49 - Disparities in Rates of Multitarget Stool DNA Test Completion for Colorectal Cancer Screening

Jeffrey Dong, MD¹, Hyder Said, MD¹, Samuel Miller, MD¹, Hannah Systrom, MD², Joseph D. Feuerstein, MD^3
1Beth Israel Deaconess Medical Center, Boston, MA; ²Beth Israel Deaconess Medical Center, Winchester, MA; ³Beth Israel Deaconess Medical Center (BIDMC), Boston, MA

Introduction: Screening for colorectal cancer (CRC) reduces CRC mortality, but over 30% of adults aged 50-75 in the United States are not up to date with CRC screening per recent studies. Multitarget stool DNA (mt-sDNA) testing is a noninvasive option for CRC screening which could help bridge this gap, but completion of mt-sDNA testing requires active engagement from the patient. We aimed to assess the rate at which patients completed mt-sDNA screening and identify characteristics associated with mt-sDNA test completion.

Methods: We conducted a retrospective cohort study of all mt-sDNA tests ordered between April 2020 and July 2021 at our institution. For each patient we recorded age, sex, race, education, preferred language, insurance status, ordering clinician, whether CRC screening was previously completed, and whether the patient completed mt-sDNA testing. Multivariate logistic regression was used to determine which factors were associated with completion of mt-sDNA testing.

Results: A total of 797 patients were ordered mt-sDNA tests during the study period. Median age was 61 years, 272 (34%) were male, 318 (40%) were non-White, and 368 (46%) had previously completed CRC screening (Table 1). 627 tests (79%) were ordered by an attending primary care physician (PCP), 81 (10%) by a resident PCP, 48 (6%) as part of an outreach program to patients overdue for CRC screening, and 41 (5%) by a gastroenterologist. A total of 483 patients (61%) completed screening, with median time to completion being 25 days (IQR 17-43). On multivariate analysis, higher mt-sDNA completion was associated with Asian race (OR 2.84, 95% CI 1.44-5.62) and completion of prior CRC screening (OR 1.51, 95% CI 1.05-2.17), whereas Black race (OR 0.58, 95% CI 0.39-0.87), order from a resident PCP (OR 0.32, 95% CI 0.19-0.53), and order from the outreach program (OR 0.44, 95% CI 0.24-0.81) were associated with lower rates of mt-sDNA completion.

Discussion: Nearly 40% percent of patients who were ordered a mt-sDNA test did not complete testing. Completion rates were lower in Black patients and patients with a resident PCP. While clinician experience may contribute to the difference, these findings may also reflect systems-level inequities such as socioeconomic disadvantages, decreased access to care, and lower trust in the healthcare system among certain patient populations. Our research identifies an opportunity to improve health equity in mt-sDNA screening.



Disclosures:


Jeffrey Dong, MD¹, Hyder Said, MD¹, Samuel Miller, MD¹, Hannah Systrom, MD², Joseph D. Feuerstein, MD³, 49, Disparities in Rates of Multitarget Stool DNA Test Completion for Colorectal Cancer Screening, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.