Abstract
Suboptimal participation is commonly observed in colorectal cancer screening programs utilizing fecal tests. This randomized controlled trial tested whether the offer of a blood test as either a "rescue" strategy for fecal test nonparticipants or an upfront choice, could improve participation. A total of 1,800 people (50-74 years) were randomized to control, rescue, or choice groups (n = 600/group). All were mailed a fecal immunochemical test (FIT, OC-Sensor, Eiken Chemical Company) and a survey assessing awareness of the screening tests. The rescue group was offered a blood test 12 weeks after FIT nonparticipation. The choice group was given the opportunity to choose to do a blood test (Colvera, Clinical Genomics) instead of FIT at baseline. Participation with any test after 24 weeks was not significantly different between groups (control, 37.8%; rescue, 36.9%; choice, 33.8%; P > 0.05). When the rescue strategy was offered after 12 weeks, an additional 6.5% participated with the blood test, which was greater than the blood test participation when offered as an upfront choice (1.5%; P < 0.001). Awareness of the tests was greater for FIT than for blood (96.2% vs. 23.1%; P < 0.0001). In a population familiar with FIT screening, provision of a blood test either as a rescue of FIT nonparticipants or as an upfront choice did not increase overall participation. This might reflect a lack of awareness of the blood test for screening compared with FIT.
Highlights
Detection is critical for reducing mortality from colorectal cancer and can be achieved through effective screening programs
Previous work that focused on identifying and removing barriers to participation in fecal test–based screening suggests that a blood test could improve screening uptake, for those who dislike fecal sampling [4, 5] or who have a benign, bleeding condition making completion of fecal occult blood tests (FOBT) inappropriate [6]
We have shown that the genes BCAT1 and IKZF1 are methylated with high frequency in colorectal neoplastic tissues [13, 14] and that methylation in these genes can be detected in the plasma of patients with colorectal cancer [15, 16]
Summary
Detection is critical for reducing mortality from colorectal cancer and can be achieved through effective screening programs. Many countries have implemented organized, population-based, screening programs with fecal occult blood tests (FOBT), but participation rates can. Previous work that focused on identifying and removing barriers to participation in fecal test–based screening suggests that a blood test could improve screening uptake, for those who dislike fecal sampling [4, 5] or who have a benign, bleeding condition making completion of FOBT inappropriate [6]. Beliefs about colorectal cancer prevention, awareness of the tests, and the benefit of screening [9], as well as test technology variables [9,10,11] are likely to be relevant when designing screening programs
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