Noninvasive test optimizes colon cancer screening rates, study finds

A study of nearly 6,000 North Texas patients suggests sweeping changes be made to the standard of care strategy for colorectal screenings, finding that participation rates soared depending on the screening method offered and how patient outreach was done.

The results also suggest that a noninvasive colorectal screening approach, such as a fecal immunochemical tests (FIT) might be more effective in prompting participation in potentially lifesaving among underserved populations than a colonoscopy, a more expensive and invasive procedure.

Researchers at UT Southwestern and the University of California, San Diego, have found that organized mailing campaigns offering two colorectal cancer tests increased screening rates as much as threefold among uninsured patients.

The study is available online in the Aug. 5 edition of JAMA Internal Medicine.

FIT, a quick and easy test that requires no special preparation, detects small amounts of occult (hidden) blood in a patient's stool sample. Completed tests are then mailed to a laboratory for analysis. The findings presented in the published paper showed that with the help of a mail campaign, FIT participation tripled, and colonoscopy participation doubled in the study sample.

In the investigation, uninsured patients at John Peter Smith (JPS) Health Network in Fort Worth ages 54 to 64 years and not up to date with their screenings were mailed invitations to use and return a no-cost FIT, or to schedule a no-cost colonoscopy. Both groups also received follow-up telephone calls to promote testing.

"The study suggests that the best approach to offering and delivering screening to underserved populations may be through FIT," said senior author Dr. Celette Sugg Skinner, associate director of population science and control for the Harold C. Simmons Cancer Center. "Questions for the future are whether superior participation can be maintained in the FIT group [because the test must be repeated every year] and how adherence rates will impact overall screening effectiveness and cost."

Study authors say the findings raise the possibility that cost-effective, large-scale public health efforts to boost screening may be more successful if noninvasive tests, such as FIT, are offered along with colonoscopy screenings.

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