CRC Screening Outreach Significantly Reduces Black-White Disparities, Including CRC Mortality Gap

A novel proactive colorectal cancer (CRC) screening program that combined annual mailed fecal immunochemical testing (FIT) to eligible adults with on-request colonoscopy resulted in dramatic increases in screening compliance among both Black and White individuals in an ethnically diverse northern California population, according to data presented by Rachel Issaka, MD, MAS, at the ACP 2025 Internal Medicine Meeting.

Even more significant, the Kaiser Permanente Northern California (KPNC) outreach effort significantly reduced the CRC mortality gap between Black and White adults among the nearly 800,000 KPNC health plan members over a 10-year period.

Patient Care© spoke with Issaka after her presentation at the ACP meeting in New Orleans and asked her to share more details of the program, the study, and the potential for other large health plans/insurers to see similar results from an organized CRC screening and follow-up program.

The following transcript has been lightly edited for style.

Patient Care: You talked about racial and ethnic disparities in screening rates for colorectal cancer and gave an example of a program that is working. Can you talk a bit about the Kaiser Permanente experiment?

Rachel Issaka, MD, MAS: I think the Kaiser example is really aspirational—it shows what’s possible across health systems. Now, it’s important to keep in mind that Kaiser is a managed care organization. It’s a closed health system, and all patients are insured, which makes a significant difference when it comes to colon cancer screening.

However, what they found was that over a 15-year period, using a mailed FIT strategy they were able to increase colon cancer screening rates to 83%. As a result, they were able to reduce colon cancer mortality by about 50%. That was among both Black and White individuals but the most significant changes were seen among Black members of the health plan.

The key takeaway for other health systems is that, despite challenges like varying insurance coverage and patients moving in and out of care networks, it’s still possible to make a big impact. If health systems can identify patients eligible for screening—especially those who aren’t coming in to see their primary care provider—and reach out with tools like mailed FIT kits, they can significantly improve screening rates among people who might otherwise go unscreened.

For more information: Doubeni CA, Corely DA, Zhao W, Lau YK, Jensen CD, Levin TR. Association between improved colorectal cancer screening and racial disparities. N Engl J Med. 2022;386:796-798 doi:10.1056/NEJMc2112409