Offering a blood test as a secondary option boosts CRC screening by nearly twofold
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Key takeaways:
- Offering a blood test as a secondary option in individuals who previously declined colonoscopy or FIT increased CRC screening by 7.5%.
- There was no decrease in uptake of first-line screening options.
Compared with reoffering colonoscopy and fecal immunochemical test alone, offering a blood test as a secondary option resulted in a nearly twofold increase in colorectal cancer screening in veterans who had declined first-line screening.
“We know screening prevents colorectal cancer, but participation in screening is suboptimal,” Peter S. Liang, MD, MPH, assistant professor of medicine and population health at NYU Langone Health, told Healio. “Compared to widely used screening modalities such as colonoscopy and stool-based testing, a blood test has certain advantages: It is noninvasive, can be done at point of care and does not require self-collection.”
He continued, “The only screening blood test currently approved by the FDA is indicated for individuals who have declined first-line tests.”
In a randomized, controlled trial published in Clinical Gastroenterology and Hepatology, Liang and colleagues assessed whether offering the septin 9 blood test, which detects the CRC biomarker methylated septin 9 DNA, as a secondary option would increase overall CRC screening uptake in people who previously had declined colonoscopy or FIT.
Researchers enrolled 359 veterans aged 50 to 75 years (75.8% aged 60-75 years, 95.5% men) at average risk for CRC who declined colonoscopy and FIT within the previous 6 months. All participants were contacted via letter and phone call to reoffer only the recommended screening options of colonoscopy or FIT (control, n = 178) or to also offer the blood test if the recommended options were declined (intervention, n = 181).
The primary outcome was completion of any CRC screening test within 6 months of outreach, while the secondary outcome was completion of a full-screening strategy of colonoscopy, negative FIT or blood test, or positive noninvasive test followed by colonoscopy.
Within 6 months of outreach, 9.6% of veterans in the control group and 17.1% in the intervention group completed any form of CRC screening, while 9% and 14.9%, respectively, completed the full-screening strategy.
“Among individuals who had previously declined screening with colonoscopy and FIT, reoffering colonoscopy and FIT with a second-line blood test option increased screening by 7.5% more than only reoffering colonoscopy and FIT,” Liang said. “There was no decrease in uptake of first-line screening tests (colonoscopy and FIT).”
Researchers also reported that of 31 veterans in the intervention group who underwent screening, 5% completed the blood test, 9.8% completed FIT and 2.2% completed colonoscopy. Conversely, among 17 individuals in the control group who underwent screening, 8.4% completed FIT and 1.1% received colonoscopy.
Overall test positivity was 18.2% for the septin 9 blood test and 8.2% for FIT.
“These results show that a blood test can improve colorectal cancer screening uptake in individuals who have previously declined colonoscopy and FIT,” Liang said. “This was a single-center VA study, so replication in other clinical environments may be needed. Whether these results will be generalizable to other blood-based CRC screening tests should also be investigated.”
Perspective
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Christine Lee, MD
We know all too well that screening prevents death from CRC; however, colon cancer screening availability and participation vary. Broadening our armamentarium can only help improve our reach and the participation of the general population. In this randomized, controlled trial, Liang and colleagues demonstrated that CRC screening increased by 7.5% among individuals offered a blood test as a secondary option after they had previously declined a colonoscopy or FIT.
Additionally, they demonstrated that the uptake of first-line screening options did not decrease. But, as they pointed out, it was a single-center study thus replication in additional clinical environments may be needed before these results can be generalized. The noninvasive, point-of-care testing model rather than self-collection remains highly attractive. However, one must not forget the need to execute a timely colonoscopy after a positive noninvasive test ― that call to action must be streamlined and emphasized.
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