Colorectal cancer screening saves lives, but many people do not get tested. This research matters for patients in community health centers who might struggle to find time or motivation for screening. The study looked at whether a newer test could help more people get screened. It also tested if automated text messages could encourage participation.
Researchers conducted a pragmatic cluster randomized clinical trial. They enrolled 5,127 English- or Spanish-speaking primary care patients aged 45 to 75 years. These patients were due for colorectal cancer screening. The study took place in community health centers in the greater Boston area in Massachusetts, Los Angeles County in California, and Rapid City, South Dakota.
Participants were divided into two groups. One group received a mailed fecal immunochemical test, known as FIT, along with outreach from study personnel. The other group received a mailed fecal DNA test, known as FIT-DNA, using the manufacturer's standard outreach protocol. The primary goal was to see if more people would complete screening within 90 days using any method, including FIT, FIT-DNA, or colonoscopy.
The results showed higher screening participation in the FIT-DNA group compared to the FIT group. Within 90 days, 27.9 percent of patients in the FIT-DNA group participated versus 22.6 percent in the FIT group. This difference was statistically significant with a p-value of .02. When looking at participation within 180 days, the FIT-DNA group reached 31.7 percent while the FIT group reached 26.7 percent. The study also found that screening participation was higher in Boston compared to Los Angeles.
Safety was not a major concern in this trial. No adverse events, serious adverse events, discontinuations, or tolerability issues were reported. However, the study did note a limitation regarding follow-up care. Only 36 percent of patients completed a follow-up colonoscopy within 180 days of an abnormal stool test result. This rate was considered suboptimal even when navigation support was available.
People should not overreact to this single study. The evidence comes from a cluster randomized clinical trial, which is a strong design, but the study has specific limitations. The lower follow-up colonoscopy rate suggests that getting patients through the entire screening process remains a challenge. This study does not prove that FIT-DNA is better than colonoscopy for finding cancer. It only shows that the FIT-DNA test with text message outreach led to higher initial screening rates in this specific setting.
For patients right now, this means that newer stool tests might be an option to consider if you are due for screening. The availability of automated text message outreach might also help remind you to schedule your appointment. However, the best screening method for you depends on your doctor's advice and your personal health history. Talk to your primary care provider about which screening test is right for you.
