In January, Darlene Brandt received a piece of mail she believes saved her life.
Her health plan sent her a home test, a fecal immunochemical test (FIT), that screens for colorectal cancer. At 65, the retired dental office employee was long overdue for colon cancer screening.
Doctors typically recommend screenings beginning at age 50 to prevent colon cancer. Brandt never had been screened.
“When I got this kit in the mail, I decided I could do this,” she recalls. “This test is so important.”
Within days of performing the test at her home and returning it for analysis, Brandt and her doctor were notified blood had been detected. A follow-up colonoscopy confirmed Brandt had stage 2 colon cancer — a mass hidden in a fold of her colon — plus seven polyps.
She underwent colon resection surgery to remove the tumor. Brandt’s early diagnosis and treatment prevented need for radiation or chemotherapy.
“It’s extremely important to take this test,” she says. “I’m thankful I’m still here.”
Removing barriers
Colorectal cancer is the third most common cancer diagnosed in both men and women in the U.S. It’s the second leading cause of cancer-related deaths and is expected to cause more than 51,000 deaths in 2019, according to the American Cancer Society.
As in Brandt’s case, colorectal cancer can be treated with early screening. But symptoms often don’t appear until after the cancer has grown or spread when it becomes more difficult to treat.
The Centers for Disease Control and Prevention generally recommends colorectal cancer screening for adults ages 50 to 75. Just 67% of Americans in that group have been screened for colorectal cancer, according to the agency’s most recent information.
Blue Cross and Blue Shield of Montana this year is joining an effort to improve screening rates for members who meet the guidelines.
In 2017, Blue Cross and Blue Shield of Texas launched a pilot to test the approach. Working with a vendor, the plan sent FIT kits to almost 2,000 members in rural areas where health care can be difficult to access.
The FIT kit is one of the least invasive screening tests used to find polyps or colorectal cancer. A stick or brush is used to collect a small stool sample, which is returned to a doctor or lab where the sample is checked for blood — an early sign of colorectal cancer. The test must be repeated annually.
The initiative expanded in 2018 to include members in Illinois, New Mexico and Oklahoma who previously may not have had access to preventive care or a relationship with a primary care doctor. FIT kits were sent to nearly 26,000 members, and almost 5,000 returned them and got screened.
Of those who performed the test, about 350 members had abnormal results. A colonoscopy is recommended as a follow-up test if a FIT detects blood. (It’s unclear how many received the follow-up testing.)
“Caught early, the outcomes can be great,” says Hala Ibrahim, the insurer's director of enterprise quality reporting, of early colorectal cancer detection. “We need to remove barriers to care.”
Persistence increases screening
Accountability is key to achieving testing success, the initiative found.
Screening rates improved when members living in the same home — spouses and partners — each received a FIT kit. Additionally, it was more difficult to process kits returned by members who didn’t have primary care doctors to notify of their test results.
“You want somebody accountable to ensure there is appropriate follow-up care,” Ibrahim says, adding that this year another estimated 28,000 members, including in Montana, have been asked to use FIT kits to screen for colorectal cancer.
Research indicates mailing people free tests improves screening rates. A 2014 study involving almost 870 people found screening rates increased by almost 40% after tests were sent to their homes.
Dr. Richard Wender, the American Cancer Society’s chief cancer control officer, believes persistence is critical in boosting colorectal cancer screening rates.
“People will get used to it,” he says. “The FIT is a pretty good test. It’s not the total solution, but it’s part of the answer. If you can perform a FIT kit every year, it may very well be the test for you.”
A voice to help others
Brandt's cancer is gone, but she requires periodic follow-up tests to ensure she’s disease-free. She encourages everyone who receives a FIT kit to use it.
“At least I found out,” Brandt says. “That’s the bottom line. I want to help people the way that I’ve been helped.”
