888 Mailed Invitations to Be Screened for Colorectal Cancer Improve Uptake in Population Based Screening Program

Abstract

Introduction: A central tenet of organized cancer screening programs is that all members of the target population be invited to be screened. While mailed invitations for colorectal cancer (CRC) screening have been shown to be effective in randomized controlled trials, to date, their effectiveness has not been reported in population-based studies. The aim of this study is to evaluate the effectiveness of mailed invitations for CRC screening in a populationbased CRC screening program. Methods: In 2008, Ontario launched its organized provincewide CRC screening program, ColonCancerCheck (CCC). In November 2009, CCC conducted a technical evaluation (“the Pilot”) of large scale mailed invitations asking patients to visit their family physician to arrange CRC screening. The Pilot comprised 102 family physicians and all their associated eligible patients (i.e., aged 50-74 years, due for screening, no prior CRC). In the current study, we linked the records of the Pilot patients to provincial health administrative records. Patient and physician factors associated with response to the mailed invitation were identified using logistic regression adjusting for clustering of patients within physicians. Using propensity scores to match in a 1:1 fashion, we then selected a control group of eligible patients from family physicians who did not participate in the Pilot. CRC screening uptake was compared between Pilot patients and matched controls using McNemar's test. Results: There were 11,302 eligible patients in the Pilot cohort. Median age (interquartile range) was 58 years (53-64), 5,853 (52%) were female and 1,548 (14%) completed an FOBT previously (from 2 to 5 years prior). 2503 (22%) completed an FOBT within 6 months of the mailed invitation. Factors significantly associated with uptake of FOBT included older patient age (70-74 vs. 50-59 years old: OR 1.6, 95% CI: 1.3 2.0), greater patient co-morbidity (greatest vs. no co-morbidity: OR 1.6, 95% CI: 1.3 2.0), having a female physician (OR 1.3, 95% CI: 1.04 1. 6), lack of intercurrent hospital admission (OR 3.5, 95% CI: 2.2 5.6) and prior FOBT(OR 2.8, 95% CI: 2.5 3.3). In the matched analysis, Pilot patients were more likely to complete an FOBT within 6 months of mailed invitation than matched controls (22% vs. 7%, p<0.0001). Benefit was maintained when the definition of uptake of CRC screening included FOBT or colonoscopy within 6 months of invitation (25% vs. 10%, p <0.0001). Seven invitations were mailed for each additional person participating in screening. Conclusion: Mailed invitations improved the uptake of CRC screening in this provincial population-based CRC screening program. Organized CRC screening programsmay wish to use mailed invitations to improve patient participation.