Adherence to multi-target stool DNA test in the US Asian population from 2017-2024.
Authors: Greene Mallik , Camardo Mark , Le Quang Anh , Johnson William K , Ozbay A Burak , Fendrick A. Mark , Dore Michael , Limburg Paul J. 
Published: January 2025

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Background:
In 2024, incidence and mortality cases related to colorectal cancer (CRC) in the US are estimated to reach 152,810 and 53,010, respectively. CRC screening can help identify malignant lesions at earlier stages; however, in 2021, only 48% of Asian American persons between the ages of 45-75 were up-to-date. Multi-target stool DNA test (mt-sDNA), a highly sensitive and guideline recommended CRC screening modality, may improve screening adherence in average-risk individuals within this population. Herein, we examined CRC screening adherence with mt-sDNA in Asian Americans using national claims data.
Methods:
A large claims database of over 165 million individuals linked with Exact Sciences Laboratories data, was used to source mt-sDNA orders for Asian Americans from 2017 to 2024. Eligible individuals were aged ≥45 years, new to mt-sDNA and average risk for CRC during the baseline period of 12 months. Primary outcome was adherence to mt-sDNA, defined as return of mt-sDNA kit within 365-days from shipment. The secondary outcome was time to kit return in days. All individuals received a standard mailed letter along with additional digital outreach through the accompanying mt-sDNA patient navigation program, according to their desired mode of communication. Baseline demographic measures included age, sex, ordering provider, residential geography, payor, and outreach preference. Association of adherence with patient characteristics was evaluated using multivariable regression.
Results:
Of the 182,259 eligible mt-sDNA orders shipped during the study period, overall adherence was 68.9%. Average time to test return was 27.1 days. The cohort was comprised mostly of women (56.7%), aged 50-64 years (58.42%), primary care provider (74.7%), and preferred ‘Digital SMS’ outreach (50.9%). Average adherence for all age groups, 45-49 years, 50-64 years, 65-75 years, and 76+ years, exceeded 65%, at 67.2%, 68.8%, 69.7%, and 72%, respectively. Medicare recipients demonstrated the highest adherence by payor type (71%, p < 0.0001), and persons who opted for ‘Digital SMS + Email’ communication were most adherent (70.9%; p < 0.0001). Of all provider specialties, individuals having their tests ordered by gastroenterologists produced the shortest time to adherence (21.8 days). Multivariable regression revealed that age, digital outreach (compared to none), micropolitan residence, and ordering provider were independent predictors of increased mt-sDNA adherence.
Conclusions:
The results of this large cohort and nationally representative analysis demonstrated high mt-sDNA adherence amongst Asian American persons, despite a low percentage of this population being current with CRC screening overall. The use of mt-sDNA, in concordance with its included patient navigation, is a viable modality to encourage test completion through screening engagement – which has the potential to reduce screening barriers in this population.