Le Quang A, Greene Mallik, Gohil Shrey, Ozbay A Burak, Dore Michael, Fendrick A Mark, Limburg Paul
Exact Sciences Corporation, Madison, WI, USA.
Department of Medicine, Duke University, Durham, NC, USA.
Int J Colorectal Dis. 2025 Jan 17;40(1):16. doi: 10.1007/s00384-025-04805-0.
Colorectal cancer (CRC) is the second leading cause of cancer mortality in the USA and is highly preventable, with early screening vital for improving outcomes. This study aimed to evaluate adherence rates of multi-target stool DNA (mt-sDNA) testing, following updated guidelines recommending screening starting at age 45.
This retrospective cohort study used aggregated data from Exact Sciences Laboratories LLC, examining new users (first-time testers) aged 45-85 with commercial, Medicare, or Medicaid insurance who received mt-sDNA test kits (point-of-care) between January 1, 2023, and June 1, 2023. Adherence was defined as the percentage of eligible participants returning a valid non-empty test kit within 365 days of initial shipment date. Descriptive statistics and logistic regression were used to analyze adherence.
Among 1,557,915 patients, the overall adherence rate to mt-sDNA testing was 71.3% (commercial insurance 72.3%, Medicare Advantage 70.2%, Medicare 69.9%, Medicaid 52.0%) (p < 0.001). Females had slightly higher adherence than males, except for commercial insurance (72.2% vs. 72.6%, p < 0.001). Adherence was highest in commercial insurance for individuals aged 76-85 (79.2%, p < 0.001), gastroenterology patients (82.5%, p < 0.001), and rural residents (73.2%, p < 0.001), along with those in Medicare Advantage earning $200 K + (78.5%, p < 0.001).
Adherence to mt-sDNA testing was robust, particularly among individuals with commercial insurance, older adults, gastroenterology patients, higher income groups, and rural residents. With a 71% adherence rate, the test demonstrates substantial engagement and value in colorectal cancer screening. Future research should assess its long-term impact and address disparities to optimize its benefits.
结直肠癌（CRC）是美国癌症死亡的第二大主要原因，且具有高度可预防性，早期筛查对改善预后至关重要。本研究旨在评估多靶点粪便DNA（mt-sDNA）检测的依从率，该检测遵循了建议从45岁开始筛查的更新指南。
这项回顾性队列研究使用了Exact Sciences Laboratories LLC的汇总数据，研究对象为2023年1月1日至2023年6月1日期间接受mt-sDNA检测试剂盒（即时检测）的45至85岁的新用户（首次检测者），这些用户拥有商业保险、医疗保险或医疗补助保险。依从性定义为符合条件的参与者在初始发货日期后的365天内返回有效非空检测试剂盒的百分比。使用描述性统计和逻辑回归分析依从性。
在1,557,915名患者中，mt-sDNA检测的总体依从率为71.3%（商业保险72.3%，医疗保险优势计划70.2%，医疗保险69.9%，医疗补助52.0%）（p < 0.001）。除商业保险外，女性的依从性略高于男性（72.2%对72.6%，p < 0.001）。商业保险中，76至85岁个体的依从性最高（79.2%，p < 0.001），胃肠病患者（82.5%，p < 0.001）、农村居民（73.2%，p < 0.001）以及医疗保险优势计划中收入超过20万美元的人群（78.5%，p < 0.001）的依从性也最高。
对mt-sDNA检测的依从性良好，特别是在拥有商业保险的个体、老年人、胃肠病患者、高收入群体和农村居民中。该检测的依从率为71%，在结直肠癌筛查中显示出了较高的参与度和价值。未来的研究应评估其长期影响并解决差异问题，以优化其益处。
