Multi-target stool DNA test adherence among average-risk 45- to 49-year-old patients from 2017-2023.
Authors: Greene Mallik , Camardo Mark , Johnson William K , Ozbay A Burak , Fendrick A. Mark , Dore Michael , Limburg Paul J. 
Published: January 2025

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Background:
Colorectal cancer (CRC) is the third most common cancer in the United States and the second most common cause of cancer-related mortality. In 2021, the US Preventive Services Task Force (USPSTF) lowered the age of initial CRC screening from 50 to 45 years of age for average risk individuals. At that time, only 20% of adults aged 45-49 years were up-to-date with CRC screening. With its at-home use, accessibility, and patient navigation, the multi-target stool DNA test (mt-sDNA) could help support screening uptake in this population. Here, we analyzed national claims data to investigate mt-sDNA adherence rates among average-risk adults aged 45-50 years.
Methods:
Using a national claims database of over 165 million individuals linked with Exact Sciences Laboratories data, mt-sDNA orders for AA patients were retrospectively identified from 2017 to 2023. Average CRC risk individuals aged ≥45 years, and new to mt-sDNA, were included in this analysis. Primary outcome of interest was adherence, defined as mt-sDNA kit return rate within 365-days from shipment. Test return time was examined as the secondary outcome. Demographics were age, sex, ordering provider, residential geography, payor, and outreach preference. Covariates on adherence were examined using logistic regression.
Results:
A total of 607,388 mt-sDNA orders were prescribed during the study period, with an overall 365-day return rate of 65.4%. Average time to test return was 30.4 days. Women outnumbered men in the cohort (58.6%), and most mt-sDNA orders were prescribed by primary care providers (59.4%). The majority of individuals preferred ‘Digital SMS’ communication (62%), and nearly 90% of the cohort was Commercially insured (87.6%). Among those in the cohort participants’ self-reported race/ethnicity was: White (37.3%), Hispanic or Latino (10.1%), Black or African American (8.8%), unknown (8.8%), Asian or pacific islander (4.6%), and other (3.7%). Adherences for the four identified races/ethnicities were all near, or above 60%. Men demonstrated higher adherence than women (66.7% vs 64.5%; p<0.0001). Time to test return was shortest in men (28.9 days) and African American persons (28.5 days). Tests ordered by gastroenterologists yielded the quickest adherence times amongst providers (26 days). After controlling for race, gender, payor class, setting (urban/rural classification), and preferred language, digital outreach and provider type were significantly associated with increased mt-sDNA adherence.
Conclusions:
This large, national analysis reports a substantially higher rate of adherence among individuals ages 45-49 with the mt-sDNA test than the current nationally reported rates. At-home testing, along with standard and preference-based navigation may have contributed to high mt-sDNA completion rates. More research is warranted to explore screening behaviors and the benefits of screening within this younger population.