Study finds that choosing between a home test and colonoscopy doubles the rate of colorectal cancer screening

Colorectal cancer screening rates more than doubled when patients were offered a choice between a home testing kit or a colonoscopy, compared with those offered a colonoscopy only, according to a new study from the Perelman School of Medicine at the University of Pennsylvania. The study, published in the journal Clinical Gastroenterology and Hepatology, provides information on how to increase screening rates among groups typically less likely to get tested.

"Providing a choice between colonoscopy or home kits appears to have the benefit of maximizing the frequency of colonoscopy — the most effective screening tool — without overwhelming people with too many choices, which could reduce overall engagement," said Shivan Mehta, MD, MBA, MSHP, lead author of the study, associate chief innovation officer at Penn Medicine and associate professor of gastroenterology.

Colon cancer screening is now recommended for low-risk patients — meaning no personal or family history of the disease, among other factors — starting at age 45. There are two main methods: colonoscopies, which are recommended every 10 years to keep screening "fresh," or at-home fecal immunochemical tests (FITs), which can be done once a year instead of colonoscopies, provided there are no abnormal findings.

When patients in Mehta’s study were offered only a colonoscopy, the results showed that less than six percent completed the test within six months. But when patients were given the option of choosing between a colonoscopy and a fecal immunochemical test (FIT), which can be done at home and sent by mail, the screening completion rate rose to nearly 13 percent. Among the group offered a choice between the two methods, about 10 percent had a colonoscopy.

One study group offered patients only FIT kits, and about 11 percent of patients completed the tests within six months. While this was also an improvement over offering colonoscopy alone, FIT kits are typically used to maintain colorectal cancer screening for one year. Colonoscopies can detect early-stage cancer and allow precancerous polyps to be removed. One screening can maintain screening for up to a decade.

The study was conducted among 738 patients aged 50 to 74 at a community health center in Pottstown, Pennsylvania. The researchers described the population as "socioeconomically disadvantaged," with about half of the patients receiving Medicaid and a baseline screening rate of about 22 percent before the study began, well below the national average of about 72 percent.

Despite the promising results of this study, there is still much work to be done. “There are some challenges with access to colonoscopy across the country due to the recovery from the slowdown during the pandemic and the expansion of screening recommendations to younger populations, but this may have a greater impact on the community health center population,” Mehta said. “Colonoscopy is important for screening, symptom diagnosis, and follow-up after a positive stool test, but we must consider offering less invasive options as an alternative and choice if we are to increase screening rates.”

Another important aspect of this study was that it offered screening via mail, which has previously been shown to increase screening rates as it does not require patients to visit a clinic. This may also explain the low overall response rate.

Research into how to offer screening could play a big role in improving surveillance and outcomes even among younger populations than those studied, as colorectal cancer rates have increased among patients under 50 years of age.