Department of Research & Evaluation News

An analysis of Kaiser Permanente patients in California found a 33% reduced risk of dying from colorectal cancer among those completing at least one at-home fecal immunochemical test (FIT) screening. The study was published in JAMA Network Open.

In 2007, Kaiser Permanente Southern California began an organized colorectal cancer screening program that includes automated outreach with annual mailings of the FIT kit to eligible members 50 to 75 years old. FIT screening is noninvasive; those with a positive test result should follow up with a colonoscopy.

“Our integrated health care system provides a big advantage and convenience to our members with our organized colorectal cancer screening program, and the use of at-home FIT screening tests allows more members the opportunity to be screened,” said co-author, Nirupa Ghai, PhD, a senior scientific program manager with the Kaiser Permanente Southern California Department of Research & Evaluation. “Together with prior studies, our findings provide strong evidence for the use of FIT to reduce rates of death from colorectal cancer, and that benefit is seen across all the racial and ethnic groups we analyzed.”

Analysis included people between 52 and 85

The analysis included 10,711 people between ages of 52 and 85 who completed a FIT screening through a Kaiser Permanente medical center in Northern and Southern California. The researchers compared 1,103 people who died from colorectal cancer with 9,608 other patients of similar age, sex, and other characteristics, but did not have a colorectal cancer diagnosis when screened.

The analysis found 63.5% of patients in the study completed one or more of the at-home screening tests. Of the 12.6% who had a positive result, 79% went in for a colonoscopy. The study found a greater risk reduction for cancers identified in the left colon and rectum.

At-home colon cancer screening works

“Colorectal cancer screening works and is one of the best ways of decreasing deaths from colorectal cancer,” said co-author  Douglas Corley, MD, PhD, a researcher with the Kaiser Permanente Northern California Division of Research, and  chief research officer for The Permanente Medical Group.

“This study — of at least one FIT screening in the previous few years — confirms this method is an effective tool. It can be performed at home and we anticipate that regular annual use, as recommended, can result in even larger reductions in cancer deaths over time,” he said. “In our setting, providing multiple methods for cancer screening has increased participation to over 80%, which has been associated with approximately a 50% reduction in colorectal cancer deaths.”

In addition to Dr. Ghai and Dr. Corley, other authors on the paper include lead author Chyke A. Doubeni, MD, MPH, of The Ohio State University College of Medicine and the Center for Health Equity, The Ohio State University Wexner Medical Center; Christopher D. Jensen, PhD, and Wei K. Zhao, MPH, of the Kaiser Permanente Northern California Division of Research; Theodore R. Levin, MD, of the Division of Research and the Kaiser Permanente Bernard J. Tyson School of Medicine; Kimberly Cannavale, MPH, of the Kaiser Permanente Southern California Department of Research & Evaluation; Kevin Selby, MD, of the Center for Primary Care and Public Health (Unisanté), University of Lausanne; Skye Buckner-Petty, MPH, of the Mayo Clinic; Ann G. Zauber, PhD, Memorial Sloan Kettering Cancer Center; Robert H. Fletcher, MD, MSc, Harvard Medical School; and senior author Joanne E. Schottinger, MD, of the Department of Research & Evaluation and the Kaiser Permanente Bernard J. Tyson School of Medicine.