Colon Cancer Screening Rate Increases When People Are Offered Choices, Study


Datelinehealth Africa Staff Writer



When people are offered choices between screening methods, the response rate for colon cancer screening increases, a new study has found.


Colon cancer screening is now recommended in the West for people at average risk starting at age 45. Those with personal or family history of colon cancer are urged to consider starting sooner.


The gold standard for screening and the definitive diagnosis of colon cancer is colonoscopy. This is recommended once every 10 years.


Colonoscopy is invasive, but the procedure allows doctors to view your entire colon by passing a flexible tube with a camera at the tip through your anus and rectum. If any suspicious areas are found, your doctor can pass surgical tools through the tube to take tissue samples (biopsies) for analysis and remove any precancerous mass (polyps) that could develop into colon cancer over time.


An alternative and non-invasive colorectal cancer screening test that people can choose among others is the fecal immunochemical test (FIT). This can be done once a year and it involves collecting a stool sample at home and mailing or dropping it to a laboratory, where it is analyzed for hidden blood in stool that can be an early sign of colon cancer.


For the purpose of outreach to get people to undertake colorectal screening, the researchers tested the hypothesis whether if people are offered the choice between colonoscopy and fecal immunochemical test (FIT), or FIT alone, response rate would increase compared with colonoscopy alone.


For the study, researchers offered colon cancer screenings to 738 patients ages 50 to 74 at a community health center in the northeastern city of Pottstown, Pennsylvania, USA over a period of six months.


The center had a screening rate of about 22% for colon cancer that was much lower than the national average of 72%.


Researchers found that only 6% of people completed screening within the six months if they were only offered a colonoscopy only. About 11% completed screening if they were only offered a take-home fecal test kit.


But when people were offered the choice between a colonoscopy and a take-home FIT kit, the screening rate jumped to nearly 13%.


Further, when given a choice, the proportion of people who then got a colonoscopy increased to 10%, researchers observed.


As a result of the surprising findings, the researchers conclude that offering people the choice of colonoscopy or take-home kits seem to boost the rate of choosing colonoscopy -- the most effective screening tool.


The study was published recently in the journal Clinical Gastroenterology and Hepatology.


While offering people a choice of screening, for the diagnosis of symptoms and follow-up of probable or suspected colorectal cancer boosted the rate of colonoscopy uptake, the researchers still think that offering less invasive options as an alternative to colonoscopy could increase screening rates within communities more.


Given the very low awareness of colorectal cancer and its screening in many African countries, the implication of the study for designing public health awareness raising interventions seems clear. Coomunities in African countries need to be provided education about the condition with the choices that are available for screening, diagnosis of symptoms and treatment, so that they will be empowered to make informed decisions towards buying into its prevention through screening.  




Mehta SJ, Palat S, McDonald C., et al. A randomized trial of choice architecture and mailed colorectal cancer screening outreach in a community health setting. Clin. Gastro. And Hep. April 30.2024.



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Published: May 22, 2024

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