August 6, 2013
Organized Mailing Campaigns May Promote Colon Cancer Screening
Lawrence LeBlond for redOrbit.com - Your Universe Online
Mention the word colonoscopy and you are likely to make people cringe with fear. While the subject is a touchy one for many, most health experts concur far-reaching changes are needed to improve people's attitudes when it comes to colorectal cancer screening.
In a new study of nearly 6,000 North Texas patients, researchers from UT Southwestern and the University of California, San Diego found screening participation rates rose depending on the screening method offered and how patient outreach was handled. The team's results also suggest a noninvasive colorectal screening approach, such as fecal immunochemical testing (FIT) may be more effective in promoting participation.
The study, published in the August 5 online edition of JAMA Internal Medicine, found organized mailing campaigns were among the best methods in prompting participation in potentially lifesaving colorectal cancer screening, especially when the mailings offer FIT screening, which is less expensive than intrusive colonoscopy. The mailings offered two colon cancer screening methods and were found to increase screening rates as much as threefold among patients who were uninsured.
The study was led by Samir Gupta, MD, MSCS, an associate professor of clinical medicine and gastroenterology at UCSD School of Medicine and Veterans Affairs San Diego Healthcare System. The research was conducted at UT Southwestern's Division of Digestive and Liver Diseases, Simmons Cancer Center, and the Moncrief Cancer Institute. The research was conducted in close collaboration with John Peter Smith Hospital in Fort Worth, Texas.
For the study, the researchers sent mailed invitations to uninsured patients between the ages of 54 and 64. The mailing asked patients to use and return a no-cost FIT sample, or to schedule and undergo a colonoscopy at no cost. Also, the researchers followed up those who took part with telephone interviews to promote test completion.
The participation tripled for the FIT method and doubled for colonoscopy when compared to the standard care strategy for colon cancer screenings. Gupta noted the difference was much bigger than anticipated and the findings could have implications for health policy.
He said the team's findings suggest large-scale public health efforts to boost screening may be more successful if noninvasive methods are offered over colonoscopy.
"Physicians shouldn't necessarily assume that use of colonoscopies is the best and only way to reduce colon cancer rates," Gupta said. "What we should ask is, what type of screening is most acceptable to underserved populations? This is because the best predictor of colorectal cancer screening outcomes may be getting any test, rather than which test is done."
"Now, the question to be studied further is whether superior participation can be maintained in the FIT group, because the test must be repeated every year, and how adherence rates will impact overall screening effectiveness and cost," added senior author Celette Sugg Skinner, PhD, associate director of Population Research & Cancer Control for the Simmons Cancer Center at UT Southwestern Medical Center in Dallas.
The FIT method is a quick and easy test that requires no special preparation. Tests can be completed at the doctor's or at home using a sample jar and then mailed to a laboratory for analysis. Analysis can detect small amounts of occult (hidden) blood in the stool sample.
Funding for this study came in part by the Cancer Prevention and Research Institute of Texas. Additional funding was provided by the National Institutes of Health.