The Strongest Predictor of Colonoscopy Completion After a Positive Stool Test Is a Multitarget Stool DNA Test

It is well known that the rates of follow-up colonoscopy after a positive fecal screening test are suboptimal, and delays in colonoscopy versus prompt colonoscopy are associated with more advanced colorectal cancer (CRC).

This study included 32,769 average-risk 50- to 75-year-olds from 5 U.S. health care organizations. All of the patients had a positive fecal screening result, a primary care visit less than 15 months before the fecal test, and some documented chart activity at least 90 days after a positive test. None of the patients had a colonoscopy within the 10 years before fecal testing, and none had a recognized screening test within the recommended interval.

The rates of completed colonoscopy were 56.1% within 360 days of a positive screening test, 51.4% within 180 days, and 43.2% within 90 days. Compared with White patients, colonoscopy completion was 15% lower for Black patients and 21% lower for Asian patients. Compared with patients with commercial insurance, Medicare patients had a 5% lower colonoscopy completion rate, and Medicaid patients had a 21% lower rate. More comorbidities were also associated with a lower rate of completed colonoscopy, including a 36% lower rate for patients with a Charlson Comorbidity Index of 5 or greater. The strongest predictor of colonoscopy completion was a multitarget stool DNA test (mt-sDNA; Cologuard), which was associated with a 63% higher rate of completion.