Adherence to Obstetrician-/Gynecologist-Ordered Multi-target Stool DNA Test Screening and Follow-Up Colonoscopy: A National Multi-payer Study of US Women.

INTRODUCTION

Colorectal cancer (CRC) screening remains below national targets among US women. Primary care providers (PCPs) play an important role in promoting CRC screening adherence. Many US women see an obstetrician/gynecologist (OB/GYN) as their PCP. We evaluated adherence among US women to multi-target stool DNA (mt-sDNA) testing and follow-up colonoscopy ordered by OB/GYNs.

METHODS

We linked Exact Sciences Laboratories (ESL) orders with a national multi-payer claims database (2016-2022). Eligible participants were average-risk women aged 45-75 years with continuous health plan enrollment (- 180 to 0 days baseline; 0-365 days to assess mt-sDNA adherence; and, after a positive mt-sDNA result, 0-365 days to assess colonoscopy). Primary outcomes were mt-sDNA completion within 365 days of kit shipment and colonoscopy completion within 365 days of a positive mt-sDNA test. Logistic regression evaluated factors associated with mt-sDNA adherence.

RESULTS

Of 160,068 women with OB/GYN-ordered mt-sDNA, 71.4% (n = 114,360/160,068) completed testing within 365 days. Test positivity was 8.6% (n = 9773/114,360). Among those with positive results, 71.3% (n = 6971/9773) completed colonoscopy within 365 days. Test adherence increased with age (45-49 years, 67.1%; 50-64 years, 71.8%; 65-75 years, 76.7%), was higher in non-metropolitan areas, and rose with higher ZIP code median household income. Test adherence was higher among individuals with traditional Medicare (85.2%) and Medicare Advantage (77.3%) than commercial insurance (71.3%) and Medicaid (61.7%).

CONCLUSION

In routine practice, more than 70% of women completed OB/GYN-ordered mt-sDNA testing and, after a positive result, more than 70% completed colonoscopy within 1 year. OB/GYN clinicians may play a key role in improving CRC screening adherence, with opportunities to address gaps by payer, income, and race/ethnicity.