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Kaiser Permanente expands at-home colorectal cancer screening

The current fecal immunochemical test program, conducted in the privacy of members' homes, is responsible for lowering deaths 50% over 20 years. Pictured, regular exercise is one healthy choice that is known to help reduce the risk of colorectal cancer.

Kaiser Permanente is expanding its easy to use, at-home colorectal cancer screening program to members age 45 and older starting in April, following a nationwide increase in deaths of people under age 50 from the disease.

The fecal immunochemical test, or FIT, for colon and rectal cancer will now be mailed out to an additional 270,000 Northern California Kaiser Permanente members each year, in addition to over a million already mailed out to those 50 and older, said Jeffrey Fox, MD, chair of Gastroenterology for The Permanente Medical Group in Northern California.

“This change in screening is acknowledging there is an increase in the rate of people being diagnosed and deaths in those ages 45 to 49,” said Dr. Fox. “And even though the absolute risk compared to older groups is still lower, the risk for those over age 50 has been declining for many years, we think, because of the screening.”

Dr. Jeffrey Fox, chair of Gastroenterology for The Permanente Medical Group in Northern California.

Theories for the 1.3% yearly increase in colorectal cancer deaths among those age 45 to 49 between 2008 and 2017 nationwide include unhealthy diet, obesity, and physical inactivity, said Dr. Fox.

The noninvasive test checks for hidden blood in a stool, which could be a sign of colorectal cancer or of benign colorectal polyps. If a test is positive, a doctor will perform a colonoscopy to examine the inner lining of the colon and rectum for signs of cancerous or pre-cancerous growths. The tests are mailed to members’ homes and members mail them back to Kaiser Permanente, free of charge.

“Most colorectal cancers grow from a benign polyp, so you can identify the precancerous state and treat it before it becomes cancer, and that works because in general we think it is a relatively slow process,” Dr. Fox explained. “There is usually time and that is why the FIT test is done annually. We have many chances to pick up the condition in a benign state.”

Kaiser Permanente’s home screening test has lowered colorectal cancer deaths by 50% among its members over the last 20 years, said Dr. Fox.

“And we estimate that our members have 30% less risk of death from colorectal cancer than non-members in part because of this testing program,” he added.

Colorectal cancer is the third leading cause of cancer deaths in the U.S. behind breast and lung cancer for women and behind prostate and lung cancer for men, Dr. Fox said.

In addition to doing the FIT test, a change in bowel habits, rectal bleeding, abdominal pain, or unexplained weight loss all should be cause for a doctor’s visit that could be related to potential colorectal problems, Dr. Fox said.

Dr. Fox noted that in addition to reducing deaths through use of the test among all members, Kaiser Permanente Northern California also drastically reduced the rate of colorectal cancer among Black members. Targeted testing outreach over the last 10 years brought the rate down from 54.2 per 100,000 to 21 per 100,000, which now is the same rate as white members.

“That is one of the biggest sources of pride about working here,” said Dr. Fox. “It means that no matter who you are or where you come from, we got your back and that includes colon cancer screening. We saw the difference, and we addressed it. That is a testament to the thoroughness of this organization.”


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