P0353 - Appropriateness of Cologuard Testing at an Academic Medical Center

Maitri Patel, MPH¹, Lindsey Bierle-Karnes, DO¹, Shaina Hasan, MD¹, Laura E. Lavette, MD², Andrew P. Copland, MD^1
1University of Virginia, Charlottesville, VA; ²University of Virginia Medical Center, Charlottesville, VA

Introduction: The development of multi-target stool DNA-based colorectal cancer screening improves accessibility and patient comfort regarding cancer prevention. While the sensitivity and specificity of Cologuard’s ability to detect cancer are comparable to fecal immunochemical tests (FIT), at 92 and 87%, respectively, there are still limitations in detecting advanced adenomas. Whereas previous studies have examined the inappropriate use of fecal occult blood tests (FOBT), we aimed to 1) better understand the impact of improper Cologuard usage, and 2) evaluate the most common patient risk factors leading to inappropriate Cologuard screening.

Methods: We conducted a retrospective cross-sectional study at a single tertiary care center from 2022-2023. We collected data on Cologuard results, follow-up colonoscopies, and risk factors that deemed patients ineligible for Cologuard testing. Descriptive analysis was performed using SAS 9.4.

Results: A total of 284 patients were prescribed a Cologuard test, of which 159 (56.0%) completed the screening. Of the 25 (15.7%) positive results, 10 were deemed inappropriate based on risk factors including personal history of polyps, family history of colon cancer, or alarm symptoms . 18 of the 25 patients completed a diagnostic colonoscopy, 15 of which had notable findings and eight met criteria for advanced adenomas. There was a mean of 4.47 polyps identified on colonoscopy. 76 (26.7%) of the total prescribed Cologuard tests were deemed inappropriate for the reasons listed in Table 1.

Discussion: More than a quarter of all prescribed Cologuard tests at our institution were inappropriately ordered and likely resulted in increased financial and emotional burden. To maintain the high specificity and sensitivity of this often-utilized screening tool, providers should be cognizant of the key invalidation criteria for Cologuard. Future work should investigate quality improvement measures that could further standardize the process of Cologuard testing and improve patient outcomes.



Disclosures:


Maitri Patel, MPH¹, Lindsey Bierle-Karnes, DO¹, Shaina Hasan, MD¹, Laura E. Lavette, MD², Andrew P. Copland, MD¹. P0353 - Appropriateness of Cologuard Testing at an Academic Medical Center, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.