Artin Galoosian, MD, MA

Credit: Linkedin

In data presented as a late-breaking abstract during Digestive Disease Week (DDW) 2023 in Chicago, a team of researchers led by Artin Galoosian, University of California Los Angeles (UCLA) David Geffen School of Medicine, determined the effective outreach strategies to maximize colorectal cancer screening participants among individuals aged 45-49 years in a diverse health system.

A Growing Problem

In recent years there has been an uptick in the incidence of colorectal cancer in young adults in the US, resulting in a corresponding increase in mortality. There have been several new guidelines promoting individuals screening beginning at age 45.

However, there has not been effective population health strategies to screen individuals in this age range.

The study took place at a large, urban, tertiary academic health system encompassing more than 3.5 million annual outpatient clinic visits. The investigators looked at all health system patients in the 45-49 age range with an average risk for colorectal cancer that were assigned to a primary care provider.

The Options

Each patient was randomized to either fecal immunochemical test (FIT) invitation, colonoscopy invitation, a choice between FIT and colonoscopy, or a mailed FIT outreach.

Each participant received an invitation through an electronic patient portal and the mail, as well as 1 initial text message and 1 reminder text message 2 weeks later.

The investigators sought primary outcomes of the completion of an colorectal cancer screening at week 26.

Overall, there were 20,509 patients included in the study with a mean age of 47.8 years. The results show an overall screening completion rate of 18.6%. The screening completion was significantly higher in the mailed FIT outreach group at 26.2% than it was in any of the other 3 groups (P <0.001).

Completion Rates

The lowest screening completion rate was in the colonoscopy invitation group at 14.5% (P <0.001).The patients offered a choice were more likely to complete screening of any kind, compared to either group of patients offered only 1 screening modality (17.4% v. 15.4%; P = 0.002).

Colonoscopy was more common than FIT (17.4% v. 15.4%; P = 0.002) and patients given a choicethey were more likely to complete a colonoscopy than FIT (12.1% v. 5.6%; P <0.001).

For the patients randomized to the FIT invitation or the mailed FIT outreach group, there was a notable conversion to colonoscopy (10.0% and 10.2%, respectively).

“We conducted a large, randomized trial to determine the most effective population health approach to screen patients aged 45-49 for CRC,” the authors wrote. “Mailing patients a FIT kit resulted in higher screening participation than offering a choice between FIT and colonoscopy, offering FIT alone, or offering colonoscopy alone. Requiring patients to opt into a screening modality appeared to decrease participation. These findings provide important insight for future population health strategies for young adults at average-risk for CRC.”