Underserved populations need options for colorectal cancer screening if screening rates are to be improved, according to a new study. It found that organized mailing campaigns could substantially increase colorectal cancer screening among uninsured patients. Also, a noninvasive colorectal screening approach, such as a fecal immunochemical test (FIT), might be more effective in promoting participation in potentially life-saving colon cancer screening among underserved populations than a colonoscopy, which is more expensive and invasive.

As part of the study, mailed invitations were sent to uninsured patients between the ages of 54 and 64 years who were not up-to-date with screening or  cared for by a safety-net health system. The invitations either asked the patients to use and return a no-cost FIT, or else it encouraged the patients to schedule and undergo a colonoscopy at no cost. In addition, both groups received telephone follow-ups to promote test completion.

The study showed that FIT participation tripled and colonoscopy participation doubled in the study sample of nearly 6,000 patients, compared with usual care strategy for colorectal screenings. According to lead author Samir Gupta, MD, MSCS, of the University of California, San Diego School of Medicine, the difference was much bigger than expected, and the findings could have health policy implications.

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Gupta noted that the findings raise the possibility that large-scale public health efforts to boost screening may be more successful if noninvasive tests, such as FIT, are offered over colonoscopy. The study was published in JAMA Internal Medicine (2013; doi:10.1001/jamainternmed.2013.9294).

“Physicians shouldn’t necessarily assume that use of colonoscopies is the best and only way to reduce colon cancer rates,” Gupta said. “What we should ask is, what type of screening is most acceptable to underserved populations? This is because the best predictor of colorectal cancer screening outcomes may be getting any test, rather than which test is done.”

“Now, the question to be studied further is whether superior participation can be maintained in the FIT group, because the test must be repeated every year, and how adherence rates will impact overall screening effectiveness and cost,” added senior author Celette Sugg Skinner, PhD, associate director of Population Research & Cancer Control for the Simmons Cancer Center at University of Texas Southwestern Medical Center in Dallas.