Kaiser Permanente study reports on impact of 13 years of annual outreach with at-home testing
Kaiser Permanente Northern California’s integrated colorectal cancer screening program reduced cancer incidence by a third, halved deaths, and eliminated racial differences in outcomes, shows new research being presented at Digestive Disease Week 2025.
“Our study shows that consistent and comprehensive screening outreach to all eligible members, with no in-person visit required, can make an extraordinary difference in reducing colorectal cancer incidence and deaths and eliminating racial disparities,” said lead researcher Douglas Corley, MD, PhD, chief research officer for The Permanente Medical Group (TPMG) and a research scientist at the Kaiser Permanente Division of Research (DOR).
Kaiser Permanente Northern California (KPNC) started its comprehensive colorectal cancer screening program in 2006. The initiative reminds people it is time for their colorectal cancer screening test and sends them a fecal immunochemical testing (FIT) kit for at-home testing.
The study included 1.1 million men and women ages 50 to 75 who were KPNC members from 2000 to 2019. This allowed the research team to look at colorectal screening, incidence, and death rates before and after the program started.
The researchers found that after implementing the initiative colorectal cancer screening rates — with colonoscopy, sigmoidoscopy, or FIT testing — more than doubled across all racial and ethnic groups, increasing from 37.4% in 2000 to 79.8% in 2019.
Colorectal cancer diagnoses initially rose. This was expected, the researchers said, because of the large number of people who were not up to date on their colorectal cancer screening or who had never been screened. Over time, as more people were routinely screened, new diagnoses decreased by about 30%. This is because cancer screening identified and led to the removal of precancerous polyps. Deaths from colorectal cancer were cut in half.
Erasing disparities
Disparities between Black and White adults in colorectal cancer screening, incidence, and death rates in the United States have been documented for more than 40 years. In the new study, the largest reduction in colorectal cancer death rates (per 100,000) was seen in Black patients, whose deaths declined from 52.2 in 2009 to 23.5 in 2019. Among Hispanic, White, and Asian patients, deaths fell to around 20 per 100,000.
“It was incredibly gratifying to see the impact our systemic screening program had on all our patients,” said study co-author Theodore R. Levin, MD, a DOR research scientist and TPMG gastroenterologist who presented the research at the meeting. “But it was especially important to see that with equal access we could eradicate differences in important outcomes.”
Colorectal cancer is the second leading cause of cancer deaths in the U.S. Screening programs create an opportunity to find colorectal cancers when they are small and easier to treat. Screening can also prevent cancers from developing through the removal of precancerous polyps.
Corley and Levin believe KPNC’s screening program could be successfully introduced in other health care settings. “If you have the ability to get in touch with all of your patients,” said Corley, “then you have an opportunity to implement a comprehensive colorectal cancer screening program.”
The study, “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,” will be presented at the Digestive Disease Week meeting on May 3.
Co-authors include Wei K. Zhao, MPH, Christopher D. Jensen, PhD, MPH, Natalia Udaltsova, PhD, and Heather Jones, MPH, of the Division of Research; Chun Chao, PhD, Nirupa R. Ghai, PhD, Richard Contreras, MS, and Kimberly L. Cannavale, MPH, of Kaiser Permanente Southern California; and Aldenise Ewing, PhD, MPH, CPH, and Chyke Doubeni, MD, MPH, of The Ohio State University.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. KPDOR seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 720-plus staff, including 73 research and staff scientists, are working on nearly 630 epidemiological and health services research projects. For more information, visit divisionofresearch.kp.org or follow us @KPDOR.
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