For this study, researchers at The Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and the Richard J. Solove Research Institute (OSUCCC — James), and Kaiser Permanente evaluated data from nearly 11,000 patients who underwent at-home FIT (fecal immunochemical testing) among Kaiser Permanente’s members in Northern and Southern California between 2002 and 2017. Kaiser Permanente has one of the largest at-home screening programs in the United States and has been a leader in implementation of at-home colorectal cancer screening to increase overall screening guideline compliance and improve racial disparity gaps.

“The right screening test is the one that gets done — and is done well. Although we have known for decades that colorectal cancer can be caught in its earliest, precancerous state through screening, only about 60% of Americans 45-75 years old are up to date with screening. This is a tragedy because we could save many more lives by making screening more accessible through non-invasive screening methods like FIT,” said Chyke Doubeni, MD, MPH, senior author of the study. Doubeni serves as chief equity officer at the Wexner Medical Center, associate director of diversity, equity and inclusion at the OSUCCC — James and professor at The Ohio State University College of Medicine.

He said some people may not get screening coloscopy due to fear or embarrassment, which results in many people being diagnosed with the disease at more advanced, less treatable stages.

“The evidence shows that FIT done every year is as good as getting a colonoscopy every 10 years for screening people of average risk. This study should give individuals and their clinicians the confidence to use this noninvasive test for screening and find ways to deploy these tests in underserved communities where colorectal cancer screening rates are very low,” said Doubeni.

He notes, however, that it is critical that anyone with a positive test to not delay getting a colonoscopy to follow up on an abnormal FIT result. Screening colonoscopy is a procedure where a thin tube with a tiny camera tip is inserted in the rectum to view the intestinal lining. Precancerous polyps can then be removed at the time of the procedure and early cancers are treated before getting to advance stage. FIT involves a stool sample that is collected at home and mailed to the laboratory where it is tested.

Study design and methods

For this new study, researchers evaluated information from 10,711 people who completed a FIT screening for colorectal cancer screening. Patients between the ages of 52 and 85 were identified across multiple medical centers between 2002 and 2017.

In addition to reducing the risk of colorectal cancer-related death by 33%, researchers observed a 42% lower risk for cancers occurring on the left side of the colon inclusive of rectal cancers. FIT screening was also associated with lower risk of colorectal cancer death among non-Hispanic Asian, non-Hispanic Black and non-Hispanic White people.

“Colorectal cancer screening works and is one of the best ways of decreasing deaths from colorectal cancer,” said Douglas Corley, MD, PhD, a co-principal investigator and the chief research officer from Kaiser Permanente, Northern California. “This study, of at least one FIT screening in the last few years, confirms this method is an effective tool. It can be performed at home, and we anticipate that regular, annual use, as recommended, can result in even larger reductions in cancer deaths over time. In our setting, providing multiple methods for cancer screening has increased participation to over 80%, which has been associated with approximately a 50% reduction in colorectal cancer deaths.”

Increasing access to at-home testing

The Wexner Medical Center and the OSUCCC — James launched a pilot program to provide at-home colorectal cancer screening tests that is now also offered in the primary care clinics. The program is a first step in broader implementation to increase to screening.

According to the American Cancer Society, Black patients are 20% more likely to be diagnosed with colon cancer and 40% more likely to die of the disease compared to non-Hispanic white patients. People in the Appalachian region also have disproportionally high rates of death from colorectal cancer.

Collaborators in the National Cancer Institute-funded study include Douglas Corley, MD, PhD, Christopher Jensen, Theodore Levin, MD, Nirupa Ghai, PhD, Kimberly Cannavale, Wei Zhao, Kevin Selby, Skye Buckner-Petty, MPH, Ann Zauber, PhD, Robert Fletcher, MD, Noel Weiss, MD and Joanne Schottinger, MD.