(HealthDay News) — Low-cost interventions relying upon mailings, text messages, and phone calls can increase adherence to colorectal cancer screening with fecal immunochemical tests (FIT) among vulnerable populations, according to a study published in JAMA Internal Medicine.

David W. Baker, MD, from Northwestern University in Chicago, and colleagues randomly assigned 450 patients seen in a network of community health centers who had previously completed a home FOBT (March 2011 through February 2012).

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Usual care included computerized reminders, standing orders for FIT tests, and clinician feedback on CRC screening rates. The intervention group additionally received (1) a mailed reminder letter, a free FIT with low-literacy instructions, and a postage-paid return envelope; (2) an automated telephone and text message FIT reminder; (3) another automated telephone and text reminder 2 weeks later when the FIT was not returned; and (4) personal telephone outreach after 3 months.

The researchers found that intervention patients were much more likely than to complete FOBT (82.2% vs. 37.3%; P < 0.001), compared to those in usual care.

For the 185 intervention patients completing screening, 10.2% completed prior to their due date (intervention was not needed), 39.6% within 2 weeks (after step 1 of intervention), 24.0% (after automated call/text reminder), and 8.4% (after personal call).

“It is possible to improve annual CRC screening for vulnerable populations with relatively low-cost strategies that are facilitated by health information technologies,” the researchers wrote.

Unfortunately, however, only 60% of those with a positive screening FOBT result underwent follow-up diagnostic colonoscopy, noted authors of a related commentary.

“Follow-up colonoscopy is crucial, since the chance of CRC is as high as 4% in individuals with a positive FOBT result, and almost one-third have advanced precancerous adenomas,” they continued.

“Lack of a follow-up colonoscopy defeats the purpose of a FOBT screening program,” they continued. “Baker et al do not describe the reasons for low rates of follow-up diagnostic colonoscopy, but for many people in the United States, the barriers to this procedure are substantial and include limited availability and cost,” they wrote.


  1. Baker DW, Brown T, Buchanan DR et al. Comparative Effectiveness of a Multifaceted Intervention to Improve Adherence to Annual Colorectal Cancer Screening in Community Health Centers: A Randomized Clinical Trial. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2014.2352.
  2. Green BB, Coronado DG. “BeneFITs” to Increase Colorectal Cancer Screening in Priority Populations. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2014.730.