Study finds choosing between at-home test and colonoscopy doubles colorectal cancer screening rate

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

"Providing a choice between colonoscopies or at-home kits appears to have the benefit of maximizing the frequency of colonoscopies—the most effective screening tool—while not overwhelming people with excessive choices, which could reduce overall uptake," said Shivan Mehta, MD., MBA, MSHP, lead author of the study, Deputy Chief Innovation Officer at Penn Medicine and Associate Professor of Gastroenterology.

Colon cancer screening is now recommended for patients at low risk - that is, without a 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 up to date, or home fecal immunochemical tests (FIT), which can be performed once a year instead of colonoscopies, provided there are no abnormal findings.

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

One study arm 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 only, FIT kits are typically used to keep colorectal cancer screening up to date for one year. Colonoscopies can detect early stages of cancer and allow precancerous polyps to be removed. One screening can keep screening current for up to a decade.

The study was conducted among 738 patients aged 50 to 74 years 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 the baseline screening rate before the study was about 22 percent, well below the national average of about 72 percent.

Despite the promising results of this study, much work remains 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 for younger populations, but this may have a greater impact on community health center populations,” 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 want 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 because it does not require patients to visit a clinic. This could also explain the low overall response rate.

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