Colorectal cancer (CRC) screening rates in underserved patient populations can be boosted by an organized mailed outreach effort supported by telephone follow-up, according to a study published Oct. 14 in JAMA Internal Medicine.

The type of screening test offered by the outreach matters, as an invitation to participate in a fecal immunochemical test (FIT) tripled CRC screening rates while colonoscopy outreach doubled rates compared with the usual care of reaching out to patients during primary care visits. “For underserved populations, our findings raise the possibility that large-scale public health efforts to boost screening may be more successful if noninvasive tests, such as FIT, are offered over colonoscopy,” wrote Samir Gupta, MD, MSCS, of Veterans Affairs San Diego Healthcare System, and colleagues.

Participation rates in CRC screening are low among underserved and uninsured populations. Since these patients lack regular access to primary care physicians, a visit-based screening outreach may not be effective, explained the authors. To test the impact of a mailed outreach program, Gupta and colleagues identified a group of nearly 6,000 uninsured patients served by the John Peter Smith Health Network, a safety net health system in Fort Worth and Tarrant County, Texas.

A group of 1,593 of the patients, average age 59 years old, were mailed an invitation to use and return an enclosed no-cost FIT, while a second group of 479 patient was invited to schedule a no-cost colonoscopy. The remaining 3,898 patients were assigned to usual care consisting of primary case visit-based screening. Those in the first two groups received a telephone follow-up to provide an additional push toward screening.

Screening participation was 40.7 percent for the FIT group and 24.6 percent for the colonoscopy group, both significantly higher than the usual care group’s 12.1 percent screening rate, reported the authors. These results were consistent across gender and racial lines.

Gupta and colleagues wrote that the results demonstrate that outreach strategies, particularly those involving noninvasive testing such as FIT, should be implemented to improve screening rates for the underserved. “If associated with higher participation rates, programmatic screening with less-invasive tests may result in similar or even better population effectiveness than population colonoscopy screening,”