Patient perceptions of stool-based DNA testing across racial groups.

Abstract

1569 Background: Despite the widespread acceptance of colonoscopy as the gold standard for Colorectal Cancer (CRC) screening, compliance rates with recommended CRC screening lag far behind screening for breast and cervical cancers. Patients often delay or forgo screening colonoscopy due to associated discomfort, inconvenience, anxiety, and high cost. In addition, recent data have casted doubt on its effectiveness, especially in detecting right-sided colon neoplasia. Stool-based DNA (sDNA) testing is an emerging CRC screening tool that is convenient, noninvasive, and effective in detecting both right and left sided colon cancer. The goal of this study was to evaluate patient attitudes towards sDNA testing, identify preferences in CRC screening tools, and assess racial differences in these attitudes and preferences. Methods: In a colonoscopy-based case-control study, 100 patients of average CRC risk were asked to complete (1) sDNA testing (LabCorp ColoSure test), (2) screening colonoscopy, and (3) a patient satisfaction survey. Results: Eighty patients completed the study, including 55 (69%) White, 22 (27%) African American, and 3 (4%) Others. Overall, patients rated sDNA testing favorably in all preparation and test related features, except for perceived accuracy. Patients reporting a preferred screening method favored sDNA testing (78%) to FOBT (12%) or colonoscopy (10%), and 83% of all patients reported that they are likely to repeat sDNA testing. Non-Caucasians rated sDNA testing less favorably than Caucasians – reporting more discomfort (ANOVA, p<0.004), more anxiety (ANOVA, p<0.001), and less suitability (Chi-Squared, p<0.0035). Of those patients reporting a preferred screening test, 82% of Caucasians and 64% of non-Caucasians selected sDNA testing. Conclusions: Although sDNA testing was ranked less favorably by non-Caucasians, it was well received overall as the preferred CRC screening test, as compared to FOBT and colonoscopy. The differences between racial groups may reflect the generally lower uptake of CRC screening among non-Caucasians, regardless of the test. In conclusion, sDNA testing may be an effective means to increase CRC screening in African Americans, hence preventing CRC and closing the racial disparity gap.