Accepting Cancer Screening Invitations

Colorectal cancer screening participation increases with mailed outreach

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Even though colorectal cancer is one of the most common cancers in the US, getting screened for the disease isn’t all that popular. This is especially true for people without insurance. In an effort to improve screening rates, some one-on-one attention did the trick.

When uninsured people were mailed invitations offering two types of free colorectal cancer screenings, participation soared.

Nearly three times as many individuals who were sent invitations had screenings compared to people who were referred to colorectal screening by clinic physicians.

"Discuss colonoscopy with your doc starting at age 50."

Samir Gupta, MD, MSCS, of the Veteran Affairs San Diego Healthcare System, and colleagues conducted this study.

The aim was to determine: 1) if mailing invitations to underserved, uninsured individuals would increase colorectal cancer screening participation; 2) if offering the non-invasive fecal immunochemical test (FIT) would be superior to colonoscopy.

A colonoscopy involves emptying the bowels the night before the exam, during which a thin tube with a camera is threaded through the colon to look for abnormal growths.  Precancerous lesions called polyps can be removed during a colonoscopy, which costs about $3,000.

The FIT test, which costs $10 to $20, involves examining a fecal sample for evidence of blood. The patient gathers the sample and mails it to a lab.

A total of 5,970 uninsured individuals — between the ages of 54 and 64, served by the John Peter Smith Health Network in Fort Worth and Tarrant County, TX and not up to date on their colorectal cancer screenings — were randomly assigned to one of three groups: 1,593 to FIT outreach, 479 to colonoscopy outreach and 3,898 to usual care.

FIT and colonoscopy outreach included the following:

  • One-page English and Spanish invitation to have a no-cost screening, along with information about the risks of colorectal cancer.
  • Two pre-recorded phone messages, the first delivered at the time of the mailing telling recipients that they’d be receiving an invitation and a reminder message delivered two weeks after the mailing.
  • As many as two live phone calls reminding people to complete the screenings and offering assistance with scheduling and preparing for the colonoscopy.

The FIT group also received a kit and instructions on how to use the test, along with a postage-paid return envelope.

People assigned to the usual care group were referred to colorectal cancer screenings by clinic physicians during medical care visits.

People who received invitations and phone follow-up had much higher screening participation than those in the usual care group. While 40.7 percent of the FIT group and 26.4 percent of those who received colonoscopy outreach participated in screening, only 12.1 percent of those who received usual care participated.

"We know that colonoscopy rates are lower than we'd like, particularly in populations that have limited access to healthcare services,” said Richard Berri, MD, director of Surgical Oncology at St. John Hospital and Medical Center's Van Elslander Cancer Center in Detroit, Michigan.

“This study shows that reaching out to people and offering them an alternative screening method results in higher participation. More out-of-the-box thinking like this is needed to improve colorectal cancer screening rates that can save lives," said Dr. Berri, who was not involved in this study.

“For underserved populations, our findings raise the possibility that large-scale public health efforts to boost screening may be successful if noninvasive tests, such as FIT, are offered over colonoscopy,” the study authors concluded.

An estimated 143,000 Americans will learn they have colorectal cancer this year.

This study was published August 5 in JAMA Internal Medicine.

The study was supported by grants from the Cancer Prevention and Research Institute of Texas, the National Institutes of Health (NIH) through the National Center for Research Resources and NIH/National Cancer Institute.

No conflicts of interest were disclosed.

Review Date: 
August 7, 2013
Last Updated:
August 9, 2013