Findings compared with three opt-in screening strategies among average-risk adults aged 45 to 49 years
By Lori Solomon HealthDay Reporter
TUESDAY, Aug. 12, 2025 (HealthDay News) — Mailing a stool-based test directly to people’s homes is the most effective strategy for increasing colorectal cancer screening rates, according to a study published online Aug. 4 in the Journal of the American Medical Association.
Artin Galoosian, M.D., from the David Geffen School of Medicine at the University of California in Los Angeles (UCLA), and colleagues sought to determine the most effective population health strategy to promote colorectal cancer screening among average-risk adults aged 45 to 49 years. Participants were randomly assigned to one of four strategies: (1) fecal immunochemical test (FIT)-only active choice; (2) colonoscopy-only active choice; (3) dual-modality (FIT or colonoscopy) active choice; and (4) usual care default mailed FIT outreach.
The researchers found that only 18.6 percent underwent screening. There was significantly lower participation observed in each of the three active choice groups (FIT only: 16.4 percent [rate difference, −9.8 percent]; colonoscopy only: 14.5 percent [rate difference, −11.7 percent]; dual-modality FIT or colonoscopy: 17.4 percent [rate difference, −8.9 percent]) compared with the usual care default mailed FIT group (26.2 percent). Participants were more likely to complete any screening if offered dual-modality active choice compared with those offered a single active choice modality (17.4 percent for dual-modality FIT or colonoscopy versus 15.4 percent for FIT only and colonoscopy only combined; rate difference, −1.8 percent). When offered a choice between two modalities (dual-modality active choice FIT or colonoscopy), colonoscopy was more common than FIT (12.0 versus 5.6 percent). There was notable crossover in the FIT-only groups to colonoscopy (9.8 percent FIT-only active choice and 9.8 percent usual care default mailed FIT). There was modest crossover from colonoscopy to FIT (2.7 percent colonoscopy-only active choice).
“When national guidance recommended screening adults age 45 to 49 for colorectal cancer for the first time, it wasn’t clear how to best reach and screen this newly eligible population,” senior author Folasade May, M.D., also from UCLA, said in a statement. “Removing the need for patients to actively opt into screening can lead to better outcomes, particularly when trying to engage younger, generally healthy adults who may not yet perceive themselves at risk for cancer.”
One author disclosed ties to Exact Sciences, Medtronic, and Geneoscopy.
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