William Grady, MD: Improving Colorectal Cancer Screening Compliance with Patient Choice

Although colonoscopy is widely considered to be the “gold standard” for colorectal cancer screening, noninvasive alternatives may offer a more appealing, convenient alternative to help improve screening rates.

Stool-based tests have long been the only recommended colonoscopy alternative for patients, including the fecal immunochemical test (FIT) and the Cologuard multitarget stool DNA test, as well as the recently approved but not yet available ColoSense multi-target stool RNA test.¹ On July 29, 2024, the US Food and Drug Administration (FDA) expanded the noninvasive screening armamentarium with the approval of Guardant Health’s Shield blood test, making it the first FDA-approved blood-based primary screening option for adults 45 years of age and older at average risk for colorectal cancer.²

“If we use the parameter of someone who's supposed to be doing screening, so between 45 and 75, the rate is around 70-75% compliant for having done it once,” William Grady, MD, medical director of the Gastrointestinal Cancer Prevention Program at Fred Hutchinson Cancer Center, said to HCPLive. “If we instead look at screening as being a program, not just a one and done, but a test that gets done at intervals during that time when somebody should be getting screening, then the compliance rates start dropping, and now we start seeing the compliance is probably in the low 60%.”

Emphasizing the impact of patient choice on compliance, Grady went on the explain how the lowest compliance rates are observed when patients are only given a single choice. When health care providers present patients with different options that have different advantages and disadvantages potentially affecting their decision, compliance generally improves.

“If we go back to thinking about compliance, 30 to 40% of people are not being compliant with colorectal cancer screening. The tragedy is we have a test already, colonoscopy, that's very accurate for detecting colorectal cancer and detecting advanced polyps, but if it's not used, it doesn't work at all,” Grady said. “For those people who are opting not to colonoscopy and not to do the stool-based testing, we’re hoping they will now do colon cancer screening with a blood test.”

References

1. ^{Campbell, P. FDA Approves ColoSense, a Noninvasive mt-sRNA Test, for Adults 45 or Older. HCPLive. May 7, 2024. Accessed August 1, 2024. https://www.hcplive.com/view/fda-approves-colosense-a-noninvasive-mt-srna-test-for-adults-45-or-older}
2. ^{Brooks, A. FDA Approves First Blood Test for Primary Colorectal Cancer Screening. HCPLive. July 29, 2024. Accessed August 1, 2024. https://www.hcplive.com/view/fda-approves-first-blood-test-primary-colorectal-cancer-screening}