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Colonoscopy, FIT outreach boosts colon cancer screening
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Mailed outreach invitations for colonoscopy or fecal immunochemical testing both increased the percentage of patients screened for colon cancer over 3 years, but the colonoscopy outreach was more effective, according to the results of a randomized controlled trial.
While previous reports showed that FIT outreach is more effective than colonoscopy outreach for increasing one-time CRC screening, long-term effectiveness may require repeat testing and timely follow-up screening for abnormal results.
Therefore, Amit G. Singal, MD, MS, of the University of Texas Southwestern Medical Center, Dallas, and colleagues aimed to compare the effectiveness of colonoscopy and FIT outreach with usual care for increasing the CRC screening rate over 3 years. They randomly assigned 5,999 individuals who were not up to date with screening (median age, 56 years; 61.9% women) to receive either a mailed FIT outreach (n = 2,400), a mailed colonoscopy outreach (n = 2,400) or typical clinic-based screening (n = 1,199).
Completion of screening was the primary endpoint, which researchers defined as either having a colonoscopy, three annual FITs, a follow-up colonoscopy for an abnormal FIT result, or evaluation for treatment in the event of CRC detection.
Both outreach interventions resulted in significantly higher completion rates compared with usual care, but colonoscopy outreach resulted in the highest completion rates. Overall, 38.4% (95% CI, 36.5-40.4) of those who received colonoscopy outreach completed screening compared with 28% (95% CI, 26.2-29.8) of those who received FIT outreach and 10.7% (95% CI, 9.1-12.6) of those who received usual care.
Further, adenoma and advanced neoplasia detection rates were significantly higher with both outreach interventions compared with usual care, but again these were highest with colonoscopy outreach. The data revealed adenomas in 14.3% of those who received colonoscopy outreach compared with 5.3% of those who received FIT outreach and 4% of those who received usual care, while data showed advanced neoplasia in 4.4%, 2% and 1.3%, respectively.
No screening-related harms occurred in any participants.
“Although the outreach strategies increased screening process completion compared with usual care, screening completion remained below 40% in both outreach groups,” the investigators noted.
“These data can help clinicians weigh the pros and cons of different CRC screening strategies in their patient population and practice environment,” they added. “It is important to consider patients’ barriers to screening initiation when recommending colonoscopy and the need for annual screening or diagnostic colonoscopy when recommending FIT.”
“This pragmatic trial yields several important lessons in a real-world context,” Michael Pignone, MD, MPH, of Dell Medical School, The University of Texas at Austin, and David P. Miller Jr, MD, MS, of Wake Forest School of Medicine in North Carolina, wrote in a related editorial.
They noted that the 33% completion rate for timely follow-up colonoscopy after a positive FIT result is suboptimal, and “particularly problematic because the mortality reduction associated with FIT screening is dependent on achieving high rates of follow-up colonoscopy.”
Further, they added that the study interventions included patient navigation measures to help patients complete the screening process, which “are especially important for vulnerable populations.”
Pignone and Miller concluded that “existing evidence suggests no single form of CRC screening promotion will be sufficient to achieve high rates of screening; instead, clinicians, health care administrators, and policy makers must work to combine different types of effective interventions.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures. Pignone reports serving as a medical editor for Healthwise, a nonprofit developer of patient decision aids and training materials for shared decision making.
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