Awareness of a patient's positive fecal immunochemical test or triennial multitarget stool DNA test increased adenoma detection rates among endoscopists, according to an early view study published Dec. 14 in Cancer Medicine.
Researchers, with the financial assistance of Exact Sciences, studied how endoscopist results varied in a colonoscopy and surveillance-only model compared to a model where patients followed-up a FIT or Cologuard test, Exact Sciences' multitarget stool DNA test, with a colonoscopy.
Researchers examined outcomes from 4,167 individuals who completed a colonoscopy every 10 years, 1,958 individuals who completed a mt‐sDNA test every three years or 2,036 individuals who completed an annual FIT. Patients from 50 to 75 years were included in the modeled scenarios and researchers reported outcomes per 1,000 individuals without diagnosed CRC at age 40. In the model, all patients with a positive test completed a follow-up colonoscopy.
In the base-case scenario, follow-up colonoscopy added the most life years gained in every model. Compared to a colonoscopy-only strategy, FIT added 90 percent LYG and mt-sDNA added 85 percent LYG.
When researchers increased differences in adenoma sensitivity between screening and follow-up surveillance, the colonoscopy-only model was less effective. In the same scenario, the follow-up colonoscopy model was more effective.
Researchers concluded, "Assuming identical adenoma sensitivities for screening and follow‐up/surveillance colonoscopies underestimate the potential benefits of stool‐based screening strategies."
Researchers disclosed that Exact Sciences contributed to the study design, data analysis and data interpretation.
A common complaint about colonoscopy-alternatives is that patients are left paying for the follow-up colonoscopy out-of-pocket because insurers do not cover the follow-up costs.