Timely Follow-Up After Positive Stool-Based Testing: Evaluating Diagnostic Colonoscopy Delays in Rural and Non-Rural Populations

Abstract

Background

Colorectal cancer is a leading cause of cancer-related deaths in the United States Hesitancy toward colonoscopy and long wait times have led to increased interest in DNA stool-based testing. Access to timely colonoscopy after positive stool-based tests may be challenging, particularly for rural populations. This study aimed to evaluate the timeliness of diagnostic colonoscopies following positive stool-based tests in rural and non-rural patients.

Methods

This was an observational case-control study of patients aged ≥18 years who had a positive DNA-based stool test and underwent diagnostic colonoscopy between January 2018 and December 2023. Participants were classified as rural or non-rural based on Rural-Urban Commuting Area (RUCA) codes. The primary outcome was the number of days from a positive stool test to diagnostic colonoscopy. Statistical analyses were performed using Wilcoxon rank-sum and Pearson’s Chi-squared tests.

Results

Of 1316 patients, 668 (50.8%) were from rural areas. The median time to colonoscopy was 35 days for rural patients and 37 days for non-rural patients (P = .6). There was no significant difference in follow-up times. Rural patients were more likely to undergo colonoscopy at an external facility (25% vs 3.1%, P < .001).

Conclusion

Both rural and non-rural patients received timely follow-up colonoscopies after positive stool-based tests, indicating that stool-based testing is an effective and accessible method for CRC screening. This supports the continued use of stool-based DNA testing in reducing the burden on health care systems and enhancing screening accessibility for all patients.