Evaluation of a colorectal cancer (CRC) screening outreach strategy by mailed invitation for either fecal immunochemical test (FIT) or colonoscopy revealed that more primary care patients chose FIT, according to a study published in Preventive Medicine.

Researchers conducted post-hoc analyses of data collected from a trial of CRC screening outreach. Patients who were not up-to-date with CRC screening were mailed invitations to either complete an enclosed FIT (n=2400) or schedule and complete colonoscopy (n=2400). Invitations for both screenings were sent every 12 months over a 3-year period; usual-care participants were advised to screen at the discretion of their primary care providers.

Compared with usual-care outreach, screening completion over the study period was higher for both mailed invitation outreach groups (FIT outreach, 28%; colonoscopy outreach, 38.4%), with colonoscopy outreach more than 3 times higher than usual care (38.4% vs 10.7%, respectively).

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Among patients who received invitations to complete an enclosed FIT, 56.6% (n=1359) initiated with FIT after the first mailing, and 3.3% (n=78) crossed over to colonoscopy. An additional 151 (15.7%) and 61 (7.7%) of nonresponders initiated screening with FIT after the second and third mailings, respectively; approximately 724 (30.2%) patients never completed FIT screening. Compared with other racial groups, more Hispanics (64.2%) and patients whose primary language is Spanish (66.9%) initiated FIT.

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A total of 613 (25.5%) patients assigned to colonoscopy outreach initiated screening after the first mailing; 18.8% (n=452) crossed over to FIT. After the second and third mailings, an additional 112 (8.4%) and 48 (4.2%), respectively, were screened for colonoscopy. A total of 1058 (44.1%) participants never initiated screening. More patients aged 60 to 64 years (21.1%), Hispanics (21.3%), and patients whose primary language is Spanish (22.6%) crossed over to FIT.

The “findings from a large, pragmatic trial of CRC screening outreach show many patients crossed over to a screening test other than the one offered through outreach. Few non-responders initiated screening after a second or third dose of the same intervention,” the authors concluded.  “Considering offering non-responders alternative interventions may optimize healthcare system efforts to implement population-based cancer screening programs.”


Murphy CC, Ahn C, Pruitt SL, et al. Screening initiation with FIT or colonoscopy: post-hoc analysis of a pragmatic, randomized trialPrev Med. 2019;118:332-335.