Comparative Effectiveness of Fecal Immunochemical Test Outreach, Colonoscopy Outreach, and Usual Care for Boosting Colorectal Cancer Screening Among the Underserved

Abstract

Colorectal cancer (CRC) screening saves lives, yet screening rates among underserved populations, such as the uninsured and minorities, are low.^1-4 The best CRC screening strategy for underserved populations is unclear. Colonoscopy is known to be the most sensitive test for colorectal neoplasia.⁵ However, it is unclear on a population level whether colonoscopy should the primary test promoted for boosting screening for all groups for several reasons. Colonoscopy may not be as acceptable as noninvasive tests such as the fecal immunochemical test (FIT) to all populations.^6-8 If associated with higher participation rates, programmatic screening with less-invasive tests may result in similar or even better population effectiveness than population colonoscopy screening.^5,9 Financial resources and infrastructure required for colonoscopy vs noninvasive screening are markedly different.¹⁰ These issues are especially germane for underserved populations because prior work suggests screening participation may differ by type of test offered⁸ and because safety-net health systems that typically care for underserved populations face financial challenges and have limited colonoscopy capacity.^11,12