Multi-target stool DNA test adherence in average-risk African Americans from 2017-2024.
Authors: William K Johnson, Mark Camardo, Mallik Greene, A Burak Ozbay, Paul J. Limburg, Jerry Lovelace
Journal: Journal of Clinical Oncology (2025)

99 Background: Colorectal cancer (CRC) stands as the second most common cause of cancer-related mortality in the United States, while being the third most common cancer in the country. African Americans (AA) are disproportionately affected with CRC (incidence and mortality), yet the disease can be prevented through screening and early detection. Data reveals that only 59% of AA between ages 45-75 were up to date with CRC screening as of 2021. Broad availability of the navigation-supported, at home multi-target stool DNA (mt-sDNA) test may help mitigate barriers to screening adherence in this population. We examined multi-target stool-DNA (mt-sDNA) test adherence rates in a nationally representative AA population. 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 2016 to 2024. 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. Time to test return 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: Among 434,951 mt-sDNA orders from 2017-2024, the overall adherence rate was 62%, and the average time to test return was 27.6 days. The cohort included higher percentages of women (61.7%), ages 50-64 years (57.8%), located in Southern US (51.4%), and metro areas (90.9%). Most patients were also commercially insured (56.1%) and received their mt-sDNA order from their primary care provider (65.4%). Digital SMS was the most preferred outreach option (47%). Patients ages ≥76 years demonstrated the highest adherence (70.3%), with all age categories near or above 60% (45-49 yrs [59.4%]; 50-64 yrs [60.8%], 65-75 yrs [64.3%]). Across payors, patients with Medicare had the highest adherence rates (66.5%). Across outreach, highest adherence was among those who preferred ‘Digital SMS + Email’ outreach (64.3%). Men were quicker to return their test than women (26.8 days vs 28 days, p&lt;0.001). Those ages ≥76 years and with tests ordered by GIs had the shortest time to test return (21.3 and 22.2 days, respectively). Adjusted analyses revealed multiple factors were associated with increased odds of adherence, including older age (≥76 years; OR=1.54; p&lt;0.001), ‘Digital SMS + Email’ outreach (OR=1.25; p&lt;0.001), rural residence (OR=1.23; p&lt;0.001), and males (OR=1.05; p&lt;0.001). Conclusions: Mt-sDNA adherence was higher for AA patients in this large, national cohort as compared to previously reported overall CRC screening adherence data for this population group. Findings suggest mt-sDNA utilization, with its included patient navigation, may help reduce screening disparities among AA patients.