Mailed Outreach for CRC Screening Effective in Underserved Populations

Reaching out to underserved populations about colorectal cancer (CRC) screening using mailed invitations resulted in significantly improved CRC screening rates in a recently published study.

The study compared mailed invitations for both fecal immunochemical testing (FIT) or colonoscopy with usual visit-based care and found that invitations for FIT were more effective than those for colonoscopy-based screening.

In addition, “the FIT outreach arm had a significantly shorter time to response and a higher percentage of early responders before reminder telephone calls than the colonoscopy outreach arm,” wrote Amit G. Singal, MD, of the University of Texas Southwestern Medical Center, and colleagues in Cancer.

The study included patients aged 50 to 64 years who were not up to date on their CRC screening. All participants were part of a large safety-net health system. Participants were randomly assigned to receive a mail FIT outreach (n = 2,400), a mailed colonoscopy outreach (n = 2,400), or usual care with opportunistic visit-based screening (n = 1,199). Any participant who did not respond to invitations within 2 weeks received reminder phone calls.

According to Singal and colleagues, “Fecal occult blood tests such as FIT have lower one-time sensitivity for polyps and cancer than colonoscopy, but are noninvasive, easy to perform at home, inexpensive, and more readily available.”

Screening rates among participants receiving the FIT outreach (58.8%) and the colonoscopy outreach (42.4%) were significantly higher compared with those getting usual care (29.6%; P < .001 for both comparisons). The researchers found that screening participation was significantly higher among patients assigned FIT outreach compared with colonoscopy outreach (P < .001) and that about twice as many participants who received FIT outreach compared with colonoscopy outreach responded before the telephone reminders (59% vs 29.7%; P < .001).

“Approximately 12% of patients in the colonoscopy arm scheduled a colonoscopy but subsequently missed or cancelled their appointments,” the researchers wrote. “These data suggest that FIT outreach may be an effective and less resource-intense CRC screening strategy for health care systems with limited resources and colonoscopy capacity.”

A multivariate analysis showed that screening participation was significantly associated with FIT outreach (odds ratio [OR], 3.84), colonoscopy outreach (OR, 1.83), black race (OR, 1.26), Hispanic ethnicity (OR, 1.98), primary care contact (OR, 2.92 for one visit and OR, 5.24 for two or more visits), and gastrointestinal subspecialty care after randomization (OR, 2.29).  

“Taken together with prior studies demonstrating higher rates of screening completion with FIT compared with colonoscopy outreach among underserved populations, the results of the current study may suggest that system-level screening programs among the underserved may be more effective if noninvasive tests, or a choice of noninvasive tests or colonoscopy, are offered,” the researchers wrote.