Lesley-Ann Miller-Wilson, PhD, MS, MBA1, Paul J. Limburg, MD, MPH2, Leah R. Helmueller, BS1, Maria João Janeiro, PhD, MS3, Paul Hartlaub, MD, MSPH4 1Exact Sciences, Madison, WI; 2Mayo Clinic, Rochester, MN; 3Maple Health Group, Mexico City, Distrito Federal, Mexico; 4Ascension Medical Group, Glendale, WI
Introduction: Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. CRC screening reduces mortality through early detection; however, screening is underutilized, with only 68.8% of eligible adults in the U.S. reportedly up-to-date in 2018 (CDC). Widely endorsed CRC screening modalities include structural visualization (e.g. colonoscopy) and stool-based tests (e.g. multitarget stool DNA, mt-sDNA; fecal immunochemical tests, FIT; or high-sensitivity guaiac-based fecal occult blood tests, gFOBT). We assessed patterns in overall CRC screening participation and test utilization following clinical availability of the mt-sDNA assay, among average-risk, screen-eligible individuals in the Ascension Wisconsin healthcare system.
Methods: Electronic medical records of individuals aged 50 to 75 years from 2015 to 2018 were reviewed to identify those who were average-risk and screen-eligible. For those with screening data available, we determined the proportion who were up-to-date with a United States Preventive Services Task Force (USPSTF) recommended screening strategy; number of screening tests performed in the measurement year; and distribution of screening modalities. Temporal trends were assessed using regression analysis, including subgroup analyses across age groups and screening modalities.
Results: A total of 115,708 individuals were included in the analysis cohort. When considering all individuals up-to-date and screened in the measurement year, overall adherence increased significantly over the 4-year study period, from 39,105 to 49,698 patients or 47% to 59% (p< 0.0001). The screening incidence between 2015 and 2018 increased from 19.44 to 23.66 tests per 1,000 persons for gFOBT and FIT, a 1.2-fold increase, and from 6.54 to 29.78 tests per 1,000 persons for mt-sDNA (p< 0.05), a 4.6-fold increase. During the same time period, the screening incidence of colonoscopy decreased from 119.99 to 110.58 tests per 1,000 persons, corresponding to a decrease of 8%.
Discussion: Our results suggest that the growing adoption of mt-sDNA may be correlated with an increase in overall screening in this average-risk population, in parallel with a slight increase in the use of other stool-based CRC screening tests.
Figure: Figure 1. Adherence (a) and screening incidence (b) from 2015 to 2018 observed in the Ascension Wisconsin Healthcare System. Adherence in patients due for screening was measured as the proportion of patients due for screening in a certain year that performed a screening test; adherence in all patients was measured as the proportion of patients that were up-to-date or screened in a certain year. Screening incidence was defined as the number of tests performed in each measurement year per 1,000 persons.
Paul Limburg: Exact Sciences – Stockholder/Ownership Interest (excluding diversified mutual funds), Other Financial or Material Support, PJL serves as Chief Medical Officer for Screening at Exact Sciences through a contracted services agreement with Mayo Clinic. PJL and Mayo Clinic have contractual rights to receive royalties through this agreement..
Maria João Janeiro indicated no relevant financial relationships.
Paul Hartlaub indicated no relevant financial relationships.
Lesley-Ann Miller-Wilson, PhD, MS, MBA1, Paul J. Limburg, MD, MPH2, Leah R. Helmueller, BS1, Maria João Janeiro, PhD, MS3, Paul Hartlaub, MD, MSPH4. P0247 - Impact of mt-sDNA in a Colorectal Cancer Screening Clinical Practice: A Real-World Survey, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.