Real-world adherence to multi-target stool DNA testing and its association with time to follow-up colonoscopy: a...

Multi-target stool DNA (mt-sDNA) testing is a noninvasive colorectal cancer (CRC) screening test with higher sensitivity and real-world adherence than fecal immunochemical testing (FIT) or guaiac fecal occult blood testing (FOBT). However, data on adherence and follow-up colonoscopy (FU-CY) within individual health systems are limited. This study evaluated mt-sDNA adherence, FU-CY completion, and predictors within Massachusetts General Hospital (MGH).

We conducted a retrospective cohort study of 23,665 patients aged 45-75 years with mt-sDNA test orders in the MGH health system (June 2016-May 2023). Adherence was defined as return of a valid mt-sDNA kit. FU-CY was assessed within 12 months after a positive result. Multivariable logistic regression models identified patient- and provider-level predictors of adherence and FU-CY completion.

Overall adherence to mt-sDNA screening was 78.4%, with a positivity rate of 10.5%. FU-CY completion within one year was 74.2%, with 91% completed within six months. Adherence was highest among adults aged 65-75 (80.1%), Asian or Pacific Islander patients (83.0%), Medicare beneficiaries (84.0%), rural residents (82.4%), and those with prior mt-sDNA testing (89.3%). Lower adherence was observed among Black (73.6%) and Hispanic (75.7%) patients, Medicaid beneficiaries (60.0%), and orders placed by nurse practitioners/physician assistants (71.7%). Multivariable analyses identified independent predictors of adherence and FU-CY completion, including race/ethnicity, payer type, income, provider specialty, geography, and patient return history. Age and sex were significant predictors of FU-CY completion.

Within a large health system, mt-sDNA screening demonstrated high overall adherence and timely FU-CY completion, exceeding those historically reported for FIT/FOBT.