July 22, 2025
Alaska Native peoples experience the highest rate of colorectal cancer (CRC) in the world. In 2018, the incidence rate for this population was 61.9 per 100,000 people. Although CRC screening rates among Alaska Native peoples have been rising, they are consistently below the national average within the United States.
One factor affecting CRC screening rates in Alaska is the size of the state. Alaska spans more than 660,000 square miles, making it the largest state by area in the United States. Additionally, more than half of rural Alaska Native communities are only accessible year-round by small aircraft rather than by car. Even though colonoscopy is covered for Alaska Native peoples via the Alaska Tribal Health System, the cost of airfare and lodging required when traveling to locations where colonoscopy is available is usually the patient's responsibility and thus poses financial and logistical challenges for many individuals living in these communities.
To better understand the experiences of Alaska Native peoples living in remote areas and their potential effects on CRC screening rates, investigators at the Alaska Native Tribal Health Consortium and Mayo Clinic collaborated to conduct a clinical trial (NCT04336397) funded by the National Cancer Institute. Through this trial, people living in one remote region in southwest Alaska were offered a choice between two no-cost CRC screening options, either colonoscopy or multitarget stool DNA (mt-sDNA) testing, after receiving education about CRC screening practices. Although mt-sDNA testing is nationally available, this test had not yet been used in rural and remote Alaska Native communities before this study.
The researchers published their study results in Life in 2024. The publication summarized patients' perspectives about the test options and what factors led them to choose one test over the other and complete the test.
Study methods
Participants included Alaska Native adults ages 45 to 75 who received their healthcare through the Alaska Tribal Health System, had at least one visit in the previous three years, resided in one of 32 intervention communities and had contact information on file in their medical records. Individuals who completed either colonoscopy or mt-sDNA testing from April 2022 to August 2024 were asked to participate in an open-ended telephone survey. The survey was designed to help the researchers learn more about the patients' experiences and identify factors influencing test choice and future screening test preference.
Results
Among the participants identified, 59% (n = 113) of the 192 people who completed mt-sDNA testing and 39% (n = 51) of the 130 people who completed a colonoscopy procedure participated in a survey on factors influencing their screening test choice. These researchers note that their findings highlight multiple complex factors that can affect CRC screening preferences within the populations studied.
"Our study demonstrated that one test choice may not fit all," explains John B. Kisiel, M.D., a gastroenterologist and researcher at Mayo Clinic in Rochester, Minnesota, who served as one of the study's co-investigators. "There were clearly patient preferences and perceptions about test options that influenced patients' choice of test."
- The majority of participants who chose mt-sDNA testing (79%) were aware of the colonoscopy option, while most participants who chose colonoscopy (72%) reported being unaware of the mt-sDNA option.
- Patients who chose mt-sDNA testing mentioned several factors that influenced their choice, including convenience (not having to travel, less time commitment, lower impact on child care and work responsibilities), physical limitations, and the fact that mt-sDNA is less invasive and has fewer associated risks than colonoscopy.
- Patients who chose colonoscopy mentioned several factors that influenced their choice, including their desire to adhere to screening recommendations, their desire to take a proactive approach to preventive health, a family history of cancer, an awareness of the higher CRC risk among Alaska Native peoples, and a belief that colonoscopy is more reliable and accurate since it is performed by medical professionals.
"This study highlights the value that people place on their time when selecting a CRC screening method, as many participants reported preferring mt-sDNA due to the inconvenience of traveling for a colonoscopy, and long wait times for appointments and limited endoscopy clinics, which were exacerbated by the COVID-19 pandemic occurring during the study intervention period," explains Dr. Kisiel. "Surprisingly, the majority of people who chose colonoscopy and agreed to postscreening survey participation indicated that they were unaware of the stool DNA test and might have chosen differently."
"This study highlights the value that people place on their time when selecting a CRC screening method, as many participants reported preferring mt-sDNA due to the inconvenience of traveling for a colonoscopy, and long wait times for appointments and limited endoscopy clinics, which were exacerbated by the COVID-19 pandemic occurring during the study intervention period."
Dr. Kisiel and co-investigators say that recognizing and addressing these perspectives, and offering different screening test options, can help CRC screening programs and healthcare organizations better meet community member needs and preferences. "The long-term goal is to improve screening rates and colorectal health outcomes," says Dr. Kisiel.
For more information
Clinical trials: Stool DNA to improve colorectal cancer screening among Alaska native people. ClinicalTrials.gov.
Jeffries LA, et al. Factors influencing the choice between multi-target stool DNA and colonoscopy for colorectal cancer screening among Alaska native peoples. Life. 2025;15:120.
Refer a patient to Mayo Clinic.