Colorectal cancer (CRC) is the second leading cause of cancer death in the United States and disproportionately impacts those receiving care in low-resource settings. Fortunately, several effective screening tests are available to detect most treatable cancers early. Researchers from Massachusetts General Brigham and UCLA Health, in collaboration with community health centers (CHCs), mailed one of two stool-based screening tests to more than 5,000 participants from CHCs in Boston and Los Angeles. The researchers found that participants were more likely to complete the screening if they received the new stool-based screening test, but the uptake of follow-up colonoscopies for participants with abnormal results remained low. The survey results are posted below JAMA Internal Medicine.
The incidence of colorectal cancer is increasing, but many people are not being screened, especially at community health centers. CHCs are an important source of care in the United States, especially for the uninsured and uninsured. Because many CHCs are under-resourced, the goal of our study was to help design interventions that specifically benefit those receiving care in these settings. ”
Jennifer Haas, MD, PhD, MSc, Department of Internal Medicine, Brigham General Hospital, Massachusetts Corresponding Author
Haas and colleagues are members of the Stand Up To Cancer (SU2C) Colorectal Cancer Health Equity Dream Team, which brings together leading researchers, patient advocates, community leaders, and clinicians to achieve several goals, including improving colorectal cancer screening in underserved communities.
Previous studies have increased CRC screening in CHCs by mailing stool-based tests to patients, but with multiple mailed tests now available, it was unclear which tests and forms of patient support would be most effective. In the current study, researchers compared completion rates among participants who received either a mailed fecal immunochemical test (FIT) or a FIT-DNA kit. Both are non-invasive at-home tests that detect blood in the stool. However, the new FIT-DNA test also identifies abnormal DNA indicative of cancerous or precancerous polyps and is repeated every three years (instead of every year). Although CHC covers the costs of mailing the FIT tests and providing patient support, the manufacturer of FIT-DNA coordinates the mailing of these tests and provides a comprehensive assistance program to support patients through the completion of the screening test.
Participants in the randomized study included adults aged 45 to 75 who were scheduled for colorectal cancer screening at eight CHCs in Boston and Los Angeles. Patients were primarily Hispanic (75%) and received Medicaid (50%). Ultimately, 28% of patients who received the FIT-DNA kit completed the screening after 90 days. This was significantly higher than the completion rate (23%) for patients who received a FIT kit and automated text message reminders in English or Spanish. The researchers suggested that the higher completion rate of FIT-DNA screening may have been due to increased support through patient assistance programs and a possible reduction in testing frequency.
In another related study conducted in a tribal area of South Dakota, FIT-DNA kits were associated with increased participation in colorectal cancer screening. Improving screening is especially important among Native Americans because of their high incidence of colorectal cancer and low screening rates.
Researchers highlight the urgency of improving access to diagnostic colonoscopies, which are required after a positive stool or blood test. In this study, even though participants with abnormal stool tests received telephone consultations to explain colonoscopy and schedule an appointment, completion rates were only 36% in both the FIT and FIT-DNA groups, lower in Los Angeles than in Boston, likely related to differences in access to colonoscopies and insurance coverage.
“Effective screening is essential because it allows us to detect and treat cancer early,” Haas said. “There are evidence-backed preventive interventions for CRC, but they need to be implemented systematically in a way that addresses barriers for both CHCs and their patients. The best screening tests are always the ones that people can complete.”
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Reference magazines:
May, F.P. Others. (2026). Colorectal cancer screening mail outreach in community health centers. JAMA Internal Medicine. DOI: 10.1001/jamainternmed.2026.1170. https://jamanetwork.com/journals/jama/fullarticle/10.1001/jamainternmed.2026.1170
