Screening Initiative Cuts Down Colorectal Cancer Rates, Deaths by 50 Percent

A potential strategy to decrease screening disparities and improve outcomes is to give patients more personal options, such as at-home testing.

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Offering patients options to test for colorectal cancer may be a good strategy, according to the results of a study by Kaiser Permanente researchers presented at Digestive Disease Week. Investigators in this 20-year population-based study sent at-home kits for fecal immunochemical testing (FIT) and colonoscopy reminders to patients overdue for colonoscopies.

“If you offer people more than one option for screening—such as colonoscopy or FIT—they’re more likely to get screened than if you offer either option by itself,” Dr. Douglas Corley, researcher and gastroenterologist, said in a news release. “To get above an 80 [percent] screening rate, you almost always have to offer people multiple options.”

Understanding FIT

FIT tests in particular are a great way to reach both patients who live in rural areas and young adults, who are experiencing more incidents of colorectal cancer even as the overall incidence declines, Corley said in an American Medical Association update.

“So there are a lot of positives about it,” he said. “And that’s one of the reasons why the U.S. Preventive Services Task Force kind of equally recommends colonoscopy and FIT for benefit in terms of decreasing the risk of death from colorectal cancer.”

FIT tests are a noninvasive way to determine whether people have blood in their stool. People with positive tests should then follow up with a colonoscopy. Some providers may also order Cologuard testing. This test looks for abnormal cell DNA shed in the stool, which can be an indication of cancer.

Study Findings

Screening rates—via colonoscopy, sigmoidoscopy, or FIT—grew from 37.4 percent in 2000 to 79.8 percent in 2019 across all racial and ethnic groups, according to the researchers.

Giving patients more options in the type of colorectal cancer screening they received—including a FIT test mailed to their home—reduced the number of those who got cancer by one-third; reduced deaths by one-half; and eliminated nearly all the racial differences in screenings, diagnoses, and deaths.

There was a spike in colorectal cancer diagnoses during the first three years of the study—because of early detection—with overall incidence dropping across the cohort by 30 percent.

Colorectal cancer deaths decreased by about 50 percent, with the largest reductions seen in black patients who have historically had worse outcomes from colorectal cancer. Deaths among black patients declined from 52.2 per 100,000 to 23.5 per 100,000.

Corley said during an online media briefing that the changes were sustained throughout the duration of the study.

“It’s really remarkable that some of these large differences by mortality in race and ethnicity that we saw two decades ago and which we see throughout the United States are now similar,” he said.

These results demonstrate that offering more options to everyone levels the playing field for preventive care, he added.

Study Strengths

The size and scope of the study indicate that similar findings could be expected if it were reproduced, Corley said. The study also had diverse participants who reflected the population at large, and it followed them for two decades.

“This model could be applied to other preventable conditions with effective interventions such as hypertension and kidney disease,” Corley said.

Offering people choices—including a test they can take without leaving their house—is one way to reach more people and simplify the screening process. He added that colonoscopies aren’t always convenient, because people may need to take a day off of work for them and because drinking the bowel prep can cause uncomfortable bowel movements. Corley noted that not everyone wants the risks involved with colonoscopies, which include tears, bleeding, infection, and reaction to sedatives.

One weakness of the study was that it didn’t look at root cause issues, such as diet and environment, that could be contributing to cause or death, he said, adding that exactly how these factors contribute is still uncertain.

However, Corley noted that screenings help everyone regardless of root cause, and the study proved that screenings do give patients a better chance to prevent cancer—and to survive if they do get it.

“I think that was one of the more remarkable things,“ he said. ”When you take something that is the second-largest cause of cancer deaths and in a short period of time you cut that in half.”