Boosting Colorectal Cancer Screening in Young Adults: An Unsolicited FIT Kit May Be the Answer

Rates of early-onset gastrointestinal cancers, including stomach, pancreatic, and colorectal malignancies, have been on the rise in adults younger than 50 years. In the United States, the rates of colorectal cancer in adults 50 years and older have been stabilizing, while they are increasing in younger adults. Colorectal cancer is now the leading cause of cancer deaths in men younger than 50 and the second leading cause in women younger than 50. Breast cancer remains the number one cause of cancer deaths in younger women.

In 2021, the U.S. Preventive Services Task Force reduced the recommended age for colorectal cancer screening from 50 to 45 years. Still, the percentage of people aged 45 to 49 participating in screening remains concerningly low (less than 2%).

Several types of tests can be used to screen for polyps or colorectal cancer. For example, the fecal immunochemical test (FIT) can be done at home by collecting a small stool sample and sending it to a laboratory using a kit provided by a healthcare professional. The test uses antibodies to detect blood in the stool. This type of test is recommended once per year.

If a FIT screening reveals unusual findings, a follow-up colonoscopy is advised. During a colonoscopy, clinicians use a scope to view the rectum and colon lining and can remove polyps and potentially cancerous areas if detected. A colonoscopy is recommended every 10 years for people without increased risk factors for colorectal cancer and when needed as a follow-up to other types of screenings.

Colorectal cancer screening rates in young adults rise with effective outreach strategies, highlighting the importance of FIT kits for early detection. © Narsil - stock.adobe.com

In light of the low screening rates seen in adults between the ages of 45 and 49, a group of researchers led by Artin Galoosian, M.D., M.A., from the University of California, Los Angeles (UCLA), conducted a large study to determine the best outreach strategy to improve colorectal screening rates in young adults. The study, published earlier this week in JAMA, randomized more than 20,000 primary care patients from UCLA Health aged 45 to 49 with an average risk for colorectal cancer to one of four outreach strategies.

The strategies were as follows:

• Asking participants if they would like to receive a screening FIT kit by mail.
• Asking participants if they would like to have a screening colonoscopy.
• Asking if they would like to participate in colorectal cancer screening and given the choice between receiving a FIT kit by mail or having a colonoscopy.
• Mailing a FIT kit to the participants as part of their usual care without asking for opt-in.

The results showed that the most effective strategy for participating in screening was to mail the FIT screening kits without requiring active opt-in or choosing between types of screening tests. About 26% of patients randomized to this strategy completed a screening test. In comparison, about 16% of those given the option to receive a FIT kit at home completed screening, 14.5% of participants offered the option of a colonoscopy underwent screening, and about 17% of those given the choice between an at-home FIT kit or a colonoscopy completed screening. More participants in this modality chose colonoscopy over FIT kits (12% versus 5.6%).

In addition, the researchers found that 73% of patients with unusual FIT results received a follow-up colonoscopy within six months.

The authors concluded that directly providing the FIT kit via unsolicited mail was the most effective strategy to improve colorectal cancer screening rates in adults aged 45 to 49 years. However, they note that overall screening rates remained low and recommend additional research to further improve screening participation in young adults.