Improved Screening for Colon Cancer: Offering Immunochemical Test vs Colonoscopy

MedicalResearch.com: Interview with: Samir Gupta, MD, MSCS

San Diego Veterans Affairs Healthcare System
Associate Professor of Clinical Medicine
Division of Gastroenterology, Department of Internal Medicine
Moores Cancer Center
University of California San Diego

MedicalResearch.com: What are the main findings?

Dr. Gupta: In a randomized, comparative effectiveness study among uninsured individuals not up to date with screening, we found that mailed outreach invitations to complete colonoscopy outreach, and mailed outreach to complete a non-invasive fecal immunochemical test (FIT) tripled screening rates compared to usual care. Additionally, we found that outreach was almost twice as effective with offers for FIT versus colonoscopy screening.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Gupta: Yes–while we expected response rates to be higher for FIT, compared with colonoscopy outreach, we were surprised by the magnitude of the difference. The absolute response rate was 15% higher for FIT, compared to colonoscopy outreach.

MedicalResearch.com: What should clinicians and patients take away?

Dr. Gupta: First, our work confirms and extends evidence supporting mailed outreach as an effective strategy for increasing screening rates among underserved populations.

Second, our results raise the possibility that large-scale efforts to boost screening among underserved populations may be similarly or even more successful if non-invasive tests, such as FIT, are offered over colonoscopy.

MedicalResearch.com: What recommendations for future research?

Dr. Gupta: The next research steps required are to measure the impact of FIT versus colonoscopy outreach over several rounds of screening offers on both screening participation as well as neoplasia detection.

Cost effectiveness of FIT vs. colonoscopy outreach requires analysis.

Also, we need to identify additional strategies that can complement outreach for maximizing screening rates among underserved populations.

Citation:

Comparative Effectiveness of Fecal Immunochemical Test Outreach, Colonoscopy Outreach, and Usual Care for Boosting Colorectal Cancer Screening Among the Underserved A Randomized Clinical Trial

Gupta S, Halm EA, Rockey DC, et al. Comparative Effectiveness of Fecal Immunochemical Test Outreach, Colonoscopy Outreach, and Usual Care for Boosting Colorectal Cancer Screening Among the Underserved: A Randomized Clinical Trial. JAMA Intern Med. 2013;():-. doi:10.1001/jamainternmed.2013.9294.

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