At-Home Tests Plus Mailed Reminders Encourage Colorectal Cancer Screening


Colorectal cancer is the third most common cancer in the United States. The American Cancer Society (ACS) states the average lifetime risk for developing this type of cancer is about one in 23 for men, and one in 25 for women. But colon cancer is also one of the most treatable if caught in the early stages.

The test routinely used to detect colon cancer and pre-cancerous polyps is a colonoscopy, a procedure that many patients fear and avoid. There are many reasons why someone may be reluctant to have a colonoscopy, but the most common complaint is the preparation, which includes drinking a significant amount of fluids and taking laxatives to empty your bowels completely. This is step is essential, though, so the bowel walls can be clearly seen.

FDA Approvals

In 2014, the Food and Drug Administration (FDA) approved the first non-invasive colorectal cancer screening test, Cologuard, that can be done at home without any of the colonoscopy prep. Along with finding blood in the stool, which could indicate cancer cells, the test also detects abnormal DNA. If there are cancerous or precancerous cells in the colon, they shed abnormal DNA, which enters the stool. Other similar tests followed. If people were avoiding colonoscopies, these tests could be a good way to help find people who have colorectal cancer before symptoms appear.

If you do get a positive result (blood or DNA are present), you will still need a colonoscopy so your physician can see inside the colon and look for possible causes. It’s also important to note that these tests are not for everyone. According to the ACS website, “Stool-based tests are not the best option for everyone. They are recommended for people who have an average risk for colorectal cancer: no personal history of pre-cancerous polyps, no colorectal cancer that runs in the family, or no other risk factors.” The tests are generally also for people who are 50 years old or older.

Before the FDA approvals for the above mentioned tests, physicians have been using fecal immunochemical tests, or FITs. These tests, developed in the 1970s, only detect blood in the stool and may be more dependable than the DNA tests.

Study Shows Benefit of FITs Plus Mailed Reminders

Even with the less invasive stool testing for colorectal cancer, many people are still slipping through the cracks. More than one-third of adults aged 50 to 75 years aren’t up to date. A study published in the journal Cancer investigated if there may be a way to increase this testing, reaching more people. The researchers mailed a reminder that screening was recommended or a reminder plus a FIT screening kit to 35,000 Medicaid patients aged 52 to 64, who had been identified as overdue for colon cancer screening.

The results showed that patients who received the reminders and the FIT kits were more likely to get screened (8,131 people) than those who got reminders alone (5,533 people). Since the goal of the study was to learn about the cost effectiveness of these interventions, the researchers also looked at the associated costs. They wrote, “From the Medicaid/state perspective, the reminder + FIT alternative dominated the reminder‐only alternative, with lower costs and higher screening rates. From the health clinic/facility perspective, the reminder + FIT versus the reminder‐only alternative resulted in an incremental cost‐effectiveness ratio of $116 per person screened.”

Better Screening, Lower Costs Overall

These findings show that it doesn’t have to cost a lot to get patients to go with recommended colorectal cancer screening. “By investing in sending the test kits with the reminder letters, health departments are expected to successfully screen more individuals for colorectal cancer at relatively low incremental costs, and Medicaid organizations are expected to actually save costs per additional person screened,” Stephanie Wheeler, PhD, MPH, said in a news release. Wheeler is with the University of North Carolina at Chapel Hill’s Lineberger Comprehensive Cancer Center. “This analysis provides strong evidence that health departments and payers like Medicaid can substantially improve colorectal cancer screening in low-income and medically underserved populations at a reasonable cost, even given limited budgets, through the implementation of mailed FIT programs.” Wheeler also noted that medically underserved populations are more likely to die from colorectal cancer than other groups, so this option could help manage their preventative healthcare more efficiently.

If you should be screened and would prefer to avoid a colonoscopy if possible, speak with your doctor or nurse practitioner about your options. Colorectal cancer is treatable, but it has to be caught as early as possible.

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