Optimizing Follow-Up Colonoscopy Rates for CRC Screening, with Mark Fendrick, MD

New research is shedding light on differences in adherence to follow-up colonoscopy after a positive result on a noninvasive colorectal cancer screening test, with results suggesting the benefit of initial screening with a stool-based DNA test.

In 2021, the US Preventive Services Task Force lowered the recommended screening age from 50 to 45, vastly expanding the screening-eligible population.1 Combined with a backlog from the COVID-19 pandemic and limited colonoscopy capacity, these factors have accelerated the push toward non-invasive testing options.

However, a follow-up colonoscopy is essential to complete the screening process when a noninvasive test yields a positive result.

“While not everyone who should be getting a follow up colonoscopy is getting them, we know that a significantly higher number of people are getting them,” Mark Fendrick, MD, professor and director of the Center for Value-Based Insurance Design at the University of Michigan, explained to HCPLive, citing the benefits of recent federal regulations mandating no-cost follow-up colonoscopies for insured patients.

Fendrick goes on to describe research being presented at Digestive Disease Week (DDW) 2025 demonstrating greater rates of follow-up colonoscopy with stool DNA testing than with FIT. Specifically, the studies looked at this trend in the context of certain variables, including age, geographic location, and race, consistently demonstrating increased rates of follow-up colonoscopy with initial multitarget stool DNA testing than fecal immunochemical tests or fecal occult blood tests.2,3

He credits much of the improved adherence to the robust patient navigation and educational support offered by manufacturers of stool DNA tests, which help address common barriers such as limited health literacy, confusion about the steps involved, and difficulty with scheduling or preparing for colonoscopy.

Looking ahead, Fendrick points to the promise stool DNA testing offers for helping to achieve the goals of minimizing the burden of colorectal cancer.

Editors’ note: Fendrick has relevant disclosures with AbbVie, Exact Sciences, Johnson & Johnson, Medtronic, MedZed, Merck, Phathom Pharmaceuticals, and others.

References

1. USPSTF. Final Recommendation Statement. Colorectal Cancer: Screening. May 18, 2021. Accessed May 4, 2025. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening

2. Greene M, Stieber B, Ozbay AB, et al. ADHERENCE TO FOLLOW-UP COLONOSCOPY AFTER POSITIVE STOOL-BASED SCREENING: EXAMINING DIFFERENCES BETWEEN MULTITARGET STOOL DNA TESTS VERSUS FECAL IMMUNOCHEMICAL OR FECAL OCCULT BLOOD TESTS IN RACIAL/ETHNIC SUBGROUPS. Abstract presented at DDW 2025 in San Diego, CA, from May 3 - May 6, 2025.

3. Greene M, Stieber B, Ozbay AB, et al. ADHERENCE TO FOLLOW-UP COLONOSCOPY AFTER A POSITIVE STOOL-BASED TEST PATIENTS AGED 45 TO 49 YEARS: REAL WORLD DIFFERENCES BETWEEN MULTITARGET STOOL DNA TESTING VERSUS FECAL IMMUNOCHEMICAL OR FECAL OCCULT BLOOD TESTING. Abstract presented at DDW 2025 in San Diego, CA, from May 3 - May 6, 2025.