Multi-target stool DNA test adherence among individuals screened for colorectal cancer through the US Defense Health Agency

Objective: Multi-target stool DNA (mt-sDNA) testing has demonstrated higher screening adherence compared with other colorectal cancer (CRC) screening modalities. Members of the US military tend to have higher CRC screening rates, but adherence to mt-sDNA testing among service members has not been adequately studied. Methods: Mt-sDNA test adherence within one year and time to kit return was measured for individuals aged 45–64 years prescribed mt-sDNA tests through the Defense Health Agency (DHA) from April 26, 2022 to October 26, 2024. Logistic regression analysis was performed to determine demographic factors associated with adherence. Results: A total of 62,209 patients were included. Overall, mt-sDNA test adherence was 80.6%. Logistic regression analysis demonstrated that patients with median household income >$125k (odds ratio [OR] 1.17, 95% CI 1.04–1.32, p = 0.007, ref: <$50k), patients with tests prescribed by gastrointestinal specialists (OR 1.55, 95% CI 1.26–1.91, p < 0.001, ref: nurse practitioner/physician assistant), patients who opted for email and text message reminders (OR 1.78, 95% CI 1.62–1.96, p < 0.001, ref: no digital communications), and patients with ≥1 prior returned test (OR 1.92, 95% CI 1.81–2.04, p < 0.001, ref: new patients) had higher odds of adherence. Adherence was high in almost all subgroups, including traditionally underserved populations. Conclusion: Among more than 60,000 US military members, retirees, and their family members, 80.6% completed provider-prescribed mt-sDNA tests. Further study of factors leading to higher CRC screening adherence among military members and their families may inform the development of strategies to improve screening adherence in other populations.