You've got mail: Delivered colorectal cancer kits may increase screening rates

Mailing colorectal cancer screening tests to Medicaid patients increased screening rates by roughly 10 percent—showing a more direct approach can improve results, according to researchers from the University of North Carolina (UNC) Comprehensive Cancer Center in coordination with the UNC Lineberger's Carolina Cancer Screening Initiative and from the Mecklenburg County Health Department in Charlotte, North Carolina who found that mailing colorectal cancer screening tests to Medicaid patients increased screening rates by roughly ten percent. 

The study serves as a model to improve screening on a larger scale, while demonstrating notable gaps in screening rates, especially for people insured by Medicaid, a population with low rates of testing, explained lead researcher Alison Brenner, PhD, a research assistant professor in the UNC School of Medicine Department of Internal Medicine, in a prepared statement.  

“There has been a national push to increase colorectal cancer screening rates since colorectal cancer is a preventable disease, but screening rates are only about 63 percent, and low-income, and otherwise vulnerable populations, tend to be screened at even lower rates,” Brenner said. “In North Carolina, many Medicaid recipients are on disability. Making something like colorectal cancer screening as simple and seamless as possible is really important. If it’s right in front of someone, it’s more likely to get done, even if there are simple barriers in place.

For the study, more than 2,100 people insured by Medicaid who were not up-to-date with colorectal cancer screenings were mailed either reminders about colorectal cancer screening and instructions to make an appointment—as the control—or reminders with a fecal immunochemical test (FIT test). Patients could complete the test at home and return it to a healthcare provider for analysis. Patients whose FIT kit came back with positive results were scheduled for follow-up colonoscopies, according to the researchers. 

Researchers found 21 percent of patients who received the mailed kits completed the screening test, compared with 12 percent of patients who only received a reminder. Additionally, 18 patients who completed FIT tests had abnormal results, with 15 eligible for a colonoscopy. 

“Preventive care amongst vulnerable populations rarely rises to the top of the mental queue of things that need to get done,” Brenner said. "This [study] is looking at expanding the medical neighborhood—to harness community resources to target patients and in this case, insured patients, who are maybe not getting this from a primary healthcare organization, and how to increase screening rates in these types of vulnerable populations."