A systematic assessment of colorectal cancer (CRC) screening status in a large diverse population, that included a mailed fecal immunochemical testing (FIT), approximately doubled the screening up-to-date status among all patients, according to new research presented at Digestive Disease Week 2025.
“The colorectal cancer deaths also fell dramatically after the initiation of screening,” said study author Douglas Corley, MD, PhD, Permanente Medical Group’s Chief Research Officer, Kaiser Permanente, Northern California, who presented the data. “It was about a 50 % drop across all of the groups to near parity.”
Within about 10 years, cancer rates were reduced by about a third, and the differences that had been previously seen by race or ethnicity were largely eliminated. “These follow -ups were then sustained in the latter years through 2019,” said Dr. Corley. “It's really remarkable that some of these large differences in mortality by race and ethnicity that we saw two decades ago and which are found throughout the United States are now similar to small chance variation in the population.”
Previous research has suggested that systematic outreach and follow-up for CRC screening increased screening rates and reduced disparities in cancer incidence and mortality between Black and White patients. However, it is still unclear what the impact is across other racial and ethnic groups, and over extended periods.
Dr. Corley and colleagues evaluated screening and CRC-related outcomes between 2000-2019 across 22 medical centers within an integrated health care system. The cohort included 1,095,612 individuals in 2019 (3664 American Indian or Alaska Native, 197,959 Asian, 76,141 Black, 173,067 Hispanic, 8025 Native Hawaiian or Pacific Islander, and 595,822 White members, 5205 members of multiple races, and 35,729 members of unknown race or ethnicity), between the ages of 50-75 years. Proactive outreach began around 2006 -2007 to members who were identified as being behind on screening, and FIT kits were sent to those who were not up -to -date with screening by another method. Screening status, colorectal cancer incidents, and mortality were tracked across the entire population.
“Screening rates more than doubled after starting the program, from around 37 % in the early years to about 80% and it stayed that high through 2019,” said Dr. Corley. “Importantly, these large increases occurred across everyone in the whole population with only small differences.”
In 2019, the screening up-to-date status was 75.9% in Hispanic, 77.2% in Black, 81.8% in White, and 83.0% in Asian members. Similar to screening prevalence, CRC incidence rates in these four groups increased from 109.1 to 126.4 cases per 100,000 in 2002, and then consistent with increased early cancer detection due to screening, which peaked during 2008-2010. Incidence then gradually declined, consistent with increased rates of polyp detection and removal, to 66.3 cases per 100,000 in Asian, 78.3 in Hispanic, 78.4 in White, and 87.1 in Black members in 2019.
Deaths due to CRC also dropped dramatically between 2002 and 2019, from 27.1 to 15.3 deaths per 100,000 in Asian, 39.8 to 20.7 in White, 42.1 to 21.9 in Hispanic, and 52.2 to 23.5 in Black members.
“It's important to note these findings do come from a large integrated health care system, which may differ from other settings, but similar outreach strategies have succeeded in safety net clinics and smaller practices,” said Dr. Corley. “These show that consistent comprehensive screening outreach for the full population without having to complete an in -person visit can make an extraordinary difference. And this model could be applied to other preventable conditions with effective intervention, such as hypertension and kidney disease.”
“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. Presented May 3, 2025. Digestive Disease Week 2025
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