mt-sDNA Adherence

Studies have indicated that adherence with multitarget stool DNA (mt-sDNA) testing is high.1,2 Up to 40% of patients using mt-sDNA have reported screening for the first time, and nearly 1 in 4 of these appear to be overdue to initiate screening by 10 years or more.3 Studies also suggest that adherence with a follow-up colonoscopy is high after a positive mt-sDNA result,3,4 and significantly higher than in those screened with fecal immunochemical (FIT) or guaiac fecal occult blood tests (FOBT).4 Modeling has suggested that at adherence rates of 65-70% or higher for mt-sDNA, deaths averted would be equal to or exceed those of colonoscopy.5

High cross-sectional adherence screening rates of 66.8-71.1% have been reported with mt-sDNA tests in real-world populations1,2

84.9% of patients with a positive mt-sDNA result vs 42.6% of those with a positive FIT/FOBT result adhered to a follow-up colonoscopy within 6 months (average-risk population)4

mt-sDNA test is less susceptible to drops in adherence rates compared to single marker fecal occult blood test (FIT/gFOBT)2

ADHERENCE TO mt-sDNA SCREENING IN A NATIONAL SAMPLE OF MEDICARE PATIENTS (N=368,494)1,a

Adherence to mt-sDNA screening in a national sample of 368,494 patients enrolled in Medicare. The graph shows a general trend of greater adherence over time, with 45.8% adherence on Day 30 and 69.7% adherence on Day 180.
  • Nearly three-quarters of the Medicare cohort beneficiaries adhered with an mt-sDNA test order for CRC screening1
  • Cross-sectional adherence rates were similar across patient age group, Medicare coverage type, and patient gender1
  • Cumulative adherence rates increased more rapidly at 30 and 60 days, followed by more gradual increases at 90 and 180 days1

FOLLOW-UP COLONOSCOPY RATES AFTER A POSITIVE STOOL TEST4,b

Table adapted from Rutten, 20204


In this study of 5818 adults ages 50-75, adherence with a follow-up colonoscopy within 6 months after a positive mt-sDNA (84.9%) was significantly higher compared with those with a positive FIT/FOBT (42.6%)4

TOP REASONS FOR LACK OF FOLLOW-UP POST-POSITIVE FIT OR mt-sDNA6,c

FIT
(n=164)
n (%)		 mt-sDNA
(n=92)
n (%)
System barriers:
GI clinic referral 48 (29.3) 11 (12.0)
COL not scheduled 5 (3.0) 17 (18.5)
Provider-level barriers:
Attributed to false positive 3 (1.8) 0 (0.0)
Failure to inform patient 0 (0.0) 7 (7.6)
Other reasons 39 (23.8) 1 (1.1)
Recent COL done 24 (14.6) 1 (1.1)
Other health issues 8 (4.9) 11 (12.0)
Patient-level barriers:
Patient refused (prior to order) 8 (4.9) 8 (8.7)
Patient refused (post order) 4 (2.5) 15 (16.3)
No show/cancellation 42 (25.6) 26 (28.3)

Table adapted from Rutten, 20204

  • Even when screening occurs, there are further barriers to appropriate follow-up6
  • Only 46.7% of FIT-positive and 71.5% of mt-sDNA-positive patients underwent a follow-up colonoscopy within six months of a positive result6
  • After a positive screening test, barriers to follow-up care were reported on the patient, provider, and system levels6

Learn more about the full Indications/Contraindications for the mt-sDNA test. Please see complete prescribing information for the Cologuard® test in the Cologuard Clinician Brochure.

FIT: fecal immunochemical test; mt-sDNA: multitarget stool DNA.

Related Topics

Footnotes

  1. Retrospective study of aggregate laboratory data as part of ongoing laboratory quality management processes and in compliance with HIPAA. N=368,494. Age=65-85.
  2. Population-based, retrospective study using the Rochester Epidemiology Project research medical records data linkage infrastructure. N=5818. Age=50-75.
  3. Retrospective ambulatory EMR-based cohort study (n=631) in a large healthcare system in the Midwest evaluated the frequency of follow-up colonoscopy post-positive mt-sDNA or FIT and identified reasons for lack of colonoscopy follow-up (January 2016 to June 2018).

List of definitions

COL: colonoscopy; CRC: colorectal cancer; EMR: electronic medical record; FIT: fecal immunochemical test; FOBT: fecal occult blood test; GI: gastrointestinal; HIPAA: Health Insurance Portability and Accountability Act; mt-sDNA: multitarget stool DNA; PPV: positive predictive value.


References

  1. Weiser E, Parks PD, Swartz RK, et al. Cross-sectional adherence with the multi-target stool DNA test for colorectal cancer screening: real-world data from a large cohort of older adults. J Med Screen. 2021;28(1):18-24.
  2. Miller-Wilson LA, Finney Rutten LJ, Van Thomme J, Ozbay, AB, Limburg PJ. Cross sectional adherence with the multi target stool DNA test for colorectal cancer screening in a large, nationally insured cohort. Int J of Colorectal Dis. 2021;36(11):2471-2480.
  3. Eckmann JD, Ebner DW, Bering J, et al. Multitarget stool DNA screening in clinical practice: high positive predictive value for colorectal neoplasia regardless of exposure to previous colonoscopy. Am J Gastroenterol. 2020;115(4):608-615.
  4. Finney Rutten LJ, Jacobson DJ, Jenkins GD, et al. Colorectal cancer screening completion: an examination of differences by screening modality. Prev Med Rep. 2020;20:101202.
  5. D’Andrea E, Ahnen DJ, Sussman DA, Najafzadeh M. Quantifying the impact of adherence to screening strategies on colorectal cancer incidence and mortality. Cancer Med. 2020;9(2):824-836.
  6. Cooper GS, Grimes A, Werner J, et al. Barriers to follow-up colonoscopy after positive FIT or multitarget stool DNA testing. J Am Board Fam Med. 2021;34(1):61-69.