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Updated: Jun 8, 2026
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Published on: August 1, 2019
Get screened: a pragmatic randomized controlled trial to increase mammography and colorectal cancer screening in a
Kevin Fiscella1, Amanat Yosha, Samantha K Hendren
1Department of Family Medicine and Community & Preventive Medicine, University of Rochester, 1381 South Ave, Rochester, NY 14620, USA. Kevin_Fiscella@URMC.rochester.edu
Background:
Most randomized controlled trials of interventions designed to promote cancer screening, particularly those targeting poor and minority patients, enroll selected patients. Relatively little is known about the benefits of these interventions among unselected patients.
Methods/Design:
"Get Screened" is an American Cancer Society-sponsored randomized controlled trial designed to promote mammography and colorectal cancer screening in a primary care practice serving low-income patients. Eligible patients who are past due for mammography or colorectal cancer screening are entered into a tracking registry and randomly assigned to early or delayed intervention. This 6-month intervention is multimodal, involving patient prompts, clinician prompts, and outreach. At the time of the patient visit, eligible patients receive a low-literacy patient education tool. At the same time, clinicians receive a prompt to remind them to order the test and, when appropriate, a tool designed to simplify colorectal cancer screening decision-making. Patient outreach consists of personalized letters, automated telephone reminders, assistance with scheduling, and linkage of uninsured patients to the local National Breast and Cervical Cancer Early Detection program. Interventions are repeated for patients who fail to respond to early interventions. We will compare rates of screening between randomized groups, as well as planned secondary analyses of minority patients and uninsured patients. Data from the pilot phase show that this multimodal intervention triples rates of cancer screening (adjusted odds ratio 3.63; 95% CI 2.35 - 5.61).
Discussion:
This study protocol is designed to assess a multimodal approach to promotion of breast and colorectal cancer screening among underserved patients. We hypothesize that a multimodal approach will significantly improve cancer screening rates.The trial was registered at Clinical Trials.gov NCT00818857.
Insights
A multimodal intervention significantly increased cancer screening rates in a pilot study, tripling participation among underserved patients. This approach combines patient and clinician prompts with targeted outreach for mammography and colorectal cancer screening.
Area of Science:
- Public Health
- Preventive Medicine
- Health Disparities
Background:
- Most cancer screening trials enroll selected populations, limiting understanding of intervention effectiveness in unselected groups.
- Underserved populations, including low-income and minority patients, often face barriers to cancer screening.
- Little is known about the benefits of cancer screening interventions in unselected patient cohorts.
Purpose of the Study:
- To assess a multimodal intervention strategy for increasing breast and colorectal cancer screening rates.
- To evaluate the effectiveness of a combined approach of patient prompts, clinician reminders, and patient outreach.
- To determine if this intervention improves cancer screening rates among underserved patients.
Main Methods:
- A randomized controlled trial involving "Get Screened," an American Cancer Society-sponsored intervention.
- Multimodal intervention included patient education tools, clinician prompts, personalized letters, automated reminders, scheduling assistance, and linkage to screening programs.
- Intervention targeted patients overdue for mammography or colorectal cancer screening in a primary care setting serving low-income individuals.
Main Results:
- Pilot data indicate the multimodal intervention tripled cancer screening rates.
- An adjusted odds ratio of 3.63 (95% CI 2.35 - 5.61) demonstrated a significant increase in screening.
- The intervention showed promise in improving screening for underserved populations.
Conclusions:
- A multimodal approach is effective in promoting breast and colorectal cancer screening.
- The intervention significantly improves cancer screening rates among underserved patients.
- Further evaluation in unselected populations is warranted to confirm these findings.
