JAMA Study Finds Uptick in mt-sDNA Use, Drop in FOBT for CRC Screening

A longitudinal study that evaluated colorectal cancer (CRC) screening habits of average-risk adults found an increase in screening rates between 2011 and 2019, although it did fall short of the 80% goal set by the National Colorectal Cancer Roundtable. Interestingly, the use of multitarget stool DNA test (mt-sDNA) increased between 2016 and 2019—once there was a reimbursement code for the test post–FDA approval. Fecal occult blood testing (FOBT) use, meanwhile, saw a decline during that same period.

The researchers used commercial and Medicare claims databases to draw information on CRC screening use between August 1, 2011, and August 31, 2019. The actual 18-year study period was split into the pre-mt-sDNA period (August 1, 2011-July 31, 2014) and the post-mt-sDNA period (August 1, 2016-July 31, 2019). Only those enrollees who were between 45-67 years old on August 1, 2011, and were at an average risk of developing CRC, were included in the study. This inclusion criteria made up nearly 98,000 individuals, with a  mean age of 50.8 years; 55.5% of them were women. About 62% of them were over 50 years old, and about 38% were aged between 45 and 49 years on August 1, 2011.

The analysis found a steady annual increase in up-to-date screening, from 50.4% in 2011-2012 to 69.7% in the final measurement year (2018-2019). While the 45-49 years old had low screening rates (25.8%) in the early years, the difference between age groups disappeared by the end of the study period (67.7%). The most interesting data were utilization patterns of the kinds of screening tests among those 50 and over:

• FIT: 17.7% in 2011-2012 to 22.6% in 2016-2017
• Colonoscopy: 64.6% in 2013-2014 to 60.3% in 2018-2019
• FOBT: 17.4% in 2011-2012 to 6.6% in 2018-2019
• mt-sDNA: 1.9% in 2016-2017 (when it was first available) to 14.2% in 2018-2019

Specifically in the 45-49 age group, colonoscopy use increased while use of FIT and FOBT decreased over the study period. However, use of mt-sDNA increased once the test was launched.

The authors attribute the successful increase in CRC screening utilization to multiple factors:

• Various population-level interventions to increase CRC screening awareness and uptake
• Changes in CRC screening guidelines, with the American Cancer Society recommending 45 years as the screening age for average-risk adults
  • The US Preventive Services Task Force has lowered the recommended screening age for average risk adults to 45 as well
• The Affordable Care Act has provided increased insurance coverage, which increases access to CRC screening