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TOPLINE:

A mailed fecal immunochemical test (FIT)-DNA outreach program increased participation rates for colorectal cancer (CRC) screening at 90 and 180 days compared with a mailed FIT approach in community health centers (CHCs); however, the rate of timely completion of colonoscopy after abnormal tests remained low, even with navigation support.

METHODOLOGY:

• Stool-based screening tests including the inexpensive annual FIT and the newer, more sensitive FIT-DNA are commonly used in CHCs where access to colonoscopy is limited; however, studies comparing these two population-level outreach strategies are lacking.
• Researchers conducted a randomized trial at eight CHCs (four in the greater Boston area, Massachusetts, and four in Los Angeles County [LA], California) between June and October 2023 to compare the effectiveness of mailed FIT vs FIT-DNA strategies in increasing the uptake of CRC screening.
• They assessed 5127 participants due for CRC screening (mean age, 54.5 years; 58.9% women), of whom 2435 were in the FIT group and 2692 in the FIT-DNA group.
• Participants received either mailed FIT kits with a primer text message about kit arrival and two automated text reminders on days 14 and 28 or mailed FIT-DNA kits with the manufacturer’s patient assistance program, which included scripted telephone calls, text messages, and emails in the user’s preferred language. Participants with abnormal FIT or FIT-DNA results were offered standardized phone navigation to address barriers to colonoscopy and encourage test completion.
• The primary outcome was participation in CRC screening through any modality (FIT or FIT-DNA) within 90 days of screening test mailing, and secondary outcomes were screening participation within 180 days and time to screening.

TAKEAWAY:

• Screening participation was higher with FIT-DNA than with FIT at 90 days (27.9% vs 22.6%; P = .02) and at 180 days (31.7% vs 26.7%). Time to screening was shorter with FIT-DNA.
• Overall screening participation was greater in Boston than in LA at 90 days (28.4% vs 23.1%); in Boston, the FIT and FIT-DNA groups had similar screening completion rates, whereas in LA, participation was higher with FIT-DNA than with FIT.
• Among 100 individuals with abnormal stool test results, only 36% completed colonoscopies within 180 days; the rate of colonoscopy completion was similar between the FIT-DNA and FIT groups, and Boston had a higher completion rate than LA.
• In a subgroup analysis, a higher rate of screening participation with FIT-DNA vs FIT was observed among participants who were at least 50 years of age, Hispanic, Spanish-speaking, or uninsured or on Medicaid.

IN PRACTICE:

“Our findings emphasize the importance of considering regional and demographic factors when implementing similar interventions,” the authors wrote.

SOURCE:

This study was led by Folasade P. May, MD, PhD, University of California, Los Angeles. It was published online in JAMA Internal Medicine.

LIMITATIONS:

This study did not include a usual care control group. The use of various test brands across different regions may have influenced the findings. A cost-effectiveness analysis was not performed.

DISCLOSURES:

This study was supported by the American Cancer Society and by a research grant from Stand Up To Cancer, a division of the Entertainment Industry Foundation. Some authors reported serving on advisory boards; holding patents with royalty payments; and receiving grants, personal fees, and nonfinancial support from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.