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Interventions for Increasing Colorectal Cancer Screening Uptake: A Systematic Review and Network Meta-Analysis
Daryl Ramai1, Chun-Wei Pan2, Bjorn Rodriguez3
1Division of Gastroenterology, Hepatology, and Nutrition, University of Utah, Salt Lake City, Utah.
Gastroenterology
|April 3, 2026
Summary
Patient navigation and mailed fecal immunochemical test (FIT) outreach are most effective for increasing colorectal cancer screening. Educational multimedia shows promise in high-uptake settings and recent studies.
Area of Science:
- Oncology
- Public Health
- Preventive Medicine
Background:
- Colorectal cancer screening significantly reduces mortality.
- Screening uptake remains suboptimal despite its benefits.
- Comparative effectiveness of various interventions to improve screening rates is unclear.
Purpose of the Study:
- To evaluate the effectiveness of different colorectal cancer screening uptake interventions.
- To compare strategies using a systematic review and network meta-analysis.
Main Methods:
- Analysis of 76 randomized clinical trials across eight intervention strategies.
- Network meta-analysis comparing interventions using risk ratios (RRs) and 95% confidence intervals (CIs).
- Assessment of intervention rankings, risk of bias, and certainty of evidence (GRADE framework).
Main Results:
- Patient navigation (RR 1.58) and mailed FIT outreach (RR 1.36) were most effective, significantly outperforming usual care.
- Mailed FIT outreach was superior to colonoscopy outreach (RR 1.35); patient navigation outperformed reminder-only interventions (RR 1.48).
- In low baseline uptake settings (<30%), mailed FIT outreach was most effective (RR 3.12); educational multimedia performed best in higher uptake populations (≥30%) and recent studies (2021-2024).
Conclusions:
- Patient navigation and mailed FIT outreach are the most effective strategies for increasing colorectal cancer screening uptake.
- These interventions are particularly impactful in populations with low baseline screening rates.
- Educational multimedia offers a scalable alternative, showing promise in recent years and high-uptake settings.
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