Study Finds Outreach Interventions Effective for CRC Screenings

Outreach interventions, including mail outreach invitations, may be effective in increasing the proportion of completed colorectal cancer screening, according to research.

A recent study, published in JAMA, compared the efficacy of the mailed fecal immunochemical test (FIT) outreach to the colonoscopy outreach for increasing 1-time colorectal cancer (CRC) screening. The researchers used the Parkland Health and Hospital System to collect medical care data, including CRC screenings, follow-up testing, and treatment evaluations.

“In the United States, most screening is visit-based and dependent on primary care encounters,” the authors explained. “Complementing visit-based screening with mailed outreach invitations increases 1-time screening among racially diverse and socioeconomically disadvantaged populations; however, most studies of screening strategies have focused on single steps in the screening process, with few comparing their effect on completion of the entire process over time.”

Individuals in the study were 50 to 64 years old and had made a primary care visit during the prior year. All eligible participants were randomly assigned to usual care, FIT outreach, or colonoscopy outreach groups. There were 5 main outcomes for the screening completion process within 3 years:

1. Colonoscopy with no cancer detected
2. Cancer detected by the colonoscopy and completed a treatment evaluation within 2 or fewer months
3. A normal FIT result repeated annually for 3 years
4. An abnormal FIT result with a colonoscopy completed within 6 or fewer months with no cancer detected
5. An abnormal FIT result with cancer detected by the colonoscopy and the treatment evaluation was completed within 2 or fewer months

Of the 5999 participants in the study, 2400 were assigned to the FIT outreach group, 2400 were assigned to the colonoscopy outreach group, and the remaining 1199 were in the usual care group. When compared with the usual care group, the between-group differences for completion were greater for both outreach groups—the highest with the colonoscopy outreach group. Additionally, the between-group differences in adenoma and advanced neoplasia detection rates were greater for both outreach groups when compared to usual care—again with the highest rates among the colonoscopy group.

“Timing such outreach in advance of an upcoming primary care visit enables the primary care clinician to support these outreach efforts and help overcome ambivalence in patients who are not quite ready to take action or who may have additional questions,” wrote Michael Pignone, MD, MPH, and David P. Miller Jr, MD, MS, in an accompanying editorial. “Helping patients identify the test to which they are most likely to adhere over time and then helping them follow through is likely to yield the greatest benefit.”

Future studies are needed to test the long-term effectiveness of outreach interventions for repeat testing and timely follow-ups, especially for those with abnormal results.