VANCOUVER, B.C.—A more proactive approach to colorectal cancer screening using fecal immunochemical tests resulted in high participation and detection rates across a large health system, according to data presented at the 2023 annual meeting of the American College of Gastroenterology.
Results of the innovative outreach initiative, which identified high-risk individuals outside the traditional healthcare system, achieved an impressive 32% response rate. More importantly, 7% of individuals who followed through with a colonoscopy ultimately were diagnosed with CRC.
“This speaks to a population that was higher risk and needed to be screened but hadn’t done so because they weren’t visiting a primary care physician,” said senior researcher Rachel Issaka, MD, MAS, a gastroenterologist and health services researcher at the Hutchinson Institute for Cancer Outcomes Research of the University of Washington, in Seattle. “This is a group that we would have never diagnosed without this initiative.”
For this study, which won the conference’s Presidential Poster Award, Dr. Issaka and her co-investigators sought to address the screening gap—specifically reaching those who had not been screened—by constructing a low-cost, home-based test for CRC (abstract P1777).
“The existing practices of screening often depend on individuals visiting healthcare facilities,” Dr. Issaka told Gastroenterology & Endoscopy News. “This innovative approach targeted a wider demographic who may not access such services regularly, yet fall in a high-risk category for colon cancer.”
This descriptive study involved implementing a mailed FIT as a screening strategy for CRC. More than 9,700 people between the ages of 45 and 75 years who had not been screened were identified as the target population for this study. In addition to mailing the tests, recipients received informational postcards and reminder messages throughout the outreach project.
Improving Screening Rates
Dr. Issaka reported that 32% of outreach patients ultimately completed CRC screening. Out of the 32% who responded, 30% completed and returned a mailed FIT while 2% chose to schedule a colonoscopy instead. Among those who had an abnormal result, 50% completed a follow-up colonoscopy.
“Individuals who would not have completed screening otherwise are now participating because of this program,” Dr. Issaka emphasized.
Despite their initial success, the researchers are continuing to refine their outreach efforts to achieve greater participation rates and improve healthcare outcomes.
“Motivating a larger percentage of the population to complete screening remains a challenge, but by identifying and reaching high-risk individuals outside of traditional healthcare systems, it has proven to be a viable strategy in the battle against colon cancer,” Dr. Issaka said. “By reducing barriers, offering persistent navigation and maintaining proactive contact, we hope to improve the response rate even more.”
Long-Term Follow-up Needed To Measure Sustainability
Trilokesh D. Kidambi, MD, the director of the colon cancer screening program at City of Hope, in Duarte, Calif., told Gastroenterology & Endoscopy News that this real-world study implementing FIT-based CRC screening underscores the importance of securing funding and involvement of key stakeholders across a health system for a program’s success.
“This type of work is translatable to similar U.S.-based health systems like Kaiser Permanente, Veterans Health or other safety-net health settings as well as abroad in nationalized healthcare settings,” said Dr. Kidambi, who was not involved with the research. “The work adds to the literature in this setting, [offering] practical ways to deliver organized colorectal screening.”
However, most Americans have private insurance, and CRC screening is determined after discussions with the primary care provider, Dr. Kidambi said. “In this context, similar lessons apply but on a smaller scale: strong communication between patient and provider on the reason for choosing a FIT test for screening and preemptive discussion on the importance of following up an abnormal result with a colonoscopy,” Dr. Kidambi said.
The short period observed is also a limitation of the study, he added. “The researchers reported on just a single round of screening and follow-up, which may have skewed results in the positive or negative direction,” Dr. Kidambi said. “Implementation studies on colorectal screening in organized health systems must evaluate long-term follow-up to confirm the sustainability of results.”
—Chase Doyle
Dr. Issaka reported a financial relationship with Guardant Health. Dr. Kidambi reported no relevant financial disclosures.
This article is from the January 2024 print issue.