Brief Article
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World J Gastroenterol. May 7, 2014; 20(17): 4972-4979
Published online May 7, 2014. doi: 10.3748/wjg.v20.i17.4972
Patient perceptions of stool DNA testing for pan-digestive cancer screening: A survey questionnaire
Dennis Yang, Shauna L Hillman, Ann M Harris, Pamela S Sinicrope, Mary E Devens, David A Ahlquist
Dennis Yang, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55902, United States
Shauna L Hillman, Division of Biostatistics, Mayo Clinic, Rochester, MN 55902, United States
Ann M Harris, Pamela S Sinicrope, Survey Research Center, Mayo Clinic, Rochester, MN 55902, United States
Mary E Devens, David A Ahlquist, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55902, United States
Author contributions: Hillman SL performed the statistical analysis; Harris AM, Sinicrope PS were involved in the design of the study and survey questionnaire; Yang D performed the literature search and wrote the first draft of the manuscript; Ahlquist DA provided the study concept, obtained funding support, and contributed critical appraisal of the manuscript; all authors were involved with the acquisition of data, analysis, interpretation, and critical revision of the final manuscript.
Supported by Research grant from the Oswald Foundation
Correspondence to: David A Ahlquist, MD, Professor of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, United States. ahlquist.david@mayo.edu
Telephone: +1-507-2664338 Fax: +1-507-2660350
Received: August 18, 2013
Revised: October 24, 2013
Accepted: November 1, 2013
Published online: May 7, 2014
Abstract

AIM: To explore patient interest in a potential multi-organ stool-DNA test (MUST) for pan-digestive cancer screening.

METHODS: A questionnaire was designed and mailed to 1200 randomly-selected patients from the Mayo Clinic registry. The 29-item survey questionnaire included items related to demographics, knowledge of digestive cancers, personal and family history of cancer, personal concern of cancer, colorectal cancer (CRC) screening behavior, interest in MUST, importance of test features in a cancer screening tool, and comparison of MUST with available CRC screening tests. All responses were summarized descriptively. χ2 and Rank Sum Test were used for categorical and continuous variables, respectively.

RESULTS: Completed surveys were returned by 434 (29% aged 50-59, 37% 60-69, 34% 70-79, 52% women). Most participants (98%) responded they would use MUST. In order of importance, respondents rated multi-cancer detection, absence of bowel preparation, safety and noninvasiveness as most attractive characteristics. For CRC screening, MUST was preferred over colorectal-only stool-DNA testing (53%), occult blood testing (75%), colonoscopy (84%), sigmoidoscopy (91%), and barium enema (95%), P < 0.0001 for each. Among those not previously screened, most (96%) indicated they would use MUST if available. Respondents were confident in their ability to follow instructions to perform MUST (98%). Only 9% of respondents indicated that fear of finding cancer was a concern with MUST, and only 3% indicated unpleasantness of stool sampling as a potential barrier.

CONCLUSION: Patients are receptive to the concept of MUST, preferred MUST over conventional CRC screening modalities and valued its potential feature of multi-cancer detection.

Keywords: Stool-DNA testing, Colorectal cancer screening, Gastrointestinal cancer screening, Patient perceptions

Core tip: The value of stool DNA testing could be expanded beyond colorectal cancer screening by simultaneously targeting gastrointestinal cancers above the colon. Early data suggest technical feasibility for such pan-cancer detection. However, while multi-organ stool DNA testing (MUST) would seem intuitively to have broad appeal; patient perceptions have not been evaluated. In this exploratory study, we demonstrate that patients were interested in using MUST if it was available to them. The potential unique ability to detect multiple cancers was its most distinguishing and attractive feature. General population surveys are warranted to corroborate these early findings.