Colorectal cancer has been climbing at a worrying pace across the United States, and public health officials are racing to catch up. In recent years, health authorities have responded by lowering the recommended screening age, intensifying awareness efforts, and expanding the range of available screening tools all in an effort to catch the disease earlier, when it is most treatable.
Now, a new study published in JAMA Internal Medicine is adding important data to that conversation, suggesting that not all screening methods are created equal and that the type of kit a patient receives could meaningfully affect whether they actually complete the test.
What the study looked at
Researchers conducted a randomized clinical trial across three cities Boston, Los Angeles, and South Dakota in 2023. The study enrolled 5,127 adults between the ages of 45 and 75, all of whom were eligible for colorectal cancer screening.
Participants were split into two groups. The first group received the faecal immunochemical test, or FIT a widely used annual stool-based mail in test that has long been the standard option. Those kits came with personalized guidance messages from healthcare professionals. The second group received the newer FIT DNA test, a more advanced stool based screening tool that only needs to be completed once every three years. That kit was accompanied by instructions and outreach messages provided directly by the manufacturer. In both cases, all materials were available in either English or Spanish.
The results and what they mean
The numbers told a clear story. Among participants who received the FIT DNA kit, 27.90% completed their screening compared to just 22.60% of those in the standard FIT group. Participants in the FIT DNA group also tended to complete their tests within a shorter timeframe, suggesting the format removed some of the friction that often delays follow through.
The differences extended beyond the initial test. Among participants who received abnormal results, 39.70% of those in the FIT DNA group went on to complete a follow up colonoscopy, compared to 31% in the standard FIT group a meaningful gap that could have real consequences for early detection and treatment outcomes.
Researchers pointed to several possible explanations for the disparity, including stronger manufacturer support for the FIT DNA kit and the psychological advantage of a longer gap between required tests. Many people avoid screening due to the inconvenience, discomfort, or anxiety associated with frequent testing, and a three year interval appears to ease some of those concerns.
The cost barrier that remains
Despite its better performance, the FIT DNA test comes with a significant drawback, it costs considerably more than the standard FIT test. For patients with limited insurance coverage or out of pocket resources, that price difference could be a serious obstacle to access undermining the very gains in participation the study documented.
The researchers acknowledged this tension, noting that real world adoption of the FIT DNA test will depend heavily on whether insurance coverage and funding structures can keep pace with the clinical evidence.
What comes next
According to projections from Global Data epidemiologists, diagnosed cases of colorectal cancer among U.S. adults are expected to rise from 150,036 in 2026 to 161,497 by 2031. Expanded screening is expected to contribute to that increase not because the disease is necessarily becoming more common, but because more cases will be detected earlier.
That distinction matters. Cases caught in the early stages are far more likely to be treated successfully, which is precisely why access to effective, user-friendly screening tools is so critical.
The findings from May and colleagues make a strong case for continuing to expand mail in screening programs, particularly those paired with meaningful patient support. They also highlight a broader truth about preventive care: getting people to actually complete a test often depends just as much on convenience, communication, and cost as it does on clinical effectiveness.
Healthcare professionals and policymakers alike will need to weigh all three as the push to bring colorectal cancer screening to more Americans continues.
