Real-world multi-target stool DNA adherence in an underserved and vulnerable prison patient population.

Abstract

e15632 Background: In 2024, colorectal cancer (CRC) is estimated to be the fourth most diagnosed cancer, as well as the second leading cause of cancer death in the United States. While adherence to regular CRC screening has been suboptimal in the general population, this holds to be especially true in populations that are medically underserved. Non-invasive tests, such as the guideline recommended multi-target stool DNA (mt-sDNA) test, offer a more accessible option to increase screening participation in difficult to reach populations. Herein, we evaluated adherence to CRC screening in a cohort of prisoners who received the mt-sDNA test at a Nebraska Department of Corrections facility in Nebraska. Methods: This was a retrospective cohort study in a small prison population. Participants included both males and females between the ages of 45 and 75 years who underwent CRC screening evaluation at the prison’s medical center between June 1st – December 31st, 2023 and were offered multiple CRC screening options, including the mt-sDNA test. No inducements were provided for completion of the mt-sDNA test. Baseline demographics were collected for cohort description. The primary variable of interest was mt-sDNA test return rate (adherence), defined as completion of the mt-sDNA test within 60 days of kit receipt. We also evaluated mt-sDNA test results in secondary analyses. Results: Once inclusion criteria were applied, the resulting analysis cohort included 129 patients who were first time mt-sDNA screeners. The cohort was largely male (96.9%) and between the ages of 50-64 years (78.3%). Overall mt-sDNA test adherence was 95.3%, with the average time to test completion being 20 days. No significant difference was seen in test completion among males and females (95.2% vs 100%, respectively). Completion rates increased with patient age, at 90.9% (45-49 years), 95% (50-64 years), and 100% (65-75 years). The shortest time to completion in the population was observed amongst patients who were females (18.8 days), and those between the ages of 45-49 years (17.1 days). Negative and positive mt-sDNA test results were observed in 82.9% and 17.1% of the cohort, respectively. Conclusions: CRC screening with the mt-sDNA test in this single-center study of incarcerated participants yielded exceptionally high adherence rates within 60 days of kit receipt. Assessment of follow up colonoscopy rates for test-positive participants is ongoing. While based on a relatively small sample size in this initial study, the mt-sDNA test exhibited favorable completion rates in a difficult to reach population, supporting further efforts to characterize patient, provider, and system-level benefits that may be obtained through broader adoption of this highly accessible screening approach in this challenging healthcare setting.