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

Michael Fuchs^1,2, Shrey Gohil³, Jordan J Karlitz³

¹Central Virginia VA Health Care System, Richmond, VA 23249, United States.

Military Medicine

|June 24, 2026

Summary

Adherence to multi-target stool DNA (mt-sDNA) colorectal cancer screening was 72.4% among Veterans Health Administration enrollees. Higher income and opting into digital notifications improved adherence, supporting mt-sDNA integration in VHA screening programs.

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Area of Science:

Oncology
Gastroenterology
Public Health

Background:

Non-invasive colorectal cancer screening relies on stool-based testing.
Multi-target stool DNA (mt-sDNA) tests show higher completion rates than other stool tests.
Limited data exist on mt-sDNA test adherence among Veterans Health Administration (VHA) enrollees.

Purpose of the Study:

To assess mt-sDNA test adherence among VHA enrollees.
To identify factors associated with mt-sDNA test adherence in this population.

Main Methods:

Retrospective study of adults aged 45-75 prescribed mt-sDNA testing via VHA insurance.
Data sourced from Abbott database (August 2022-January 2026).
Kaplan-Meier, log-rank, and logistic regression analyses used to evaluate adherence and associated factors.

Main Results:

Overall adherence was 72.4% (6,234/8,613); median time to adherence was 16 days.
Lower adherence linked to metropolitan residence (aOR=0.78).
Higher adherence associated with income ≥$125k (aOR=1.49), prescription by OB/GYN (aOR=1.45), and digital notifications (aOR=2.02).

Conclusions:

VHA enrollee adherence to mt-sDNA testing exceeds previously reported rates.
Findings support integrating mt-sDNA testing into VHA colorectal cancer screening.
Future research should examine follow-up colonoscopy adherence to optimize screening.