An RCT of Fecal Immunochemical Test Colorectal Cancer Screening in Veterans Without Recent Primary Care

Area of Science:

• Public Health
• Preventive Medicine
• Gastroenterology

Background:

• Colorectal cancer (CRC) screening prevents mortality, but access remains a challenge for individuals with infrequent healthcare encounters.
• Veterans without recent primary care visits may be unaware of or miss opportunities for vital CRC screening.

Purpose of the Study:

• To evaluate the effectiveness of mailed screening invitations and fecal immunochemical tests (FIT) in boosting CRC screening uptake among veterans.
• To identify optimal strategies for reaching veterans who do not regularly engage with primary care.

Main Methods:

• A pragmatic randomized trial involving screening-eligible veterans aged 50-75 without recent primary care visits.
• Three arms: usual opportunistic screening, mailed screening invitation with reminders, and mailed FIT with reminders.
• Primary outcome was CRC screening completion within six months post-randomization.

Main Results:

• Mailed FIT significantly increased CRC screening rates (26.1%) compared to usual care (5.8%) and mailed invitations (7.7%).
• The mailed invitation arm showed no significant improvement in screening participation over usual care.
• Relative risks demonstrated a 4.52-fold increase with mailed FIT versus usual care.

Conclusions:

• Mailed fecal immunochemical test outreach is an effective strategy to enhance CRC screening participation in veterans with limited primary care access.
• Mailed invitations, even with reminders, are less effective than mailed FIT for this population.
• Targeted mailed interventions are crucial for improving preventive screening in underserved veteran populations.