At-Home Screening Gets More Patients Tested for Colon Cancer

A new study published in JAMA Internal Medicine looked at how to help more people complete screening for colorectal cancer, which remains one of the leading causes of cancer-related deaths in the U.S. A team of investigators focused on patients receiving care in community health centers — settings that often serve people who may face barriers to screening, such as cost, access or language.

“Rates of colorectal cancer are rising, but many eligible people are unscreened, especially in community health centers,” explained study investigator Jennifer Haas, M.D., MSPH, of the Division of Internal Medicine in the Mass General Brigham Department of Medicine. “Community health centers are an important source of care in the United States, especially for under- or uninsured people. Since many community health centers are under-resourced, the goal of our research was to help design an intervention to specifically benefit people who receive care in these settings.”

The goal was to compare two types of at-home stool tests mailed directly to patients:

• A fecal immunochemical test (FIT), which detects hidden blood in the stool
• A FIT-DNA test, which looks for both blood and DNA changes linked to cancer

How the Study Worked

More than 5,100 adults aged 45 to 75 who were due for screening took part in this study. Most participants were from diverse and underserved communities, with many preferring Spanish and nearly half covered by Medicaid or uninsured.

Participants were grouped by clinic and received one of two outreach strategies:

• A mailed FIT test with text message reminders
• A mailed FIT-DNA test with manufacturer support

Investigators then tracked how many people completed screening within 90 days and 180 days.

What the Study Found

The results showed that FIT-DNA testing led to higher screening rates:

At 90 days:

• 27.9% completed screening with FIT-DNA
• 22.6% completed screening with FIT

At 180 days:

• 31.7% (FIT-DNA) versus 26.7% (FIT)

This suggests that FIT-DNA may be a more effective way to encourage people to complete screening when tests are mailed to their homes.

However, the study also revealed an important gap:

• Among patients with abnormal results, only 36% completed a follow-up colonoscopy within 6 months

Follow-up testing is critical because a positive stool test does not diagnose cancer, but it does signal the need for further evaluation.

Why This Matters for Patients

Colorectal cancer is highly treatable when caught early, but screening rates remain lower in underserved populations. This study shows that bringing screening directly to patients, by mail, can make a real difference, especially when using more advanced tests like FIT-DNA.

At the same time, the low follow-up rates highlight a key challenge: Screening is only the first step. Patients need support to complete the full process, including a colonoscopy if needed.

The Bottom Line

For patients, this research reinforces a few important points:

• At-home stool tests are easy, effective screening options
• FIT-DNA tests may encourage more people to participate
• Follow-up care is essential if results are abnormal

Expanding access to convenient screening and ensuring patients can complete the next steps could help save lives, especially in communities that need it most.

“Effective screening is essential because it allows us to catch and treat cancer early,” said Haas. “There are evidence-backed, preventive interventions for colorectal cancer, but they need to be implemented systematically in a way that addresses barriers for both the community health centers and the patients they are serving. The best screening test will always be the one that people are able to complete.”