Sending home testing kits to people and helping them navigate any required follow up testing significantly improves the uptake of colorectal cancer testing, shows research carried out at the University of North Carolina at Chapel Hill.
The at-home fecal immunochemical test (FIT) tests a person’s stool to look for hidden blood that can be an early sign of colorectal cancer. These kinds of tests are effective for initial screening purposes but are underused.
Research in large, integrated health systems in wealthier populations has shown that sending FIT tests directly to people who need screening can increase uptake, but whether this is effective in lower-income populations that are served by federally qualified health centers is less clear.
In this study, lead investigator Daniel Reuland, MD, a professor at the University of North Carolina, and colleagues randomly assigned 4,002 people eligible for colorectal cancer screening to either usual care or the intervention group in a 1:1 ratio.
The intervention group were sent an introductory letter and FIT test packet with return postage included. If needed, a couple of reminder letters were sent and anyone in this group who had a positive FIT test result were offered help to attend a colonoscopy follow up test.
The results, published in the journal JAMA Network Open, showed that 30% of the intervention group had completed screening within six months and 34.6% within 12 months of being sent the tests. The six- and twelve-month screening rates in the control group were 9.7% and 16.6%, respectively, demonstrating that the intervention significantly increased screening rates.
For those who had a positive FIT test result, 68.8% of the intervention group went on to complete a follow-up colonoscopy examination versus 44.4% of the control group.
“Reaching a largely unscreened, predominantly low-income population using centralized mailed screening kits and patient navigation for those with abnormal tests can substantially increase guideline-recommended colorectal cancer screening in federally qualified health centers,” said Reuland in a press statement.
“There is limited colonoscopy capacity in many parts of North Carolina, and with the Medicaid expansion, the need for colonoscopies is increased. This kind of FIT-based outreach strategy could help us increase screening while making optimal use of limited colonoscopy capacity.”
The team is now carrying out a cost analysis to assess whether this kind of intervention can be rolled out more widely in the area.
“FIT testing is inexpensive, so we anticipate that this kind of outreach will be a very cost-effective way to improve population screening. In tandem with this, we’re working to find ways to scale and sustain this kind of intervention to have greater impact,” Reuland added.
