Within recent years, colorectal cancer (CRC) has seen an alarming rise in the US. In response to these epidemiological trends and revised risk factor evaluation, public health and clinical authorities have placed a greater stress on screening for early detection. This undertaking has taken several forms, including lowering the recommended screening age, more aggressive awareness campaigns, and the proliferation of novel CRC screening methods to expand access. In a recent US study published in JAMA Internal Medicine, Folsade May and colleagues analysed the relationship between access to CRC’s various screening methods and screening participation. Among the screening modalities, a novel mailed screening kit complemented by outreach messages from the kit manufacturer yielded significantly higher screening participation than the traditional mail-in kit. According to GlobalData epidemiologists, the diagnosed incident cases of CRC among adults are expected to increase from 150,036 to 161,497 in the US between 2026 and 2031. Provided that CRC screening outreach and methods continue to expand, the incidence may increase due to earlier, more widespread detection. However, ideally, the higher proportion of cases will be caught in the early stages of the disease.
May and colleagues conducted a randomised clinical trial in Boston, Los Angeles, and South Dakota in 2023 among 5,127 eligible adults between the ages of 45 and 75 years. Participants were provided with either a faecal immunochemical test (FIT), a widely utilised annual stool-based mail-in screening test, or the newer FIT-DNA test mailed directly to screening patients every three years. While traditional FIT cases were accompanied by personalised messages from healthcare professionals on test administration, the FIT-DNA kits were complemented by messages with manufacturer instructions. In both cases, outreach efforts were offered in English or Spanish according to patient preference. Results showed that a significantly higher proportion of participants followed up with screening in the FIT-DNA group at 27.90% compared to 22.60% in the FIT group (Figure 1). Furthermore, participants tended to perform screening within a shorter window of time. Participants who received abnormal results on either test were recommended to seek a colonoscopy, which was performed among 39.70% of abnormal FIT-DNA participants and 31% of FIT participants. The authors attribute the difference in screening participation to factors including better support from FIT-DNA providers and a longer screening interval for FIT-DNA screening. However, they note that FIT-DNA costs are on average significantly higher than those of FIT screening, presenting real-world complications in uptake if patients have insufficient insurance coverage or funds.
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The findings presented by May and colleagues bolster the case for expanding access to mail-in CRC screening kits, especially when complemented by support services for patients. Furthermore, it explores the motives among participants that could drive higher participation, including longer intervals of time between tests and accurate results, which address some of the behavioural barriers to screening due to inconvenience, discomfort, or cost. Healthcare professionals should continue to push these and other measures to expand awareness of and access to CRC screening. Through this multifaceted approach, hope remains that the alarming trends in CRC can be curbed.
