Colorectal cancer screening program helped eliminate racial disparities


New research conducted by Kaiser Permanente—and funded by the National Cancer Institute—has found that a multi-pronged screening program for colorectal cancer eliminated racial disparities among people with insurance.

The report, led by the Kaiser Permanente Division of Research, tracked colorectal cancer screening and death rates among people aged 50 to 75 within the insurer’s patient base in Northern California. The study spanned from 2000 to 2019, with the screening program implemented between 2006 and 2008.

The program identified people within Permanente’s patient base that are recommended for—or are behind on—getting screened for colorectal cancer, and were either mailed a self-administering test to their home or scheduled a colonoscopy. The proactive outreach and standardized testing regimen addressed inconsistencies in screening strategies across demographics, while also increasing participation and follow-up care, according to a letter published in the New England Journal of Medicine this week.

According to the study, the screening strategy increased screening 80% among Black members and 83% among white members by 2019.

At its launch, colorectal cancer death rates among Black members was 54.2 per 100,000, compared to 32.6 per 100,000 for white members. Ten years later, those margins slimmed considerably and mortality dropped, with death rates among Black people—within the Permanente network—tracking at 21 people per 100,000, compared to 20 individuals per 100,000 among white people.

The drop in mortality rates was attributed to earlier and more frequent detection of colorectal cancer, especially among Black people. This allowed physicians to prevent cancer from forming via polyp removal or to combat the cancer in its earlier and more treatable state.

Kaiser researcher Douglas Corley said the study underlined the need for healthcare organizations to meaningfully strategize member engagement for preventative health screenings as a way to reduce health disparities.

“We are always looking to improve, to understand why a small proportion of people choose not to be screened, to identify those at highest risk for more intensive screening and to increase efforts for culturally appropriate care,” he said. “Our findings suggest similar organized approaches can play a major role nationally and internationally in decreasing disparities for colorectal cancer and potentially for other diseases.”

Last year, the U.S. Preventative Services Task Force lowered the age to begin colon and rectal cancer screening from 50 to 45, in order to address the rising number of people in that age range that are being diagnosed with cancer. The American Cancer Society implemented the same change in 2018.

Colorectal cancer is one of the most lethal forms among people aged 50 and older, according to the Centers for Disease Control and Prevention. In 2018, 68.8% of adults were up to date with screening. However, prevalence among adults aged 50 to 64, as well those without insurance, was much lower.


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