Automatically sending stool test kits to individuals’ homes could be the most effective strategy for increasing colorectal cancer screening among adults aged 45 to 49, according to a new study.
The research, published Aug. 4 in the Journal of the American Medical Association (JAMA), found that significantly more people in this age group completed screenings when they received an unsolicited fecal immunochemical test (FIT) in the mail—compared to those who were asked to opt in or choose a method themselves.
“Removing the need for patients to actively opt into screening can lead to better outcomes,” said senior author Dr. Folasade May, a gastroenterologist and cancer prevention researcher at UCLA Health’s Jonsson Comprehensive Cancer Center. “This is especially true for younger, healthier adults who may not yet view themselves at risk for colorectal cancer.”
The American Cancer Society (ACS) lowered its recommended screening age from 50 to 45 in 2018, a move echoed by the U.S. Preventive Services Task Force in 2021. That change has led to improved early detection rates in this age group.
However, overall screening participation remains low. One recent study found that fewer than 2% of eligible individuals aged 45–49 undergo screening.
To investigate effective outreach methods, researchers randomly assigned over 20,500 patients in the UCLA Health system to four groups, each receiving different prompts:
- One group was asked if they’d like to receive a mailed stool test.
- Another was asked about opting in for a colonoscopy.
- A third group could choose between the two.
- The fourth group was automatically mailed a stool test kit with no prior request.
The group that received the unsolicited test kit had the highest screening rate, exceeding 26%. In comparison, rates were 17% for those asked to opt in with their choice of test, 16% for those offered only the stool test, and under 15% for those prompted to opt in for a colonoscopy.
Follow-up data showed that 73% of participants who received abnormal stool test results completed a colonoscopy within six months—a crucial step in confirming cancer diagnoses or ruling them out.
While screening rates were still modest overall, researchers emphasized that automatic mailing is a low-cost, scalable approach that can quickly engage thousands.
“Our study showed that automated outreach can get results quickly and efficiently,” said May. “In just six months, over 3,800 people were screened with minimal effort from our physicians. That’s thousands of chances to detect or prevent colorectal cancer early.”
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