Linking home test kits could improve colorectal cancer screening rates

Researchers have demonstrated that targeted interventions can improve screening rates in patients who are not adhering to current colorectal cancer screening recommendations. According to a recent study published by Reuland et al. JAMA network open.

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Colorectal cancer screening is an effective tool for early detection of the disease, often when it is most treatable. However, screening is underutilized in patient populations receiving primary care at federally qualified health centers.

Previous research has shown that a combination of at-home screening kits and coordinated outreach can be effective in large integrated health systems. Nevertheless, the impact remains unknown in federally qualified health centers. Health centers operate as small, grant-funded organizations that often lack resources and function as safety-net care providers.

Increasing screening rates at federally qualified health centers, which provide care to nearly 10% of the U.S. population and the underserved population, would reduce colorectal cancer incidence and mortality. It has the potential to improve care for many people.

“Using centralized mail-in screening kits and patient navigation for test abnormalities to reach predominantly low-income populations who are largely unscreened, the guidelines are recommended at federally qualified health centers. “We can significantly increase colorectal cancer screening,” the study's lead author emphasized. Daniel Ruland, MD, MPHthe Robert A. Ingram Distinguished Professor at the University of North Carolina (UNC) School of Medicine and co-director of the Carolina Cancer Screening Initiative at the UNC Lineberger Comprehensive Cancer Center.

Community health centers in North Carolina currently serve patient populations and communities with low screening rates for colorectal cancer. Many people in these communities have never received such cancer screening.

The National Cancer Institute estimates that in 2024, more than 152,000 people in the United States will be diagnosed with colorectal cancer and approximately 53,000 people will die from the disease. Although these incidence rates have decreased in patients aged 65 years and older, the number of infections and deaths among patients younger than 50 years has increased since 1990.

Research methods and results

In the SCORE study, researchers enrolled 4,002 participants aged 50 to 75 who were at average risk for colorectal cancer and were not adhering to recommended screening guidelines to receive at-home screening, community support, and , assigned to receive either a combination of usual care or usual care alone. . Participants who underwent at-home screening will be mailed a free fecal immunochemical test (FIT) kit, and a positive at-home FIT (indicates trace amounts of blood in the stool, an early sign of infection) navigation services for follow-up colonoscopies were provided in cases of Colorectal cancer. The study was conducted in collaboration with two federally qualified health centers in North Carolina: Blue Ridge Health Center and Roanoke Chowan Community Health Center.

Researchers will measure how many participants complete a colorectal cancer screening within six months and how many of them undergo a colonoscopy within six months after receiving a positive FIT result. The purpose was to In collaboration with federally qualified health center staff, the outreach team distributed FIT kits, coordinated result tracking, and conducted follow-up of positive FIT results. The navigator ensured that the information was entered into the participant's electronic medical record and communicated with the primary care provider.

Researchers found that targeted interventions could triple screening completion rates compared to usual care. For example, compared to participants who received usual care only, participants who received the intervention had colorectal symptoms within 6 months (30% vs. 9.7%) and within 12 months (34.6% vs. 16.6%). were more likely to undergo screening.

Among those with positive FIT results, participants in the intervention group had higher follow-up colonoscopy rates, with 68.8% completing the procedure compared to 44.4% of participants in the usual care alone group. .

conclusion

“Mail-in FIT is an excellent complement to regular care screening services,” stressed the senior study author Alison Brenner, PhD, MPHis an associate professor at the UNC School of Medicine and associate director of the Carolina Cancer Screening Initiative at the UNC Lineberger Comprehensive Cancer Center. “This therapy will be applied to many patients who, for whatever reason, are not tested under normal care, and will significantly increase testing rates.Intensive approach, As demonstrated in the SCORE trial, both resource scarcity can be alleviated. [federally qualified health centers] “We need to address this preventive service outside of the clinic visit, not just on the crowded agenda of primary care,” she suggested.

Researchers are now considering ways to expand the targeted intervention, including prior consultation with North Carolina Medicaid officials, which expanded eligibility last year to include more patients.

“Our team is completing a cost analysis of the intervention. Because the FIT test is inexpensive, we expect this type of outreach to be a very cost-effective way to improve population screening. In parallel, we are working to find ways to scale up and continue to have greater impact on this type of intervention,” Dr. Roiland emphasized. “Many areas of North Carolina have limited colonoscopy capacity, and Medicaid expansion has increased the need for colonoscopies. This type of FIT-based outreach strategy “It could help increase screening while making optimal use of limited colonoscopy capacity,” he concluded.

Disclosure: Research for this study was supported by gifts from the National Cancer Institute, the University Cancer Research Foundation, John Goodacre, Donna Schmidt, and Greg Schmidt. For full research author disclosure, please visit: jamanenetwork.com.