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Effect of Colonoscopy Outreach vs Fecal Immunochemical Test Outreach on Colorectal Cancer Screening Completion: A Randomized Clinical Trial.

Abstract Mailed fecal immunochemical test (FIT) outreach is more effective than colonoscopy outreach for increasing 1-time colorectal cancer (CRC) screening, but long-term effectiveness may need repeat testing and timely follow-up for abnormal results.
PMID
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Authors

Mayor MeshTerms

Colonoscopy

Occult Blood

Keywords
Journal Title jama
Publication Year Start




PMID- 28873161
OWN - NLM
STAT- MEDLINE
DA  - 20170905
DCOM- 20170912
LR  - 20170912
IS  - 1538-3598 (Electronic)
IS  - 0098-7484 (Linking)
VI  - 318
IP  - 9
DP  - 2017 Sep 05
TI  - Effect of Colonoscopy Outreach vs Fecal Immunochemical Test Outreach on
      Colorectal Cancer Screening Completion: A Randomized Clinical Trial.
PG  - 806-815
LID - 10.1001/jama.2017.11389 [doi]
AB  - Importance: Mailed fecal immunochemical test (FIT) outreach is more effective
      than colonoscopy outreach for increasing 1-time colorectal cancer (CRC)
      screening, but long-term effectiveness may need repeat testing and timely
      follow-up for abnormal results. Objective: Compare the effectiveness of FIT
      outreach and colonoscopy outreach to increase completion of the CRC screening
      process (screening initiation and follow-up) within 3 years. Design, Setting, and
      Participants: Pragmatic randomized clinical trial from March 2013 to July 2016
      among 5999 participants aged 50 to 64 years who were receiving primary care in
      Parkland Health and Hospital System and were not up to date with CRC screenings. 
      Interventions: Random assignment to mailed FIT outreach (n = 2400), mailed
      colonoscopy outreach (n = 2400), or usual care with clinic-based screening (n =
      1199). Outreach included processes to promote repeat annual testing for
      individuals in the FIT outreach group with normal results and completion of
      diagnostic and screening colonoscopy for those with an abnormal FIT result or
      assigned to colonoscopy outreach. Main Outcomes and Measures: Primary outcome was
      screening process completion, defined as adherence to colonoscopy completion,
      annual testing for a normal FIT result, diagnostic colonoscopy for an abnormal
      FIT result, or treatment evaluation if CRC was detected. Secondary outcomes
      included detection of any adenoma or advanced neoplasia (including CRC) and
      screening-related harms (including bleeding or perforation). Results: All 5999
      participants (median age, 56 years; women, 61.9%) were included in the
      intention-to-screen analyses. Screening process completion was 38.4% in the
      colonoscopy outreach group, 28.0% in the FIT outreach group, and 10.7% in the
      usual care group. Compared with the usual care group, between-group differences
      for completion were higher for both outreach groups (27.7% [95% CI, 25.1% to
      30.4%] for the colonoscopy outreach group; 17.3% [95% CI, 14.8% to 19.8%] for FIT
      outreach group), and highest in the colonoscopy outreach group (10.4% [95% CI,
      7.8% to 13.1%] for the colonoscopy outreach group vs FIT outreach group; P < .001
      for all comparisons). Compared with usual care, the between-group differences in 
      adenoma and advanced neoplasia detection rates were higher for both outreach
      groups (colonoscopy outreach group: 10.3% [95% CI, 9.5% to 12.1%] for adenoma and
      3.1% [95% CI, 2.0% to 4.1%] for advanced neoplasia, P < .001 for both
      comparisons; FIT outreach group: 1.3% [95% CI, -0.1% to 2.8%] for adenoma and
      0.7% [95% CI, -0.2% to 1.6%] for advanced neoplasia, P < .08 and P < .13,
      respectively), and highest in the colonoscopy outreach group (colonoscopy
      outreach group vs FIT outreach group: 9.0% [95% CI, 7.3% to 10.7%] for adenoma
      and 2.4% [95% CI, 1.3% to 3.3%] for advanced neoplasia, P < .001 for both
