A recent study indicates that a noninvasive colorectal cancer screening test, which can be performed at home, may lower the chance of dying from colorectal cancer by 33%. This research was published in JAMA Network Open and is the first to examine the effectiveness of this tool across different racial demographics.
Researchers from The Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and the Richard J. Solove Research Institute (OSUCCC — James), along with Kaiser Permanente, analyzed data from close to 11,000 patients who had home-based FIT (fecal immunochemical testing) from Kaiser Permanente’s members in Northern and Southern California between 2002 and 2017. Kaiser Permanente is recognized for having one of the largest home screening initiatives in the United States and has been at the forefront of promoting at-home colorectal cancer screening to enhance adherence to screening guidelines and address racial disparities.
Chyke Doubeni, MD, MPH, the senior author of the study, emphasized, “The optimal screening test is one that is performed and done correctly. Although it has been known for years that colorectal cancer can be identified at its earliest, precancerous stage through screening, only about 60% of Americans aged 45-75 are current with their screenings. This is a missed opportunity, as we could save many lives by making screening more accessible with non-invasive options like FIT.” Doubeni also holds the position of chief equity officer at the Wexner Medical Center and is a professor at The Ohio State University College of Medicine, focused on diversity, equity, and inclusion.
He explained that fear or embarrassment may prevent some individuals from getting screened via colonoscopy, leading to diagnoses at more advanced and less treatable stages of the disease.
“Research indicates that annual FIT screening is equally effective as a colonoscopy done every ten years for individuals at average risk. This study should provide individuals and their healthcare providers with confidence to use this non-invasive test and implement it in communities where colorectal cancer screening stats are low,” Doubeni noted.
However, he emphasized the importance of timely follow-up colonoscopy for anyone who receives a positive test result from a FIT screening. A screening colonoscopy involves inserting a thin tube equipped with a small camera into the rectum to inspect the intestinal lining, allowing for the removal of any precancerous polyps during the procedure and treatment of early-stage cancers before they advance further. In contrast, FIT utilizes a stool sample collected at home and sent to a lab for analysis.
Study Design and Methods
The evaluation of this recent study included data from 10,711 individuals who completed a FIT screening for colorectal cancer. Participants aged 52 to 85 were selected from various medical centers between 2002 and 2017.
Besides the 33% reduction in colorectal cancer death risk, the researchers found a 42% decrease in the risk of cancers located on the left side of the colon, including rectal cancers. The FIT screening was also associated with a lower risk of colorectal cancer deaths among non-Hispanic Asian, non-Hispanic Black, and non-Hispanic White populations.
“Colorectal cancer screening is effective and one of the best strategies to reduce deaths from this disease,” stated Douglas Corley, MD, PhD, a co-principal investigator and chief research officer at Kaiser Permanente, Northern California. “This study, which involved at least one FIT screening in the past few years, confirms the efficacy of this method. It can be conducted at home, and we believe that regular annual use, as recommended, could lead to even greater reductions in cancer deaths over time. In our experience, providing various screening methods has increased participation to over 80%, which correlates with a roughly 50% decrease in colorectal cancer mortality.”
Enhancing Access to At-Home Testing
The Wexner Medical Center and OSUCCC — James initiated a pilot program for at-home colorectal cancer screening tests, now also available in primary care clinics. This program is the first step in a broader effort to enhance screening access.
According to the American Cancer Society, Black individuals face a 20% higher likelihood of being diagnosed with colon cancer and a 40% increased risk of dying from the disease compared to their non-Hispanic white counterparts. Additionally, people residing in the Appalachian area also experience disproportionately high mortality rates from colorectal cancer.
The study was conducted with the contributions of various collaborators funded by the National Cancer Institute, including 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.
