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Study Recommends Mail-in Tests To Increase Colon Cancer Screening Among Underserved And Uninsured

Contents of a mail-in screening program for colorectal cancer
A colorectal cancer screening kit from a government health program

A new study from UT Southwestern Medical Center found asking patients to send in stool samples could expand screenings in underserved and uninsured communities. The study follows success over 10 years with a mail-in testing program.

KERA’s Sam Baker talked about the new study with co-author Dr. Amit Singal, a professor of internal medicine, medical director of the Liver Tumor Program, and clinical chief of hepatology at UT Southwestern.

He also spoke with Dr. Keith Argenbright, director of the center’s Moncrief Cancer Institute in Fort Worth, and a professor in the Harold C. Simmons Comprehensive Cancer Center.

Isn’t Colonoscopy The Gold Standard For Colon Cancer Screening?

Dr. Argenbright: There are multiple ways to screen for colon cancer. The underserved and the uninsured find it more convenient to do a mailed-in, at-home test. You don't have to have the prep. You don't have to take off work. You don't have to have the anesthesia. You don't have to have somebody drive you home. For people working hourly jobs, if they were going to take off a couple of days for a colonoscopy, they wouldn't get paid for those days.

About The Mail-In Program

Dr. Argenbright: Me and Dr. Singal were part of a CDC work group, looking at best practices for this mail-in campaign, because there are several of these going on throughout the country.

The one that we're doing at Southwestern, funded by CPRIT, has been going on for about 10 years. We have sent out these kits to over 50,000 people. So far about 20 to 30% have returned them. We have found some cancers and some pre-cancerous.

Without The Mail-In Tests, The Cancers Probably Would Have Gone Undetected?

Dr. Argenbright: Without question. Colon cancer is a long process that starts with a growth called an adenoma that over time turns into cancer. These FIT tests can detect the adenomas as well. So not only did we find people with cancer, we found people who were about to get cancer and prevented them from ever getting it.

You've Long Worked To Bring Cancer Prevention And Early Detection Services To Underserved Communities – What Are Some Of The Programs They Weren’t Accessing Before?

Dr. Argenbright: For instance, they don't have a primary care physician or they don't have insurance. So they can't afford to get to a regular physician or they have cultural issues that cause suspicion of the healthcare system or no one has told them the importance of these programs. These were the people that we were not reaching.

We put in these systematic programs and worked with churches, community centers, county fairs, to reach people outside of the traditional healthcare system, because they weren't engaged in the traditional healthcare system, the way that you and I think about that.

Best Practices To Make Mail-in Programs Effective

Dr. Singal: There's eight total. A few come to mind:

  • The instructions clearly need to be written in a very simple and understandable language.
  • Send a text message or a postcard or a phone call, letting people know this is coming.
  • Send the stool-based study to complete colorectal cancer screening.
  • Follow up with a reminder.
  • Navigation. If the test is positive, you need a colonoscopy to see if that screening test really suggests the presence of colon cancer or not.

Getting Colonoscopies For The Underserved And Or Uninsured

Dr. Singal: One of the things that you would really need to do is to tap into health systems that you can work with. For example, in Dallas County, Parkland Health and Hospital System and Tarrant County, JPS.

In counties outside areas where you have a safety net provider, you can work with individuals in the community who are willing to work with you to see those patients and to perform diagnostic colonoscopies.

Reliability Of Mail-In Screening

Dr. Singal: Stool-based or fit-based screening is actually highly accurate. The United States Preventative Services Task Forcelabels FIT-based screening and colonoscopy as both being the highest level of tests available for colorectal cancer screening. We need options. We need that screening rate to be 80%, 90%, if not 100%. That's the first thing that we really need to aim for.


UTSW: Mail-in Screening Study

Cancer Stats Facts: Colorectal Cancer

FIT test outreach campaign

Interview highlights were lightly edited for clarity.

Got a tip? Email Sam Baker at You can follow Sam on Twitter @srbkera.

KERA News is made possible through the generosity of our members. If you find this reporting valuable, consider making a tax-deductible gifttoday. Thank you.

Sam Baker is KERA's senior editor and local host for Morning Edition. The native of Beaumont, Texas, also edits and produces radio commentaries and Vital Signs, a series that's part of the station's Breakthroughs initiative. He also was the longtime host of KERA 13’s Emmy Award-winning public affairs program On the Record. He also won an Emmy in 2008 for KERA’s Sharing the Power: A Voter’s Voice Special, and has earned honors from the Associated Press and the Public Radio News Directors Inc.