- Jennifer Middleton, MD, MPH
Despite multiple available options for colorectal cancer screening, a significant portion of adults aged 50-74 in the United States do not get screened as frequently as recommended by the United States Preventive Services Task Force (USPSTF). A pair of studies this past week describe moderately successful outreach strategies to patients and physicians, respectively, to boost rates.
The first study randomized nearly 6000 US adults aged 50-64 who were not up to date on their colon cancer screening into 3 groups: a colonoscopy outreach group, a fecal immunochemical test (FIT) outreach group, and a usual care group. Participants in the colonoscopy outreach group received mailings encouraging them to call to schedule a colonoscopy; if they didn't within 2 weeks, research staff called them. Participants in the FIT outreach group received mailings with a FIT kit and accompanying instructions. 38.4% of the colonoscopy outreach group and 28.0% of the FIT outreach group completed screening compared to only 10.7% of the usual care group. In the discussion section, the authors note some disappointment that "screening process completion for both outreach groups remained below 40%, highlighting the potential for further improvement."
The second study randomized nearly 1500 general practitioners in France into 3 groups: physicians in the first group received a personalized letter listing all of their patients who were not up to date on colorectal cancer screening, physicians in the second group received a letter describing their region's overall screening rate, and physicians in the third group received no communication at all. The researchers found a small increase in colorectal cancer screening rates in the physician group that received personalized letters (24.8% versus 21.7% for the regional screening information group versus 20.6% for the usual care group) that was statistically significant compared to the other 2 groups. In the discussion section, these authors note that this increase was "modest" and that they, similar to the study described above, also expected a higher screening rate than their results found.
Dr. Lin has written previously on the blog about the various methods available to screen for colorectal cancer in the US and the USPSTF's lack of guidance regarding which method to choose. The USPSTF states that, in addition to colonoscopy and FIT, fecal DNA testing and CT colonography are also options, and the task force encourages physicians to choose the test "that would most likely result in completion." You can read more about these methods in this 2015 AFP article and in the AFP By Topic on Colorectal Cancer.
I'd like to see a study that combines outreach efforts to physicians and patients; it would be interesting to see if the effect is additive in terms of increasing rates. In the meantime, perhaps your own office might create or review a registry of patients not up to date on their colorectal cancer screening, while also providing physicians with a list of these patients. Perhaps you might implement a standard script to discuss colorectal cancer screening with patients at appointments. Or, perhaps you might hire or train an existing staff member to serve as a care coordinator to manage these lists and reach out to patients.
With so many methods to choose from, which one will your office try next to improve colorectal cancer screening rates?