Closing the loop in colorectal cancer screening: real-world adherence to follow-up colonoscopy after positive mt-sDNA vs FIT/FOBT, stratified by payer type
Bibliographic record
Abstract
Introduction A positive result from a multi-target stool DNA (mt-sDNA) test, fecal immunochemical test (FIT), or fecal occult blood test (FOBT) requires timely follow-up colonoscopy (FU-CY) to minimize colorectal cancer (CRC) incidence and reduce CRC-related mortality. To examine differences in FU-CY adherence between patients who received a positive mt-sDNA test or FIT/FOBT result by payer type.Methods This retrospective analysis utilized a large national claims database linked to the Exact Sciences Laboratories database, which covers over 20 million individuals. Eligible patients were 45-75 years of age and had a positive result between 1/01/2017 and 6/30/2022, with the first test result serving as the index date. Primary outcomes included FU-CY adherence and time to colonoscopy completion.Results A total of 362,646 (mt-sDNA n = 292,300; FIT/FOBT n = 70,346) patients with a positive result were identified during the study period. Overall adherence to FU-CY was significantly (p<.001) higher for the mt-sDNA test cohort (77.1%) compared to the FIT/FOBT cohort (45.1%). By payer type, FU-CY adherence for patients in the mt-sDNA test cohort was highest in those covered by commercial insurance (80.7%) and lowest in those with Medicaid (69.8%); for patients in the FIT/FOBT cohort, commercial insurance coverage (42.3%) was lower than for other payer types (47.4–47.9%). In the regression analysis, FU-CY adherence was significantly (p<.001) higher following screening with mt-sDNA than FIT/FOBT across payer types, sex, and race/ethnicity. Within 180 days, FU-CY rates across payer types were high ranging from 62.7%-74.9% following a positive mt-sDNA test, compared to 36.1%-42.5% observed for FIT/FOBT.Conclusion In this large, comprehensive study combining two national databases, overall, as well as across each payer type, adherence to FU-CY was substantially higher in patients that initially screened with mt-sDNA compared with FIT/FOBT. In addition, FU-CY rates within 180 days were significantly higher in patients that had a positive mt-sDNA test.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".