Improving CRC screening in an underserved population: real-world adherence to mt-sDNA testing among the incarcerated in Nebraska, United States.

Objectives: This study assessed adherence to colorectal cancer (CRC) screening with a multi-target stool DNA (mt-sDNA) test in a real-world, carceral setting.

Methods: This was a retrospective observational study in a prison system using laboratory data from Exact Sciences Laboratories LLC. Individuals aged 45-85 years incarcerated by the Nebraska Department of Correctional Services (Nebraska, United States) covered under a single National Provider Identifier were included. Participants underwent CRC screening evaluation at the prison's medical center (June 1, 2023-April 1, 2024). Adherence and the time to test return (days) were evaluated overall and across patient characteristics.

Results: A total of 189 patients were included (50-64 years: 78.3%; male: 94.7%). Overall adherence was 92.6%. Adherence was numerically higher in those aged 65-75 years and in participants from rural and small-town correctional facilities (95.2% each). Mean overall time to test return from shipment of mt-sDNA kit to receipt of a valid test was 21 days, with numerically shortest time to test return in participants aged 45-49 years (18.8 days), from small-town correctional facilities (19.2 days), and females (17.3 days). Overall mt-sDNA test positivity rate was 17.7%.

Conclusion: High rates of adherence to the mt-sDNA test were observed in an underserved, incarcerated population, suggesting the potential of this screening approach in increasing rates of CRC screening and completion in this population. Future investigation into the possible individual-, provider-, and system-level benefits that may be obtained through broader adoption of the mt-sDNA screening test is warranted.