Early Screening of African Americans (45-50 Years Old) in a Fecal Immunochemical Test-Based Colorectal Cancer Screening Program

Gastroenterology. 2020 Nov;159(5):1695-1704.e1. doi: 10.1053/j.gastro.2020.07.011. Epub 2020 Jul 20.


Background & aims: Some guidelines recommend starting colorectal cancer (CRC) screening before age 50 years for African Americans, but there are few data on screening uptake and yield in this population.

Methods: We performed a prospective study of fecal immunochemical test (FIT) screening among African American members of the Kaiser Permanente Northern California health plan. We compared data from African American members screened when they were 45-50 years old (early screening group) in 2018 with data from previously unscreened African American, white, Hispanic, and Asian/Pacific Islander health plan members who were 51-56 years old. Screening outreach was performed with mailed FIT kits. Logistic regression models, adjusted for sex, were used to evaluate differences among groups in screening uptake, colonoscopy follow-up of abnormal test results, and test yield.

Results: Among 10,232 African Americans in the early screening group who were mailed a FIT, screening was completed by 33.1%. Among the 4% with positive test results, 85.3% completed a follow-up colonoscopy: 57.8% had any adenoma, 33.6% had an advanced adenoma (adenoma with advanced histology or polyp ≥10 mm), and 2.6% were diagnosed with CRC. African Americans in the early screening group were modestly more likely to have completed screening than previously unscreened African Americans, whites, and Hispanics 51-56 years old. The groups did not differ significantly in positive results from the FIT (range, 3.8%-4.6%) and more than 74% received a follow-up colonoscopy after a positive test result. The test yields for any adenoma (range, 56.7%-70.7%), advanced adenoma (range, 20.0%-33.6%), and CRC (range, 0%-7.1%) were similar.

Conclusions: Proportions of African Americans who participated in early (aged 45-50 years) FIT screening and test yield were comparable to those of previously unscreened African Americans, whites, Hispanics, and Asian/Pacific Islanders who were 51-56 years old.

Keywords: Colon Cancer; Detection; Ethnicity; Race.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Biomarkers, Tumor / analysis*
  • Black or African American*
  • California / epidemiology
  • Colonoscopy
  • Colorectal Neoplasms / chemistry
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / ethnology
  • Colorectal Neoplasms / pathology
  • Early Detection of Cancer*
  • Feces / chemistry*
  • Female
  • Humans
  • Immunologic Tests*
  • Male
  • Middle Aged
  • Pilot Projects
  • Predictive Value of Tests
  • Prospective Studies
  • Proto-Oncogene Proteins c-kit / analysis*
  • Race Factors
  • Risk Assessment
  • Risk Factors


  • Biomarkers, Tumor
  • KIT protein, human
  • Proto-Oncogene Proteins c-kit