The Kaiser Permanente Division of Research has been an indisputable innovator in the science of screening for colorectal cancer; studies by DOR researchers have contributed to national screenings guidelines while delivering the most effective methods to KP members and the community.
Now, a 5-year, $5.7 million PROSPR study funded by the National Cancer Institute is providing DOR researchers with the opportunity to investigate why some colorectal cancers are still missed by screening and to develop science-based improvements in the methodology.
The NCI program, designed to ultimately improve cancer-screening processes, has funded 7 research centers around the United States to examine screening for breast, cervical, and colorectal cancer. KP Northern and Southern California are among the 7 research sites.
With 2 million members of screening age in Northern and Southern California, KP offers “one of the largest resources of its kind for studying cancer screening,” said Douglas A. Corley, MD, PhD, MPH,
Douglas A. Corley, principal investigator for PROSPR study of colorectal screening
a DOR staff scientist, gastroenterologist at the San Francisco Medical Center, and principal investigator for the NCI program’s colorectal cancer component.
Early Detection Saves Lives
More than 142,000 new cases of colon and rectal cancer are diagnosed in the United States annually, and these cancers cause about 50,000 deaths each year. Many of these cancers are preventable with screening and early detection.
KP recommends that all members over age 50 have colorectal cancer screening with one of three options: annual fecal immunochemical tests (FIT), a sigmoidoscopy every 5 years, or a colonoscopy every 10 years. Annual FIT testing and intermittent colonoscopy are approximately equally effective at preventing deaths from colorectal cancer. FIT has the added benefits of being noninvasive, not requiring a bowel prep or sedation, and having virtually no risk of complications. Members who have a positive FIT result (which indicates the presence of blood in the stool), are scheduled for a follow-up colonoscopy.
With KP HealthConnect, DOR researchers are able to link colorectal cancer screening results with a host of other demographic and medical factors to get an even clearer picture of what is working within the region’s screening program, or how it can be improved.
Important Insights and Next Steps
In year 2, the NCI-funded research has already yielded some important insights.
First, adherence rates for KP’s recommended annual FIT screenings are high, and the screenings are working. While about 50 percent of the U.S. population is screened for colorectal cancer, more than 85 percent of California KP members were adequately screened over a 5-year period. Of those diagnosed with colorectal cancer, the FIT screening found 73 percent of the cases in 2007 and 80 percent of the cases in 2008.
“We were able to quantify what our system is able to do,” said Theodore R. Levin, MD, KP NCAL’s director of Colorectal Cancer Screening who is also a principal investigator on the NCI study and a Kaiser Permanente gastroenterologist in Walnut Creek.
In addition, Dr. Corley’s research has shown that the detection rate of adenomas, the benign tumors that may develop into colorectal cancer, is associated with the patient’s subsequent risk of cancer. Dr. Corley, who will present these results to the American Gastroenterological Association in May, says the next step is to look for ways to refine the colonoscopy exam to optimize the detection of adenomas for all patients.
“We will be conducting the first systematic evaluation of the whole process of doing a colon exam,” he said. ”The ultimate goal is to maximize the detection of adenomas that are most likely to become cancers.”
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