How to connect communities to colorectal cancer screening

Penn Medicine has been on a multiyear journey to both raise the rates of screening for colorectal cancer and increase uptake of follow up care, with the goal of driving down colorectal cancer death rates and addressing inequities. Right now, colorectal cancer is the second leading cause of cancer death in the U.S., with higher rates in the Black community than any other racial/ethnic group. Black Americans are 20% more likely to get colorectal cancer, and 40% more likely to die of it compared to most other groups, according to the American Cancer Society.

A pair of hands holding a cancer screening kit vial in one hand and paperwork in another extended to a person standing in a park.
A FIT Kit comes in an envelope and includes instructions, a prepaid return mailing envelope, and a small tube to contain a probe that the user will insert into a stool sample to capture a tiny particle. In the lab, the small sample is tested for signs of blood in the stool, which may not be visible. (Image: Penn Medicine Service in Action)

“It’s not one thing that’s causing the disparity. It’s a series of small failures at every step. When you add those small failures together, you get a big disparity like this,” says Richard Wender, chair of the department of Family Medicine and Community Health at the Perelman School of Medicine, and chair of the National Colorectal Cancer Roundtable.

More screening alone won’t fix the racial disparity, but it’s an important start. And Penn Medicine is taking that running start in multiple ways: not solely relying on patients scheduling colonoscopies, but partnering with community health centers, churches, and community groups to distribute at-home testing kits, and pulling data from electronic health records to mail kits to patients who need to be screened.

In this first step of increasing screenings, there are already signs of success.

Not only is that higher than the overall 68.8% rate in the U.S. of all adults in 2018, the last year data is available, but Penn achieved this during the pandemic, when patients were less likely to come into healthcare settings, and when almost every other cancer screening rate fell.

“If we can help eliminate those barriers to accessing colorectal cancer screenings, we would find it earlier and maybe prevent its progression, and reduce the rates of colorectal cancer death in our region that disproportionately falls on Black and Latino patients,” says Armenta Washington, senior research coordinator at Penn Medicine. “We can make a real difference in our communities, and save lives.”

A colonoscopy isn’t the only way to screen for colorectal cancer. At-home testing kits use a stool sample, collected by the patient at their convenience, to test for the presence of blood, which can be a signal that polyps or cancer is present in the colon or rectum. A FIT kit, which Penn Medicine uses for population-based screening in addition to colonoscopies, can be as effective in reducing the burden of colorectal cancer as colonoscopy if it’s done every year.

Penn Medicine has launched two efforts into getting FIT kits to people who are at high risk of colorectal cancer, both of which address every step in the colorectal screening process: identifying who could benefit from an at-home kit, following up to make sure they drop off or return kits, and then helping those who test positive get colonoscopies, in some cases helping them obtain funding and/or health insurance to cover the costs of treatment.

This story is by Jen. A. Miller. Read more at Penn Medicine Service in Action.