Centralized Colorectal Cancer Screening Outreach in Health Centers
Importance
Colorectal cancer (CRC) screening is effective but is not widely used in federally qualified health centers (FQHCs).
Objective
This study aimed to evaluate a centralized outreach program for CRC screening that included sending fecal immunochemical testing (FIT) kits by mail and providing support for follow-up colonoscopy after abnormal results.
Study Design
This was a randomized clinical trial conducted in North Carolina from July 2020 to September 2021. Participants aged 50 to 75 years who were not up-to-date with CRC screening were included.
Intervention
Participants in the intervention group received:
- A mailed introductory letter
- A FIT kit with instructions and prepaid return postage
- Two reminder letters if necessary
Those with positive FIT results were offered assistance to complete their colonoscopy. The control group received standard care only.
Main Outcomes
The primary measure was the completion of CRC screening within 6 months. Secondary measures included the completion of colonoscopy after positive FIT results and the detection of advanced colorectal neoplasia.
Results
A total of 4002 participants were included. The intervention group had a significantly higher screening completion rate (30.0% vs 9.7%). Additionally, 68.8% of those with positive FIT results in the intervention group completed their colonoscopy, compared to 44.4% in the control group. Advanced colorectal neoplasia was detected in 1.4% of the intervention group and 0.7% of the control group.
Conclusions
This trial showed that a centralized outreach program significantly increased CRC screening and detection of advanced colorectal neoplasia among diverse patients in FQHCs. Future research should explore the cost-effectiveness and scalability of this approach.
Clinical Trials Registration
ClinicalTrials.gov Identifier: NCT04406714
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