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Noninvasive Test Optimizes Colon Cancer Screening Rates

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Key Points

  • The study showed that fecal immunochemical test participation tripled and colonoscopy participation doubled in the study sample of nearly 6,000 patients, when compared to usual care strategy for colorectal screenings.
  • Screening was significantly higher for fecal immunochemical test than for colonoscopy outreach (P < .001).
  • The findings raise the possibility that large-scale public health efforts to boost screening may be more successful if noninvasive tests are offered over colonoscopy.

Organized mailing campaigns could substantially increase colorectal cancer screening among uninsured patients, according to a study published online in JAMA Internal Medicine. The research also suggested that a noninvasive colorectal screening approach, such as a fecal immunochemical test, might be more effective in promoting participation in potentially lifesaving colon cancer screening among underserved populations than a colonoscopy, a more expensive and invasive procedure.

The study was led by Samir Gupta, MD, MSCS, an Associate Professor of Clinical Medicine and gastroenterologist at the University of California, San Diego, School of Medicine and VA San Diego Healthcare System.

Study Details

In the study, uninsured patients not up-to-date with screening between the ages of 54 to 64 years and cared for by a safety-net health system were randomly assigned to one of three groups: fecal immunochemical test outreach, consisting of mailed invitations to use and return a no-cost fecal immunochemical test (n = 1,593); colonoscopy outreach, consisting of mailed invitations to schedule a no-cost colonoscopy (n = 479); or usual care, consisting of opportunistic primary care visit–based screening (n = 3,893). Both fecal immunochemical and colonoscopy outreach groups received telephone follow-up to promote test completion.

The study showed that fecal immunochemical test participation (40.7%) tripled and colonoscopy participation (24.6%) doubled in the study sample of nearly 6,000 patients, when compared to usual care strategy (12.1%) for colorectal screenings. Screening was significantly higher for fecal immunochemical test than for colonoscopy outreach (P < .001). In stratified analyses, screening was higher for fecal immunochemical test and colonoscopy outreach than for usual care, and higher for fecal immunochemical test outreach among whites, blacks, and Hispanics (P < .005 for all comparisons).

Health Policy Implications

According to Dr. Gupta, the difference was much bigger than expected, and the findings could have health policy implications. He noted that the findings raise the possibility that large-scale public health efforts to boost screening may be more successful if noninvasive tests, such as fecal immunochemical test, are offered over colonoscopy.

“Physicians shouldn’t necessarily assume that use of colonoscopies is the best and only way to reduce colon cancer rates,” Dr. Gupta said. “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.”

“Now, the question to be studied further is whether superior participation can be maintained in the fecal immunochemical test group, because the test must be repeated every year, and how adherence rates will impact overall screening effectiveness and cost,” added senior author Celette Sugg Skinner, PhD, Associate Director of Population Research & Cancer Control for the Simmons Cancer Center at UT Southwestern Medical Center in Dallas.

Primary funding was provided by the Cancer Prevention and Research Institute of Texas. Additional funding was provided by grants from the National Institutes of Health.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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