Colorectal Cancer Screening Rates Vary Across Patient Groups

Fecal Immunochemical tests (FITs) screening participation reached 59% among eligible adults in a large multi-state study, although substantial differences emerged across demographic groups and stages of the colorectal cancer screening pathway. The findings highlighted both the potential of accessible screening approaches and the importance of ensuring patients receive appropriate follow-up care.

Understanding FIT Screening Participation

Colorectal cancer (CRC) remains one of the most common causes of cancer incidence and mortality in the United States. Although early detection is essential for improving outcomes, screening participation continues to fall below public health targets.

Fecal immunochemical tests (FITs) offer a lower-barrier approach to screening, with the potential to increase participation and reduce disparities. However, their effectiveness depends on regular annual testing and timely follow-up when results are abnormal.

To investigate screening patterns, researchers conducted a retrospective observational study across a multi-state health system. The analysis included 158,128 age-eligible adults who received a mailed FIT between January 2019 and March 2025. Participation was assessed across three stages: initial screening, continued participation through repeat testing, and connection to follow-up care following an abnormal result.

Screening Rates and Follow-Up Findings

The results demonstrated encouraging participation, with 59% of patients who received an initial FIT returning their test. Among patients eligible for repeat screening, 73% participated in a second test, suggesting continued engagement with accessible screening options.

However, follow-up care presented an additional challenge. Among patients with abnormal FIT results, only 59% underwent a colonoscopy within 12 months of receiving their result. This finding highlighted a potential gap between initial screening participation and the completion of subsequent diagnostic investigations.

Across all three stages, screening rates varied according to race and ethnicity, language, payor, and geographical location. These differences indicated that participation was not consistent across patient populations, highlighting the importance of examining the entire screening pathway rather than focusing solely on initial test completion.

Addressing Gaps Across the Screening Pathway

The findings demonstrated the potential value of low-barrier CRC screening approaches, particularly for encouraging initial and continued participation. Nevertheless, the proportion of patients completing follow-up after abnormal results highlighted an important opportunity to strengthen care pathways.

Reference

Gronowski B et al. At-home colorectal cancer screening participation, persistency, and connection to follow-up care: insights from a large multi-state system. Sci Rep. 2026; DOI:10.1038/s41598-026-77616-0.