title: Multitarget stool DNA tests increases colorectal cancer screening among previously noncompliant Medicare patients.
abstract: OBJECTIVE
  To determine the uptake of noninvasive multitarget stool DNA (mt-sDNA) in a cohort of colorectal cancer (CRC) screening non-compliant average-risk Medicare patients.
  
  
  METHODS
  This cross sectional primary care office-based study examined mt-sDNA uptake in routine clinical practice among 393 colorectal cancer screening non-compliant Medicare patients ages 50-85 ordered by 77 physicians in a multispecialty group practice (USMD Physician Services, Dallas, TX) from October, 2014-September, 2015. Investigators performed a Health Insurance Portability and Accountability Act compliant retrospective review of electronic health records to identify mt-sDNA use in patients who were either > 10 years since last colonoscopy and/or > 1 year since last fecal occult blood test. Test positive patients were advised to get diagnostic colonoscopy and thereafter patients were characterized by the most clinically significant lesion documented on histopathology of biopsies or excisional tissue. Descriptive statistics were employed. Key outcome measures included mt-sDNA compliance and diagnostic colonoscopy compliance on positive cases.
  
  
  RESULTS
  Over 12 mo, 77 providers ordered 393 mt-sDNA studies with 347 completed (88.3% compliance). Patient mean age was 69.8 (50-85) and patients were 64% female. Mt-sDNA was negative in 85.3% (296/347) and positive in 14.7% (51/347). Follow-up colonoscopy was performed in 49 positive patients (96.1% colonoscopy compliance) with two patients lost to follow up. Index findings included: colon cancer (4/49, 8.2%), advanced adenomas (21/49, 42.9%), non-advanced adenomas (15/49, 30.6%), and negative results (9/49, 18.4%). The positive predictive value for advanced colorectal lesions was 51.0% and for any colorectal neoplasia was 81.6%. The mean age of patients with colorectal cancer was 70.3 and all CRC's were localized Stage I (2) and Stage II (2), three were located in the proximal colon and one was located in the distal colon.
  
  
  CONCLUSIONS
  Mt-sDNA provided medical benefit to screening noncompliant Medicare population. High compliance with mt-sDNA and subsequent follow-up diagnostic colonoscopy identified patients with clinically critical advanced colorectal neoplasia.
authors.affiliation: Mark Prince, USMD Health System, Arlington, TX 76017, United States.
authors.forename: Mark
authors.initials: M
authors.lastname: Prince
authors.affiliation: Mark Prince, USMD Health System, Arlington, TX 76017, United States.
authors.forename: Lynn
authors.initials: L
authors.lastname: Lester
authors.affiliation: Mark Prince, USMD Health System, Arlington, TX 76017, United States.
authors.forename: Rupal
authors.initials: R
authors.lastname: Chiniwala
authors.affiliation: Mark Prince, USMD Health System, Arlington, TX 76017, United States.
authors.forename: Barry
authors.initials: B
authors.lastname: Berger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D004273:DNA, Neoplasm / Q000032:analysis*; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods*; D005243:Feces / Q000737:chemistry*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D006278:Medicare; D008875:Middle Aged; D009780:Occult Blood; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014481:United States
chemical_list: D004273:DNA, Neoplasm
keywords: Advanced adenoma; Colonoscopy; Colorectal cancer screening; Multitarget stool DNA; Preventive; Screening compliance