Early CRC Screening: Uptake Strong in Younger Adults Using Stool DNA Test

Early CRC Screening: Uptake Strong in Younger Adults Using Stool DNA Test

As colorectal cancer (CRC) incidence rises among younger adults, updated guidelines have lowered screening age recommendations from 50 to 45 years. However, adherence remains a challenge. New real-world data, published in Clinical and Translational Gastroenterology in June of 2025, highlight substantial uptake and predictors of adherence among individuals aged 45 to 49 using multi-target stool DNA (mt-sDNA) testing—a noninvasive, home-based screening option. Here is a brief overview of the study and its results.

Examining the Real-World Landscape

Researchers performed a retrospective analysis involving more than 1.1 million average-risk adults aged 45 to 49 years prescribed mt-sDNA tests. Data, spanning January 2017 to December 2023, were tokenized and integrated between a national multi-payor claims database and Exact Sciences Laboratories, then de-identified. Adherence was defined as returning a valid test result within one year of prescription.

Robust Adherence and Key Predictors

The study found notably high adherence rates to mt-sDNA screening, with the following results:

• Overall adherence was 68.9 percent, substantially surpassing reported fecal immunochemical test (FIT) adherence in similar age groups.
• Adherence was highest—at 75.5 percent—when tests were prescribed by a gastroenterologist compared to primary care, which had a rate of 70.7 percent.
• Individuals with commercial insurance exhibited the greatest adherence at 70.9 percent compared with significantly lower rates among Medicaid beneficiaries, which were at 47.2 percent.

Digital Communication: A Key to Higher Screening Rates

Digital outreach emerged as a powerful determinant of test completion, finding that:

• Those receiving both text (SMS) and email reminders had adherence rates of 71.4 percent, versus only 54.9 percent among individuals who received no digital communication.
• Logistic regression confirmed digital outreach as the strongest predictor of adherence in this age group, with a two-fold higher likelihood of adherence among individuals receiving combined SMS and email reminders compared to no digital outreach.

Lower Adherence in Minority Populations

Despite strong overall adherence, screening disparities remain, demonstrating that:

• African American and Hispanic or Latino individuals had notably lower adherence rates compared to White individuals, at 62.3, 63.5, and 69.5 percent respectively.
• Spanish-speaking participants had significantly better adherence than English speakers, highlighting the potential value of language-specific outreach.

Clinical and Systemic Implications

These findings underscore the importance of tailored, accessible CRC screening for adults aged 45 to 49 years. Leveraging digital communication platforms to enhance patient engagement and adherence could mitigate barriers faced by underserved populations. Provider type also matters—gastroenterologists drive the highest compliance, potentially due to patient concern leading to specialist referral.

Given the growing demands on healthcare infrastructure from expanding CRC screening guidelines and post-pandemic backlogs in colonoscopy services, higher-adherence at-home tests like mt-sDNA could substantially ease pressure on health systems while improving early CRC detection.

Addressing Gaps

Further research should explore interventions aimed at improving adherence among groups with lower uptake, including Medicaid enrollees and underserved populations. Enhancing digital navigation, particularly multilingual outreach, represents a readily implementable strategy. Longitudinal studies could clarify the factors influencing provider choice and the impact of targeted patient education on adherence.

Reference:

1. Greene M, Camardo M, Ozbay AB, Dore M, Fendrick AM, Limburg P. Adherence to multi-target stool DNA testing in individuals aged 45-49 years with average risk for colorectal cancer. Clin Transl Gastroenterol. Published online ahead of print 2025. doi:10.14309/ctg.0000000000000878.