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Mailed FIT Outreach Spurs Screening Rise and Early-Stage Colorectal Cancer Detection in 45–49 Year Olds

Recent JAMA publications demonstrate that default mailed FIT kits outperform active-choice outreach, revealing persistent screening gaps among uninsured and less-educated populations.

Overview

  • The American Cancer Society in 2018 and USPSTF in 2021 lowered the average-risk colorectal cancer screening age from 50 to 45, expanding eligibility to roughly 20 million more adults.
  • Up-to-date screening among 45–49 year olds climbed from 20.8% in 2019 to 33.7% in 2023 while rates for those aged 50–75 remained stable, dispelling concerns of resource diversion.
  • SEER registry data show local-stage colorectal cancer diagnoses in 45–49 year olds surged by 50% between 2021 and 2022, driven largely by first-time screenings.
  • A randomized JAMA trial found unsolicited mailed fecal immunochemical test kits achieved a 26.2% completion rate, significantly outpacing the 14.5–17.4% uptake in active-choice outreach groups.
  • Screening increases have been minimal among uninsured individuals and those without a high school diploma, underscoring the need for equitable implementation and continued monitoring of mortality outcomes.