 50 at the beginning of the year versus toward the end of the year may exhibit different patterns. Another limitation was that FIT utilization may be underestimated as some FIT screenings available through various programs may not generate a claim; the authors pointed out that it is also important to note that only 15% of FIT results were available for this study, and data from enrollees with a positive and available FIT result may not be generalizable to the entire population of enrollees who receive a positive FIT result.
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
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Important Information about the Cologuard products


Indications for Use

The Cologuard® and Cologuard Plus™ tests are 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)/advanced precancerous lesions (APL) and should be followed by a colonoscopy. The Cologuard test and Cologuard Plus test are indicated to screen adults of either sex, 45 years or older, who are at average risk for CRC. These tests are not a replacement for diagnostic colonoscopy or surveillance colonoscopy in high-risk individuals.

Contraindications

The Cologuard products are not for high-risk individuals, including patients who have the following:

  • a personal history of colorectal cancer and adenomas
  • a positive result from another colorectal cancer screening method within a test recommended timeframe
  • have been diagnosed with a condition associated with high risk for colorectal cancer such as IBD, chronic ulcerative colitis, Crohn’s disease
  • have a family history of colorectal cancer, or certain hereditary syndromes

Warnings and Precautions

All positive results should be referred to colonoscopy.

The Cologuard products may produce false positive and false negative results. A false positive result occurs when a result is positive, even though a colonoscopy will not find CRC or APL. A false negative result occurs when a result is negative, even when a colonoscopy identifies APL or CRC.

A negative result does not guarantee the absence of colorectal 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. Performance when used for repeat testing has not been established.

Refer to the Cologuard test Clinician Brochure or the Cologuard Plus test Clinician Brochure for additional information about the benefits and risks of using each version of the Cologuard product for CRC screening.

Rx only.