Arjun Juneja, 1, Jhana Parikh, BS2, Puneet Reheja, MBBS3, Raja Vadlamudi, MD, MPH4, Neeraj K. Sachdeva, MD5, Sanjay Jagannath, MD5 1Duke University, Durham, NC; 2North Carolina State University, Cary, NC; 3Wake Endoscopy Center, New Delhi, Delhi, India; 4Wake Endoscopy Center, Cary, NC; 5Wake Endoscopy Center, Raleigh, NC
Introduction: Colorectal cancer (CRC) is the number 3 cancer in the US and the second most common cause of cancer-related deaths, affecting approximately 4% of the population1. Barriers to obtaining a screening colonoscopy include discomfort, financial strain, or lack of access2,3. Cologuard is a noninvasive method of detecting blood and altered DNA in stool that can be indicative of CRC4. Cologuard is increasingly being prescribed to circumvent barriers to colonoscopy but is not appropriate for patients with family history of CRC or personal history of polyps, who should be directly referred for colonoscopy2. Therefore, we sought to determine the prevalence of inappropriately ordered Cologuard tests in a community setting.
Methods: We performed an IRB approved retrospective analysis of medical records for patients with a positive Cologuard test referred to Wake Endoscopy between May 2019-May 2021. We identified contraindications to the Cologuard test as family history of CRC and/or personal history of polyps and calculated prevalence rates for patients who met either criteria.
Results: A total of N=202 patients with a positive Cologuard test were referred for a colonoscopy. The median age was 63.8 ± 8.7 years, with 98% over the age of 50. 54% of patients were female. Nearly one-quarter (48/202, 24%) of patients were inappropriately prescribed Cologuard; 11% (23/202) had a known family history of colon cancer, 10% (21/202) had a personal history of polyps, and 2% (4/202) had both contraindications.
Discussion: The Cologuard test is intended to combat barriers to routine screenings for colon cancer and is effective when used appropriately. In our practice, which reflects community-based care, nearly 25% of patients who were prescribed Cologuard should have been directly referred for colonoscopy. However, this study involved patients at a single site and only evaluated two broad categories of elevated risk. Further research in community settings and increased education for providers and patients is warranted to reduce patient anxiety and the number of inappropriately ordered tests.
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Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Multitarget Stool DNA Testing for Colorectal-Cancer Screening. New England Journal of Medicine 2014. 1287–1297.
Disclosures: Arjun Juneja indicated no relevant financial relationships. Jhana Parikh indicated no relevant financial relationships. Puneet Reheja indicated no relevant financial relationships. Raja Vadlamudi indicated no relevant financial relationships. Neeraj Sachdeva indicated no relevant financial relationships. Sanjay Jagannath indicated no relevant financial relationships.
Arjun Juneja, 1, Jhana Parikh, BS2, Puneet Reheja, MBBS3, Raja Vadlamudi, MD, MPH4, Neeraj K. Sachdeva, MD5, Sanjay Jagannath, MD5. P0254 - Appropriateness of ColoGuard Usage for Average Risk Patients by Primary Care Physicians in a Community Setting - Retrospective Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.