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Mailed Outreach Is Superior to Usual Care Alone for Colorectal Cancer Screening in the USA: A Systematic Review and Meta-analysis

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Abstract

Mailed outreach promoting colorectal cancer (CRC) screening with a stool blood test kit may increase participation, but magnitude and consistency of benefit of this intervention strategy is uncertain. Our aim was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing mailed outreach offering stool tests to usual care, clinic-based screening offers on CRC screening uptake in the USA. We performed a systematic literature search of five databases for RCTs of mailed outreach from January 1980 through June 2017. Primary outcome was screening completion, summarized using random-effects meta-analysis as pooled differences in proportion completing the screening and relative risk of achieving screening compared to control. Subgroup analyses by test type offered—fecal immunochemical test (FIT) or guaiac fecal occult blood test (gFOBT), the presence of telephone reminders, and the presence of predominant underserved/minority population within study were performed. Quality of evidence was evaluated using the GRADE framework. Seven RCTs which enrolled 12,501 subjects were included (n = 5703 assigned mailed outreach and n = 6798 usual care). Mailed outreach resulted in a 28% absolute (95% CI 25–30%; I2 = 47%) and a 2.8-fold relative (RR 2.65, 95% CI 2.03–3.45; I2 = 92%) increase in screening completion compared to usual care, with a number needed to invite estimated to be 3.6. Similar outcomes were observed across subgroups. Overall body of evidence was at moderate quality. Mailed outreach offering a gFOBT or FIT is associated with a large and consistent increase in CRC screening completion and should be considered for more widespread implementation for improving screening rates nationwide.

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Acknowledgments

Funding for this project was provided by the National Cancer Institute of the National Institutes of Health under Award Numbers: U54CA132384, U54CA132379, and 1R37CA222866-01. The project described was also supported by Merit Review Award number 1 I01 HX001574-01A1 from the United States Department of Veterans Affairs Health Services Research and Development Service of the VA Office of Research and Development. Siddharth Singh is supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number K23DK117058, and also by the American College of Gastroenterology Junior Faculty Development Award and the Crohn’s and Colitis Foundation Career Development Award.

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Authors and Affiliations

  1. San Diego State University, San Diego, USA

    Mark Jager

  2. Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, USA

    Josh Demb

  3. Department of Medicine, University of California San Diego, San Diego, USA

    Ali Asghar

  4. Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, USA

    Kevin Selby

  5. Kaiser Permanente, Panorama City, USA

    Evelyn Marquez Mello

  6. University of California San Diego Library, San Diego, USA

    Karen M. Heskett

  7. Rady School of Management, University of San Diego, San Diego, USA

    Alicea J. Lieberman

  8. Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, USA

    Zhuo Geng

  9. Moores Cancer Center, UC San Diego, San Diego, USA

    Balambal Bharti & Samir Gupta

  10. Division of Gastroenterology, University of California San Diego, San Diego, USA

    Siddharth Singh

  11. Division of Biomedical Informatics, University of California San Diego, San Diego, USA

    Siddharth Singh

  12. Division of Gastroenterology, VA San Diego Healthcare System, 3350 La Jolla Village Drive MC 111D, San Diego, CA, 92161, USA

    Samir Gupta

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  1. Mark Jager
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Correspondence to Samir Gupta.

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Jager, M., Demb, J., Asghar, A. et al. Mailed Outreach Is Superior to Usual Care Alone for Colorectal Cancer Screening in the USA: A Systematic Review and Meta-analysis. Dig Dis Sci 64, 2489–2496 (2019). https://doi.org/10.1007/s10620-019-05587-6

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