      comparisons). There were no screening-related harms in any groups. Conclusions
      and Relevance: Among persons aged 50 to 64 years receiving primary care at a
      safety-net institution, mailed outreach invitations offering FIT or colonoscopy
      compared with usual care increased the proportion completing CRC screening
      process within 3 years. The rate of screening process completion was higher with 
      colonoscopy than FIT outreach. Trial Registration: clinicaltrials.gov Identifier:
      NCT01710215.
FAU - Singal, Amit G
AU  - Singal AG
AD  - Department of Internal Medicine, University of Texas Southwestern Medical Center,
      Dallas.
AD  - Parkland Health and Hospital System, Dallas, Texas.
AD  - Department of Clinical Sciences, University of Texas Southwestern Medical Center,
      Dallas.
AD  - Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern
      Medical Center, Dallas.
FAU - Gupta, Samir
AU  - Gupta S
AD  - Division of Gastroenterology, Veterans Affairs San Diego Health Care System, San 
      Diego, California.
AD  - Department of Internal Medicine, Moores Cancer Center, University of California, 
      San Diego, La Jolla.
FAU - Skinner, Celette Sugg
AU  - Skinner CS
AD  - Department of Clinical Sciences, University of Texas Southwestern Medical Center,
      Dallas.
AD  - Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern
      Medical Center, Dallas.
FAU - Ahn, Chul
AU  - Ahn C
AD  - Department of Clinical Sciences, University of Texas Southwestern Medical Center,
      Dallas.
AD  - Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern
      Medical Center, Dallas.
FAU - Santini, Noel O
AU  - Santini NO
AD  - Parkland Health and Hospital System, Dallas, Texas.
FAU - Agrawal, Deepak
AU  - Agrawal D
AD  - Department of Internal Medicine, University of Texas Southwestern Medical Center,
      Dallas.
FAU - Mayorga, Christian A
AU  - Mayorga CA
AD  - Department of Internal Medicine, University of Texas Southwestern Medical Center,
      Dallas.
FAU - Murphy, Caitlin
AU  - Murphy C
AD  - Department of Clinical Sciences, University of Texas Southwestern Medical Center,
      Dallas.
FAU - Tiro, Jasmin A
AU  - Tiro JA
AD  - Department of Clinical Sciences, University of Texas Southwestern Medical Center,
      Dallas.
AD  - Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern
      Medical Center, Dallas.
FAU - McCallister, Katharine
AU  - McCallister K
AD  - Department of Clinical Sciences, University of Texas Southwestern Medical Center,
      Dallas.
FAU - Sanders, Joanne M
AU  - Sanders JM
AD  - Department of Clinical Sciences, University of Texas Southwestern Medical Center,
      Dallas.
FAU - Bishop, Wendy Pechero
AU  - Bishop WP
AD  - Department of Clinical Sciences, University of Texas Southwestern Medical Center,
      Dallas.
AD  - Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern
      Medical Center, Dallas.
FAU - Loewen, Adam C
AU  - Loewen AC
AD  - Department of Clinical Sciences, University of Texas Southwestern Medical Center,
      Dallas.
FAU - Halm, Ethan A
AU  - Halm EA
AD  - Department of Internal Medicine, University of Texas Southwestern Medical Center,
      Dallas.
AD  - Parkland Health and Hospital System, Dallas, Texas.
AD  - Department of Clinical Sciences, University of Texas Southwestern Medical Center,
      Dallas.
AD  - Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern
      Medical Center, Dallas.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Pragmatic Clinical Trial
PT  - Randomized Controlled Trial
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
SB  - AIM
SB  - IM
MH  - *Colonoscopy
MH  - Colorectal Neoplasms/*diagnosis
MH  - Early Detection of Cancer/*methods/utilization
MH  - Female
MH  - Health Promotion/*methods
MH  - Humans
MH  - Male
MH  - Mass Screening/methods
MH  - Middle Aged
MH  - *Occult Blood
MH  - Safety-net Providers
EDAT- 2017/09/06 06:00
MHDA- 2017/09/13 06:00
CRDT- 2017/09/06 06:00
AID - 2652650 [pii]
AID - 10.1001/jama.2017.11389 [doi]
PST - ppublish
SO  - JAMA. 2017 Sep 5;318(9):806-815. doi: 10.1001/jama.2017.11389.