At-home colorectal cancer screening participation, persistency, and connection to follow-up care: insights from a large multi-state system

Colorectal cancer (CRC) is one of the most common sources of cancer incidence and mortality in the United States. Early detection is crucial for positive outcomes, but screening rates persistently fall short of public health goals. Low-barrier screening options like fecal immunochemical tests (FITs) have the potential to increase screening and reduce disparities across demographic groups, but they require annual testing and follow-up for abnormal results. The study used a retrospective, observational design to assess screening patterns for three types of FIT participation (i.e., initial, continued, and connection to follow-up care) in a multi-state health system. All age-eligible adult patients mailed a FIT from January 2019 to March 2025 were included ( n = 158,128). The main measure for initial and continued participation was FIT return; the main measure for follow-up participation was having a colonoscopy within 12 months of receiving an abnormal FIT result. The majority (59%) of patients who received a FIT participated, and 73% of eligible patients participated in a second test. Among those with abnormal results, 59% had follow-up testing within a year. Initial, continued, and follow-up screening rates varied by race/ethnicity, language, payor, and geography. Findings highlight the potential benefits of low-barrier CRC screening like FIT for certain groups, as well as opportunities to engage all eligible patients across the CRC screening paradigm.