Patient perceptions of stool-based DNA testing for colorectal cancer screening

Stool-based DNA (SB-DNA) testing is an emerging colorectal cancer screening strategy that offers a convenient, noninvasive, and potentially more acceptable alternative to existing screening tests. The objectives of this study were to compare patient perceptions of SB-DNA testing, fecal occult blood testing (FOBT), and colonoscopy, and elicit screening preferences.

A prospective survey was conducted between August 2001 and March 2003 of asymptomatic, mostly average-risk subjects aged > or =50 years who were participating in a multicenter comparison of SB-DNA testing and FOBT for detecting colorectal neoplasia. Subjects completed a 25-item questionnaire within 48 hours after undergoing a colonoscopy, which served as the standard. Respondents were asked to rate each of the three screening tests on various prep- and test-related features, using a five-point ordinal scale or yes/no format, and to select a preferred strategy.

A total of 4042 subjects completed the survey (84% response rate). SB-DNA testing received the same or higher mean ratings than FOBT for most prep- and test-related features. When compared with colonoscopy, SB-DNA testing received higher ratings for all prep- and test-related features except perceived accuracy, where colonoscopy was rated higher. Overall, a higher percentage of patients preferred SB-DNA testing (45%) to both FOBT (32%) and colonoscopy (15%) for routine screening (p <0.001); 8% had no preference.

Patients willing to undergo colonoscopy, SB-DNA testing, and FOBT perceive SB-DNA testing to have a number of advantages over the other two tests. Moreover, many such patients prefer SB-DNA testing to FOBT and colonoscopy for routine screening.