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Mailed fecal immunochemical test outreach is more effective than colonoscopy outreach for increasing 1-time colorectal cancer screening, but long-term effectiveness may need repeat testing and timely follow-up for abnormal results. Dr Amit Singal and colleagues compared the effectiveness of fecal immunochemical test outreach and colonoscopy outreach to increase completion of the colorectal cancer screening process within 3 years. The researchers performed a pragmatic randomized clinical trial from 2013 to 2016 among 5999 participants aged 50 to 64 years who were receiving primary care in Parkland Health and Hospital System and were not up to date with colorectal cancer screenings. The participants were randomly assigned to mailed fecal immunochemical test outreach, mailed colonoscopy outreach, or usual care with clinic-based screening.  | | Screening process completion was 38% in the colonoscopy outreach group | | Journal of the American Medical Association |
Outreach included processes to promote repeat annual testing for individuals in the fecal immunochemical test outreach group with normal results and completion of diagnostic and screening colonoscopy for those with an abnormal fecal immunochemical test result or assigned to colonoscopy outreach. The researchers' primary outcome was screening process completion, defined as adherence to colonoscopy completion, annual testing for a normal fecal immunochemical test result, diagnostic colonoscopy for an abnormal fecal immunochemical test result, or treatment evaluation if colorectal cancer was detected. Secondary outcomes included detection of any adenoma or advanced neoplasia, and screening-related harms. All 5999 participants were included in the intention-to-screen analyses. The research team observed that screening process completion was 38% in the colonoscopy outreach group, 28% in the fecal immunochemical test outreach group, and 11% in the usual care group. Compared with the usual care group, the team found that between-group differences for completion were higher for both outreach groups, and highest in the colonoscopy outreach group. Compared with usual care, the team noted that between-group differences in adenoma and advanced neoplasia detection rates were higher for both outreach groups, and highest in the colonoscopy outreach group. There were no screening-related harms in any groups. Dr Singal's team comments, "Among persons aged 50 to 64 years receiving primary care at a safety-net institution, mailed outreach invitations offering fecal immunochemical test or colonoscopy compared with usual care increased the proportion completing CRC screening process within 3 years." "The rate of screening process completion was higher with colonoscopy than fecal immunochemical test outreach."
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