Multitarget DNA Stool Testing Kits Could Reduce Colorectal Cancer Screening Non-Compliance

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An assessment to improve colorectal screenings by shipping Cologuard kits to non-compliant patients proved beneficial for a Mayo Clinic research team.

Utility of the non-invasive, at-home multitarget stool DNA testing kit Cologuard, for the screening of colorectal cancer (CRC), could help improve noncompliant colorectal screenings by approximately 14%, according to a new study.

In data presented at the American Academy of Physician Associates (AAPA) 2024 Conference & Expo in Houston, TX, this week, a team of Mayo Clinic-based investigators reported findings from their in-clinic analysis showing a notable increase in completed CRC screenings among patients who were non-compliant to a colonoscopy referral at the time that instead received an at-home Cologuard stool collection kit.

The study also showed the testing kit’s capability to detect at-risk individuals, who were then referred for an in-person colonoscopy screening on the basis of their results.

Led by Brittany Strelow, DMSc, PA-C, of the SEMN departments of family medicine and community internal medicine at Mayo Clinic Rochester, the team sought to improve routine colorectal screenings among non-compliant patients in their region of southeast Minnesota. The team identified a benchmark goal of 17% improvement, to reduce their noncompliant list to approximately 11,000 patients by February 2023.

As they noted, noncompliance to CRC screening is a recurring issue in the matter of curbing the third-leading cause of cancer-related mortality in the US among both men and women. While screening strategies may include the current standard colonoscopy, as well as sigmoidoscopy and stool tests, noninvasive remote stool-based screening is an increasingly popular option among patients.

“Cologuard offers a convenient, at-home stool collection and preservation method coupled with a prepaid UPS pickup label,” the team wrote.

Pivotal clinical trial data supporting the multitarget stool DNA test were presented at last year’s American College of Gastroenterology (ACG) 2023 Annual Scientific Meeting, when investigators from the BLUE-C trial showed an associated 94% sensitivity and 91% specificity for CRC detection with Cologuard.

The team’s patient population included non-compliant, moderate-risk patients aged 45 - 75 years old. Patients received a telemedicine portal message explaining how the testing kit worked. Those who did not refuse the prompt received kits to their home address. The patients who received the kit were responsible for providing a stool sample collection and returning the kit.

A total of 12,032 Cologuard kits were sent to such patients; the team reported 1738 (14.4%) were returned. Of that total, 198 (11.4%) tested positive for cancerous DNA and fecal occult blood, and necessitated a colonoscopy referral for the patient.

Strelow and colleagues noted 1696 (98%) patients who returned their kits preferred English language; only 25 (1%) preferred Spanish. The team observed only patients who identified as White reported a higher rate of Cologuard testing kit return compared to the overall patient average of 14.4 (17.7%). Just 8.54% of Black or African American patients returned their kit.

Though their assessment missed the target goal of 17% improvement, the team highlighted all the same that Cologuard testing kits improved the non-compliance list for CRC screening by 14.4%, while proving to be a potentially more convenient and preferable initial testing method for patients.

Among the takeaways derived for clinicians, investigators wrote, included the significant of completing CRC screening for cancer risks earlier, as well as the importance of provider encouragement for patients to complete referred screening.


  1. Strelow B, Dorff H, Katula W, Pokuta J. Reducing Patient Barriers to Colorectal Cancer Screening via At-home Provision of Multitarget Stool DNA Testing Kits. Paper presented at: American Academy of Physician Associates (AAPA) 2024 Conference & Expo. Houston, TX. May 18 - 22, 2024.
  2. Kunzmann K. Taha Qazi, MD: Best Screening for Colorectal Cancer. HCPLive. Published August 7, 2023.
  3. Kunzmann K. Next-Generation Cologuard Improves Colorectal Cancer Detection, False Positive Rates in BLUE-C. HCPLive. Published October 23, 2023.