SU2C Dream Team Trial Tackles Disparities in Colorectal Cancer Screening

DNA-based home test for colorectal cancer increased screening rates among Hispanic and Black people

Disparities in colorectal cancer screening continue to be a major public health problem, with persistently lower screening rates among people from specific racial/ethnic and lower-income groups.

In an effort to find ways to help reverse this trend, the Stand Up To Cancer Colorectal Cancer Health Equity Dream Team conducted a clinical trial that involved mailing people a screening test they can perform at home. All participants in the trial received their health care at community health centers.

Overall, the trial’s results were positive, finding that substantially more people who were mailed a newer type of stool-based home screening test, called a FIT-DNA test, completed the screening than those who were sent a standard FIT test.

But the news wasn’t all good. Regardless of which test was used, only about one-third of participants who had an abnormal result took the follow-up step of getting a colonoscopy. FIT tests require follow-up of all abnormal results with a colonoscopy because it’s the only way to know for sure if the person has cancer or precancerous growths.

The finding highlights the central challenge of home FIT tests for people who experience the routine barriers to care that are strongly linked to health-related disparities, explained the study’s lead researcher, Jennifer Haas, MD, of Mass General Brigham Cancer Institute in Boston.

Because of staffing and other issues, getting a colonoscopy in a timely fashion has become a challenge across the United States, Dr. Haas said. But the population groups that experience disparities have a host of other barriers to overcome, from lack of access to facilities that offer colonoscopy, difficulties with transportation to and from the procedure, and insurance issues, to name a few.

“It’s not just as simple as ‘I can’t get a colonoscopy booked,’” she said.

Taking cancer research into the community

The research team deliberately chose to conduct the trial, called CARES, in community health centers. These centers “provide primary care services to 34 million people, mostly low-income, uninsured, and racial/ethnic minority populations,” Dr. Haas said. Community health centers, she continued, are “a source of health care in this country that’s unfortunately often overlooked in research.”

As the second leading cause of cancer death in the United States, colorectal cancer has a disproportionate impact on people who get much of their medical care at these centers. Death rates from colorectal cancer, for example, are significantly higher for Black and Hispanic people than White people, with studies identifying low screening rates for the disease as an important contributor to this disparity.

The CARES trial included more than 5,100 people who get their health care at one of eight community health centers in Boston and Los Angeles. Most participants were Hispanic and all were due for screening. They were randomly assigned to be mailed a standard FIT test along with texted outreach and reminders about screening, or the FIT-DNA test known as Cologuard, which was accompanied by standard outreach and patient navigation from the company that makes the test, Exact Sciences.

About 28% of participants who received the FIT-DNA test completed screening (defined as returning a completed FIT test or undergoing a screening colonoscopy) within 90 days, compared with about 23% in the regular FIT test group. After 180 days, those figures were approximately 32% and 27%.

Among the 100 participants from both groups who had an abnormal result, only 36% completed a follow-up colonoscopy within 180 days. The complete study results were published April 27 in JAMA Internal Medicine.

More work to do to decrease colorectal cancer disparities

“It’s encouraging that mailed outreach led to a significant increase in [FIT] screening,” Dr. Haas said while presenting the trial’s results in April at the American Association of Cancer Research 2026 annual meeting.

But there’s still significant room for improvement, and a critical need to help people who get their health care at community health centers, she stressed. “Unfortunately, as more people lose [health] insurance, it’s anticipated that this population will grow,” Dr. Haas said.

She and her Dream Team colleagues are planning to build on, and learn from, this trial. They have established strong partnerships with the health centers in the study, she said, “and those are going to continue and will be leveraged hopefully for new [research] opportunities.”