Primary Care Physicians Order 88% of FIT-Fecal DNA Tests

Colorectal

Douglas K. Rex, MD, MASGE reviewing Weiser E, et al. J Med Screen 2020 Feb 13.

This industry-sponsored study examined adherence rates to the fecal immunochemical test (FIT)-fecal DNA test commercially available from Exact Sciences Laboratories. The authors were all associated with the company.

Between September 1, 2016, and August 31, 2017, there were 368,494 Medicare patients (64% female) who had the test ordered, and 71% completed the test. The test was ordered by primary care physicians (PCPs) in 88% of the instances, gastroenterologists in 6%, and other specialists in the remainder. The adherence rate was lower when ordered by PCPs compared to gastroenterologists (71% vs 78%).

Comment:

These results indicate good completion rates for the FIT-fecal DNA test in Medicare beneficiaries, which likely, in part, reflects the company-sponsored navigation program. The strengths of the product continue to be high cancer sensitivity, aggressive marketing and education about colorectal cancer, and the navigation program.

However, the test is less effective and less cost-effective than annual FIT and colonoscopy every 10 years. Colonoscopy remains a very viable average-risk screening option, particularly in this elderly population, for which the false-positive rate of FIT-fecal DNA is high. These data indicate that messaging PCPs in the local practice environment about the value of colonoscopy is the best way to promote the continued high-level use of screening colonoscopy in the U.S.

Douglas K. Rex, MD, MASGE

Bio and Disclosures

Citation(s):

Weiser E, Parks PD, Swartz RK, et al. Cross-sectional adherence with the multi-target stool DNA test for colorectal cancer screening: real-world data from a large cohort of older adults. J Med Screen 2020 Feb 13. (Epub ahead of print) (https://doi.org/10.1177%2F0969141320903756)