“Rescue” of Nonparticipants in Colorectal Cancer Screening: A Randomized Controlled Trial of Three Noninvasive Test Options

Abstract

Few studies have directly targeted nonparticipants in colorectal cancer screening to identify effective engagement strategies. We undertook a randomized controlled trial that targeted nonparticipants in a previous trial of average-risk subjects which compared participation rates for mailed invitations offering a fecal test, a blood test or a choice of either. Nonparticipants (n = 899) were randomized to be offered a kit containing a fecal immunochemical test (FIT), directions on how to arrange a blood DNA test, or the option of doing either. Screening participation was assessed 12 weeks after the offer. To assess the cognitive and attitudinal variables related to participation and invitee choice, invitees were surveyed after 12 weeks, and associations were investigated using multinomial logistic regression. Participation rates were similar between groups (P = 0.88): 12.0% for FIT (35/292), 13.3% for the blood test (39/293), and 13.4% for choice (39/290). Within the choice group, participation was significantly higher with FIT (9.7%, 28/290) compared with the blood test (3.8%, 11/290, P = 0.005). The only variable significantly associated with participation was socioeconomic status when offered FIT, and age when offered choice but there was none when offered the blood test. Survey respondents indicated that convenience, time-saving, comfort, and familiarity were major influences on participation. There was no clear advantage between a fecal test, blood test, or choice of test although, when given a choice, the fecal test was preferred. Differences in variables associated with participation according to invitation strategy warrant consideration when deciding upon an invitation strategy for screening nonparticipants. Prevention Relevance: This trial of screening for those at average risk for colorectal cancer targeted past fecal-test nonparticipants and compared participation rates for mailed invitations offering a fecal test, blood test, or choice of either. Although there was no clear advantage between strategies, factors associated with participation differed between each strategy.

Acceptability of alternative technologies compared with faecal immunochemical test and/or colonoscopy in colorectal cancer screening: A systematic review

“… 32 – 40 To assess acceptability, studies compared participants who had completed a screening intervention or a comparator. Eight studies compared CT colonography and colonoscopy, 20 – 24 , 34 – 37 , 38 five studies compared FS and FIT, 25 – 28 , 39 four studies compared FS and colonoscopy, 21 , 26 , 36 – 37 four studies compared blood-based biomarker tests and FIT, 29 – 32 two studies compared colon capsule endoscopy and colonoscopy, 33 , 40 two studies compared CT colonography and FOBT 21 , 23 and one study compared CT colonography and FIT. 24 …”

“…The results found participants from a higher socio-economic group were more likely to take part in both FS and FIT screening (p < 0.05). Three RCTs 29 – 31 and one observational 32 study compared uptake of blood-based test and FIT ( Figure 2(c) ). In two of these studies, 29 – 30 differences in observed uptake were not significant.…”

“…Three RCTs 29 – 31 and one observational 32 study compared uptake of blood-based test and FIT ( Figure 2(c) ). In two of these studies, 29 – 30 differences in observed uptake were not significant. In the third study, by Liles, 31 differences in observed uptake were higher in blood-based test than FIT (99.5% vs. 88.1%, p < 0.001).…”

“…Key characteristics of the included studies are outlined in Table 2. Twelve studies were RCTs [20][21][22][23][24][25][26][27][28][29][30][31] and eight studies were observational. [32][33][34][35][36][37][38][39][40] To assess acceptability, studies compared participants who had completed a screening intervention or a comparator.…”

“…The differences in observed uptake were higher with FIT (50.4%, p < 0.001) than both reduced (28.1%) and full-preparation (25.2%) CT colonography. 20 Forbes et al (2006) (Australia) 21 Stoop et al (2011) (Netherlands) 22 You et al (2015) (Canada) 23 Sali 25 Segnan et al (2007) (Italy) 26 Hol et al (2009) (Netherlands) 27 Randel 29 Young et al (2021) (Australia) 30 Liles et al (2016) (USA) 31 Ioannou et al 36 Senore et al (2011) (Italy) 37 Observational study…”