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Member Research & Reports

Member Research & Reports

UNC Researchers Boost Colorectal Cancer Screening by Sending Tests in the Mail

Mailing colorectal cancer screening tests to patients insured by Medicaid increased screening rates for this population, report researchers at the University of North Carolina Lineberger Comprehensive Cancer Center.

In collaboration with the Mecklenburg County Health Department in Charlotte, researchers with UNC Lineberger’s Carolina Cancer Screening Initiative examined the impact of targeted outreach to more than 2,100 people insured by Medicaid who were not up-to-date with colorectal cancer screening.

The project resulted in a nearly 9 percent increase in screening rates for patients who received a screening kit in the mail compared with patients who received only a reminder, and it demonstrated that their method could serve as a model to improve screening on a larger scale.

Dr. Stephanie Wheeler, associate professor of health policy and management at the University of North Carolina Gillings School of Global Public Health, is senior author of the study, which was published online July 13 in the journal Cancer.

The American Cancer Society (ACS) estimates that more than 97,000 people will be diagnosed with colorectal cancer in the United States this year, and 50,600 of them will die. Colorectal cancer is third most common type of cancer in the United States, and the second leading cause of cancer death.

While colorectal cancer screening has proven effective in reducing cancer deaths, researchers report too few people undergo screening. Current guidelines from ACS recommend regular screening with either a high-sensitivity stool-based test or a structural (visual) exam for average-risk people ages 45 years and older, and that all positive results should be followed with colonoscopy.

Despite these recommendations, studies have identified notable gaps in screening rates, including by race, geographic region and other socio-economic factors. Among patients who are insured, people with Medicaid have the lowest rates of colorectal cancer testing.

For the project, researchers either mailed reminders about colorectal cancer screening and instructions on how to arrange one with the health department, or reminders plus a fecal immunochemical test (FIT) kit, which can detect blood in the stool – a symptom of colon cancer. The patient completes the test at home and returns it to a provider for analysis. Patients who have a positive FIT kit result are scheduled for a colonoscopy.

The researchers worked with the Mecklenburg County (North Carolina) Health Department staff, who coordinated the reminders and mailings and ran the test analyses. They also partnered with Medicaid care coordinators to provide patient navigation support to patients who had abnormal test results and required a colonoscopy.

Twenty-one percent of patients who received FIT kits in the mail completed the screening test, compared with 12 percent of patients who only received a reminder. Eighteen people who completed FIT tests had abnormal results, and 15 of those were eligible for a colonoscopy. Of the 10 who completed the colonoscopy, one patient had an abnormal result.

“This collaborative and pragmatic quality improvement effort demonstrates the feasibility, acceptability and efficiency of using existing health services resources and infrastructure, including Medicaid-based navigation to colonoscopy to deliver timely cancer screening services to low income populations,” said Dr. Wheeler.

She said researchers plan to move forward to study whether they can implement their approach on a larger scale, and to understand all of the cost implications.

UNC Lineberger’s Dr. Alison Brenner, assistant professor of internal medicine in the UNC School of Medicine, is the study’s first author.

[Photo: Dr. Stephanie Wheeler]