Adherence to the multi-target stool DNA test in the US Hispanic population from 2016-2024.
Authors: Camardo Mark , Greene Mallik , Johnson William K , Ozbay A Burak , Rincón López Juliana Vanessa , Limburg Paul J. , Duarte Martha 
Published: January 2025

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Background:
With colorectal cancer (CRC) as the second most common cause of cancer-related mortality in the US, adherence to CRC screening is a vital component to alleviating the cancer burden. Statistics show that only 52% of Hispanic or Latino individuals ≥45 years were up-to-date with CRC screening in 2021. A guideline-recommended, at-home CRC screening option, such as the multi-target stool DNA test (mt-sDNA), could be an efficient modality for screening average-risk individuals. Using a large national claims database, we examined CRC screening adherence with mt-sDNA in the US Hispanic population.
Methods:
Data was sourced from a database of over 165 million individuals linked with Exact Sciences Laboratories data. Hispanic persons who received mt-sDNA orders and resided in the US were retrospectively identified from 2016 to 2024. The analyses included persons who were ≥45 years of age, new to mt-sDNA and average risk for CRC during the 12-month pre-index period. Primary outcome of interest was adherence, which was defined as the mt-sDNA kit return rate within 365-days from shipment. All patients received a mailed letter along with digital outreach through the accompanying patient navigation program, according to their communication preference. The modes of digital outreach included: SMS, email, or both. Baseline demographics collected included age, sex, ordering provider, residential geography, payor, and outreach preference. Adjusted analyses were used to examine effects of covariates on adherence.
Results:
A total of 447,968 mt-sDNA orders were shipped during the study period and the overall adherence rate was 62.5%. Average time to test return was 28.5 days. Women comprised the majority of the cohort (59.9%), resided mostly in the Southern US (46.9%), aged 50-64 (60.9%), resided in a metropolitan area (91.2%), and received their mt-sDNA order from their primary care provider (62.7%). Across evaluated age groups, adherence was above 60% for all: ages 45-49 [60.5%]; 50-64 [62.6%], 65-75 [62.6%]), and ≥ 76 years [66.8]. By payor, Medicare-insured patients demonstrated the highest adherence (65.5%). Digital SMS was the preferred contact method (51.2%), and those opting for SMS + Email had the highest adherence rate (64.2%). Of provider specialties, individuals having their tests ordered by GIs produced the shortest time to adherence (23.2 days). Regression analyses revealed that older age (≥ 76 years), living in a rural area, and receiving fully or partially digital outreach were associated with increased mt-sDNA adherence.
Conclusions:
This large, national analysis reveals high mt-sDNA adherence amongst Hispanic individuals in the US, despite reports of low national CRC screening rates in this population. These data support the important role of mt-sDNA in facilitating screening engagement, while emphasizing the importance of preference-based navigation in facilitating screening test completion.