A study of nearly 500,000 adults finds that consistent annual testing leads to earlier diagnoses and is heavily influenced by provider outreach strategies.
A Rutgers Health-led study of nearly 500,000 adults reveals that nearly half of patients who complete an initial at-home stool test for colorectal cancer fail to repeat the screening consistently. The research, published in Clinical Gastroenterology and Hepatology, indicates that health system outreach is a primary driver of patient adherence to annual testing.
The study followed 492,812 adults from four large health systems for up to a decade after a negative home stool fecal immunochemical test (FIT). Results showed that 54% of participants repeated the annual test in more than 75% of subsequent years, while 30% repeated it at least once, and 16% never retested.
“This isn’t just about a doctor’s recommendation or the individual prevention beliefs of a patient. Systems can have a powerful impact,” says Ethan Halm, MD, MPH, MBA, vice chancellor for population health at Rutgers Health and lead author of the study, in a release.
Impact on Cancer Staging
The consistency of retesting significantly impacted the stage of cancer at the time of diagnosis. Among patients subsequently diagnosed with colorectal cancer, advanced disease accounted for 19% of initial diagnoses in those who never retested, compared to 12% in those who retested at least once. Local-stage cancer, which is the easiest to treat, was the initial diagnosis for 56% of consistent retesters and 44% of those who never retested.
The FIT screenings involve patients collecting a stool sample and returning it to a laboratory to check for microscopic blood, which can indicate colorectal cancer or advanced polyps. While the test is inexpensive and easy to conduct, it is less sensitive than a colonoscopy, requiring annual repetition according to clinical guidelines.
“For those doing FIT testing, this is not a one-and-done testing strategy. You need to check your rear every year,” says Halm, who also serves as the deputy chief population health officer at RWJBarnabas Health, in a release.
The Role of Population Outreach
The study found that the health system providing the care was the strongest predictor of retesting rates. Even after researchers adjusted for patient differences, the odds of consistent testing varied more than 20-fold among the four systems studied: Parkland Health in Dallas and the Kaiser Permanente systems in Northern California, Southern California, and Washington state.
Kaiser Permanente Northern California demonstrated the highest adherence rates. The system utilized organized population outreach strategies, such as mailing FIT kits to patients who were overdue and making kits available for pickup at primary care offices, laboratories, pharmacies, and flu clinics. These methods helped reach patients who do not regularly visit doctors for annual checkups.
Halm says the differences in retesting rates should inform how medical practices speak to patients and how health systems organize outreach programs.
“The best test is the test that gets done,” says Halm in a release.
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