Presentation (CTI)

OBJECTIVES: Colorectal cancer (CRC) is a leading cause of cancer-related death in the United States, yet screening uptake remains low among incarcerated adults due to persistent logistical and access barriers. Noninvasive, scalable screening options are needed to improve participation in correctional settings. The multi-target stool DNA (mt-sDNA; Cologuard®) test is a guideline-recommended, home-based CRC screening tool with high sensitivity for cancer and advanced adenomas. This study evaluated adherence to mt-sDNA testing among adults served by the Connecticut Department of Correction (DOC-CT).
METHODS: This retrospective cohort study used deidentified, real-world data from Exact Sciences (2017-2025). Eligible records included mt-sDNA point-of-care orders placed by DOC-CT providers for adults aged 45-75 years. Records were excluded if participants were outside the eligible age range or had incomplete demographic information. The primary outcome was adherence, defined as return of the mt-sDNA kit with a valid result within 180 days of the shipment request date. Demographics were summarized, and adherence rates were compared overall and by age and sex using χ² tests.
RESULTS: A total of 1,220 mt-sDNA orders were included. The cohort was predominantly male (94.3%) and aged 45-64 years (92.7%). Overall adherence was 73.8% (900 of 1,220). Adherence varied by age group, ranging from 72.7% among those aged 50-64 years to 78.9% among those aged 65-75 years (p<0.0001), and was higher among males (74.8%) than females (57.1%; p=0.0011). Cumulative completion increased from 52.9% at 30 days to 73.8% at 180 days.
CONCLUSIONS: Adherence to CRC screening using the mt-sDNA test in the DOC-CT population was notable (73.8%), highlighting the feasibility of mt-sDNA screening in correctional settings. These findings support mt-sDNA as an equitable and practical strategy to expand CRC prevention in underserved populations.