TY - JOUR
T1 - Mailed Outreach Is Superior to Usual Care Alone for Colorectal Cancer Screening in the USA
T2 - A Systematic Review and Meta-analysis
AU - Jager, Mark
AU - Demb, Josh
AU - Asghar, Ali
AU - Selby, Kevin
AU - Mello, Evelyn Marquez
AU - Heskett, Karen M.
AU - Lieberman, Alicea J.
AU - Geng, Zhuo
AU - Bharti, Balambal
AU - Singh, Siddharth
AU - Gupta, Samir
N1 - Publisher Copyright:
© 2019, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.
PY - 2019/9/15
Y1 - 2019/9/15
N2 - 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.
AB - 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.
KW - Cancer screening
KW - Colorectal cancer
KW - Meta-analyses
KW - Systematic review
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UR - http://www.scopus.com/inward/citedby.url?scp=85064220343&partnerID=8YFLogxK
U2 - 10.1007/s10620-019-05587-6
DO - 10.1007/s10620-019-05587-6
M3 - Review article
C2 - 30915656
AN - SCOPUS:85064220343
SN - 0163-2116
VL - 64
SP - 2489
EP - 2496
JO - Digestive Diseases and Sciences
JF - Digestive Diseases and Sciences
IS - 9
ER -