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Mailed outreach improved colorectal cancer screening rates over standard care
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Patients overdue for colorectal cancer screening were more likely to participate if they received a mailed outreach invitation for colonoscopy or fecal immunochemical testing in a recent study.
In a prospective comparative effectiveness trial, researchers evaluated data from uninsured patients aged 54 to 64 years enrolled in the John Peter Smith Health Network medical assistance program who were due for colorectal cancer (CRC) screening. Participants were randomly assigned standard care, in which CRC screening was offered during primary care visits (n=3,898); mailed outreaches either inviting the participant to schedule a free colonoscopy (n=479) or enclosing a fecal immunochemical test (FIT) to be used and returned at no cost (n=1,593).
The FIT and colonoscopy outreach groups had higher screening participation rates than standard care recipients, while the FIT group also had better participation than the colonoscopy outreach group (40.7% for FIT, 24.6% for colonoscopy and 12.1% for standard care; P<.001 for both standard care comparisons and for FIT vs. colonoscopy). Investigators calculated a number-needed-to-invite of eight patients for colonoscopy and 3.5 for FIT to yield one additional CRC screening vs. standard care.
The higher screening rate among FIT recipients, and among outreach recipients vs. those who received standard care, was observed among men, women and white, black and Hispanic patients (P<.005 for all).
CRC was observed in 0.4% of FIT recipients, 0.4% of colonoscopy outreach recipients and 0.2% of standard care patients, with no significant differences between groups. Advanced adenomas were detected in 0.8%, 1.3% and 0.4% of patients in the groups, respectively, with a difference observed between colonoscopy outreach and standard care recipients (P<.05).
Samir Gupta
“Physicians shouldn't necessarily assume that use of colonoscopies is the best and only way to reduce colon cancer rates," Samir Gupta, MD, MSCS, associate professor of clinical medicine and gastroenterologist at University of California, San Diego School of Medicine, said in a press release. "What we should ask is, 'What type of screening is most acceptable to underserved populations?' This is because the best predictor of colorectal cancer screening outcomes may be getting any test, rather than which test is done."
Disclosure: The researchers report no relevant financial disclosures.
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