Adherence to Multi-Target Stool DNA Testing for Colorectal Cancer Screening Among Veterans and Civilians Enrolled in...

Stool-based testing is used for non-invasive colorectal cancer screening. The multi-target stool DNA (mt-sDNA) test has higher completion rates than other stool-based tests; however, data are scarce on mt-sDNA test adherence among Veterans Health Administration (VHA) insurance plan enrollees in the United States.

We retrospectively assessed adults aged 45 to 75 years prescribed mt-sDNA testing through a VHA insurance plan, including veterans receiving VHA-authorized care and civilians covered by the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). Study data were obtained from the Abbott database (August 2022-January 2026). The primary outcome was test completion (adherence) within 365 days of kit shipment. Kaplan-Meier and log-rank analyses were used to evaluate time to adherence, and logistic regression was used to evaluate factors associated with mt-sDNA test adherence.

Of 8,613 enrollees prescribed mt-sDNA testing, 72.4% (n = 6,234) were adherent; median time to adherence was 16 days. Metropolitan residence was associated with lower adherence (reference: small town; adjusted odds ratio [OR], 0.78; 95% confidence interval [CI], 0.65-0.92; P = .004). Factors associated with higher adherence included median annual household income ≥$125k (reference: <$50k; OR, 1.49; CI, 1.04-2.12; P = .029), test prescription by an obstetrician/gynecologist (reference: nurse practitioner/physician assistant; OR, 1.45; CI, 1.10-1.92; P = .009), and opting in to email and text notifications (reference: no digital notification; OR, 2.02; CI, 1.65-2.46; P < .001). Time to adherence differed significantly by outreach type and prior mt-sDNA return history (both log-rank P < .0001).

Adherence to mt-sDNA testing among VHA enrollees was higher than stool-based test adherence rates previously reported among United States veterans or the general population. These findings support broader integration of mt-sDNA testing within VHA colorectal cancer screening programs to help improve screening participation. Future studies could assess follow-up colonoscopy adherence in an effort to optimize colonoscopy utilization.