Mailed FIT Kit Results in Highest Colorectal Cancer Screening Rate for Adults Aged 45 to 49 Years

What is the most effective outreach strategy to promote colorectal cancer (CRC) screening in adults aged 45 to 49 years?

In adults aged 45 to 49 years, the study found that mailing an unsolicited fecal immunochemical test (FIT) kit is more effective than offering active choice alternatives via a patient portal and text messages promoting CRC screening. However, clinicians should note that current US guidelines differ in their recommendations regarding CRC screening in adults in that age group. (Level of Evidence = 1b)

To determine the optimal method for promoting CRC screening, the investigators identified adult members of a large US health care system at average risk for CRC (no personal or family history of predisposing conditions). Eligible patients aged 45 to 49 years (n = 20,509) were randomly assigned to one of four groups: an invitation via the patient portal and three text messages for CRC screening from the active choices of FIT only, colonoscopy only, or dual-modality (FIT or colonoscopy) vs deferring screening, or an unsolicited, mailed FIT kit. Complete follow-up occurred for all patients at 6 months.

Using intention-to-treat analysis, screening completion occurred significantly less often in the three active choice groups compared with the default mailed group (FIT only: 16.4%; colonoscopy only: 14.5%; FIT or colonoscopy: 17.4% vs 26.2%).

Study design: Randomized controlled trial (single-blinded)

Funding source: Government and foundation

Allocation: Concealed

Setting: Population-based

Author disclosure: No relevant financial relationships.