04 May DDW25: Kaiser Program Reduced Racial Differences in Colorectal Cancer Screening and Outcomes Through Outreach Program
MedicalResearch.com Interview with:
Dr. Corley
Douglas Corley, MD, PhD
Chief Research Officer, The Permanente Medical Group
Kaiser Permanente, Northern California
MedicalResearch.com: What is the background for this study?
Response: Kaiser Permanente Northern California (KPNC) is an integrated health care system that designs and implements population-based programs that support cancer prevention and early detection. In 2006, KPNC began to implement a comprehensive colorectal cancer screening program with the goal of increasing member screening rates, preventing colorectal cancer through polyp removal, and reducing cancer mortality. The initiative identifies whether screening-eligible KPNC members are up to date with their colorectal cancer screening test by either a colonoscopy or by stool-based tests, such as a fecal immunochemical testing (FIT) kit. If they are not up to date with screening, it mails them a FIT kit for at-home testing. Members can also choose other options for colorectal cancer screening, such as a colonoscopy, through their physician.
MedicalResearch.com: What are the main findings?
Response: We evaluated screening and colorectal cancer-related outcomes annually from 2000 through 2019 across 22 KPNC medical centers for 1.1 million active members 50-75 years of age. The screening program was introduced across our medical centers from 2006 to 2008. Annual ascertainment of up-to-date status by colonoscopy (within 10 years), sigmoidoscopy (within 5 years), or fecal immunochemical testing (FIT) (in a measurement year) and mailed outreach was performed using FIT for those not up to date. Sigmoidoscopy was mainly used in the early years of the study and has been almost entirely replaced by colonoscopy for endoscopic screening. We then measured colorectal cancer incidence and mortality rates (per 100,000 population) with follow-up extended through age 79 to evaluate for potential effects beyond cessation of routine screening.
We found that, after starting the screening outreach intervention, the proportion of people who were up to date with colorectal cancer screening more than doubled across all racial and ethnic groups, increasing from 37.4% in 2000 to 79.8% in 2019. In the following years, colorectal cancer incidence initially rose, consistent with early detection, and then fell by 33% within 10 years. We also saw a 50% reduction in colorectal cancer-related mortality. This is remarkable on its own. It’s even more remarkable when you put this into the context of colorectal cancer being the second most common cause of cancer death — and that these cancer deaths fell by 50% within only a decade.
MedicalResearch.com: Was there a difference in outcomes between patients who had colonoscopy vs FIT testing?
Response: The intervention was designed to increase the number of people up to date with screening overall. It was not a comparison between colonoscopy and FIT testing. The incidence and mortality results reflect this combination. Large proportions were screened by each modality, though the large rise in up-to-date status was mainly from the FIT outreach. Studies have shown that offering patients more than one screening option increases screening more than offering either test alone. Almost no large settings in the United States have consistently achieved >80% screening rates offering only one option.
Modeling studies suggest that colonoscopy and FIT are likely similar, when used correctly, at decreasing deaths from colorectal cancer. This is through a combination of identifying cancers earlier, when they are more curable, and detecting and removing precancerous polyps. Colonoscopy appears better at decreasing cancer incidence, because it is more sensitive for pre-cancerous polyps. No head-to-head randomized trials of colonoscopy vs. FIT have been completed, though some are underway.
MedicalResearch.com: What should readers take away from your report?
Response: Our research shows that consistent and comprehensive screening outreach for a full population with a test that doesn’t require an in-person visit can make an extraordinary difference in both risk of getting cancer and the chance of dying from cancer. This is likely because this organized approach identifies who needs care and then reaches people in their homes, even if they are not making visits to the doctor. It also largely eliminates prior differences in who is dying from cancer, which varies by patient demographics.
What recommendations do you have for future research as a result of this study?
Response: I would like to see future research that looks at the implementation of a similar comprehensive programs for other preventable conditions with effective interventions, such as hypertension and kidney disease.
MedicalResearch.com: Is there anything else you would like to add?
Response: This organized approach offers great potential for reaching people where they are and achieving the best outcomes for many diseases. It underscores that if you can reach all your patients who need care, you also have a unique opportunity to implement a comprehensive colorectal cancer screening program that can reduce colorectal cancer deaths for everyone.
I have no disclosures.
Disclosures:
Dr. Corley presented data from the study, “Racial and ethnic differences in colorectal cancer screening and outcomes in a large integrated healthcare setting following introduction of a programmatic screening assessment of a 20-year period,” abstract 271, at 4 p.m. PDT Saturday, May 3, 2025
https://ddw.org/
More information:
- American Cancer Society
https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html - American College of Gastroenterology (ACG)
https://journals.lww.com/ajg/Fulltext/2021/03000/ACG_Clinical_Guidelines__Colorectal_Cancer.14.aspx
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Last Updated on May 4, 2025 by Marie Benz MD FAAD
