OAKLAND, Calif. — Colorectal cancer disparities between Black and white adults were eliminated among Kaiser Permanente members in Northern California after the health care organization instituted a regionwide, structured colorectal cancer screening program, new research shows.

“Our study found that organized screening works to improve colorectal cancer outcomes for all of our members,” said the study’s senior author Theodore R. Levin, MD, a research scientist at the Kaiser Permanente Division of Research and a gastroenterologist with The Permanente Medical Group. “I knew our program had helped to reduce disparities, but I was surprised by the magnitude and the rate of improvement. It exceeded my expectations.”

Disparities between Black and white adults in colorectal cancer screening, incidence, and death rates have been documented for more than 40 years. Screening programs create an opportunity to find colorectal cancers when they are small and easier to treat. Screening can also prevent cancers from developing through the removal of precancerous polyps.
The new study, published February 24 in the New England Journal of Medicine, looked at colorectal cancer screening participation, incidence, and death rates for Black and white Kaiser Permanente members in Northern California age 50 to 75 from 2000 through 2019. The 19-year time period spanned 6 years before and 11 years after the colorectal cancer screening program was rolled out in 2006 through 2008.

In 2009, the colorectal cancer death rate (per 100,000) was 54.2 for Black members and 32.6 for white members. By 2019, death rates had fallen by more than half among Black members — decreasing to 20.9 — compared to 19.3 for white members, essentially eliminating the previous disparity. Colorectal cancer incidence also markedly decreased with similar rates seen between Black and white members.

“It is inspiring that organized screening outreach markedly and rapidly increases screening rates for everyone,” said the study’s co-lead author Douglas A. Corley, MD, PhD, MPH, a research scientist at the Kaiser Permanente Division of Research and a gastroenterologist with The Permanente Medical Group. “This is a powerful message that organization is crucial for knowing when and how to engage members in screening and follow-up.”

The findings highlight the need for health care organizations to address the social and structural barriers that contribute to ongoing health disparities. “Many people have sought to show that health equity is not just a pipe dream,” said the study’s co-lead author Chyke A. Doubeni, MBBS, MPH, who directs the Mayo Clinic Center for Health Equity and Community Engagement Research. “This study shows how a thoughtful, intentional, coordinated, and sustained approach to delivering care in an equitable manner can eliminate health disparities.”

Endoscopy Homepage