A newer, mail-in stool test – FIT-DNA – showed a modest improvement over the traditional fecal immunochemical test (FIT) in boosting colorectal cancer (CRC) screening uptake in community...
The pragmatic, cluster randomized clinical trial involved 5,127 participants across eight community health centers in Boston, Massachusetts, and Los Angeles County, California, with an additional site in Rapid...
Among the 5,127 participants in the randomized controlled trial (RCT) regions, 2,435 (47.5%) were in the FIT group, and 2,692 (52.5%) were in the FIT-DNA group.
A newer, mail-in stool test – FIT-DNA – showed a modest improvement over the traditional fecal immunochemical test (FIT) in boosting colorectal cancer (CRC) screening uptake in community health centers, according to a study published April 27, 2026, in JAMA Internal Medicine. However, rates of follow-up colonoscopies after an abnormal result remained low, highlighting a continued challenge in ensuring effective screening.
The pragmatic, cluster randomized clinical trial involved 5,127 participants across eight community health centers in Boston, Massachusetts, and Los Angeles County, California, with an additional site in Rapid City, South Dakota. Patients aged 45 to 75 who were due for CRC screening were enrolled between June 7, 2023, and October 24, 2023. Participants received either mailed FIT with automated text message outreach or mailed FIT-DNA with the manufacturer’s outreach protocol.
Among the 5,127 participants in the randomized controlled trial (RCT) regions, 2,435 (47.5%) were in the FIT group, and 2,692 (52.5%) were in the FIT-DNA group. The average age of participants was 54.5 years, with 3,018 (58.9%) identifying as female and 2,109 (41.1%) as male. A significant majority, 3,818 individuals (74.5%), were Hispanic.
FIT-DNA Shows Increased Screening Uptake
The primary outcome measured was CRC screening participation – using FIT, FIT-DNA, or colonoscopy – within 90 days. Researchers found that screening uptake was higher in the FIT-DNA group compared to the FIT group. Secondary outcomes included screening participation within 180 days and time to screening participation.
Community Health Centers United States Jennifer Haas
The study also examined the completion of follow-up colonoscopy within 180 days of an abnormal stool test result. Among the 100 individuals with an abnormal stool test result, 36 (36.0%) completed a colonoscopy within that timeframe.
Addressing Disparities in Colorectal Cancer Screening
Colorectal cancer is the second most common cause of cancer mortality in the United States and disproportionately affects individuals in under-resourced settings. “Rates of colorectal cancer are rising, but many eligible people are unscreened, especially in community health centers,” said Jennifer Haas, MD, MSPH, of the Division of Internal Medicine in the Mass General Brigham Department of Medicine.
“CHCs are an important source of care in the United States, especially for under- or uninsured people. Since many CHCs are under-resourced, the goal of our research was to help design an intervention to specifically benefit people who receive care in these settings.”
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Jennifer Haas, MD, MSPH, Division of Internal Medicine, Mass General Brigham
Nova Scotia Health – FIT Test – Colon Cancer Screening – How a FIT Test works.
Haas and her colleagues are part of the Stand Up To Cancer (SU2C) Colorectal Cancer Health Equity Dream Team, which aims to improve colorectal cancer screening in medically underserved communities. The research highlights the importance of targeted interventions to address screening disparities.
The findings suggest that FIT-DNA may be a more advantageous approach to increase colorectal cancer screening uptake compared to mailed FIT outreach in community health centers. However, the study underscores the need for strategies to improve follow-up rates for those with abnormal results, ensuring that screening leads to timely diagnosis and treatment.
The researchers noted that while FIT-DNA showed a modest advantage, overall uptake and follow-up remained low, indicating that further efforts are needed to optimize CRC screening programs in community health centers.
