Colorectal Cancer Screening, Fecal Immunochemical Test, Multi-target Stool DNA, Colorectal Cancer (CRC)
Conditions
Keywords
screening, early detection, colorectal cancer, stool blood test, mailed outreach
Brief summary
The objective of this study is to measure the comparative effectiveness of mailed outreach of two stool based tests, multi-target stool DNA (Cologuard) and the fecal immunochemical test (FIT) in screening eligible adults ages 45-49 receiving care at the University of California San Diego Health system.
Detailed description
Adults ages 45-49 who are insured, deemed average risk and not currently up to date with colorectal cancer screening will be enrolled. Eligible participants will be randomized to either mailed Cologuard outreach, facilitated by Exact Sciences or mailed FIT outreach. Colorectal cancer screening completion within 12 months of randomization will be measured as the primary outcome, in addition to secondary outcomes of Cologuard or FIT positivity rate measured within 12 months of randomization, and follow-up colonoscopy uptake and CRC incidence, measured within 24 months of randomization.
Interventions
DIAGNOSTIC_TESTCologuard
Multi-target stool DNA test for colorectal cancer screening implemented by Exact Sciences. Cologuard has 94% sensitivity and 87% specificity to detect colorectal cancer.
DIAGNOSTIC_TESTFecal Immunochemical Test
Stool blood test for colorectal cancer screening. FIT has 75% sensitivity and 90% specificity to detect colorectal cancer.
Sponsors
National Cancer Institute (NCI)
University of California, San Diego
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SCREENING
Masking
NONE
Intervention model description
Two-arm intervention trial comparing mailed Cologuard outreach (Intervention 1) to mailed FIT outreach (Intervention 2)
Eligibility
Sex/Gender
ALL
Age
45 Years to 49 Years
Healthy volunteers
No
Inclusion criteria
* Adults ages 45-49 with EHR documentation indicating that the patient has an assigned primary care provider at UCSD Health * ≥1 UCSD Health System health visit within the last year * Resides in San Diego or Imperial County * Currently not up to date with CRC screening * Insured by private, public or other health insurance.
Exclusion criteria
* Up-to-date with screening * Prior history of colonic disease, including inflammatory bowel disease, one or more colorectal neoplastic polyps (i.e., adenomas) or colorectal cancer. * Prior history of colectomy * Lack of health insurance
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of Colorectal cancer screening completion | Within 12 months of randomization | The proportion of individuals who complete any colorectal cancer screening test recommended by US Preventive Services Task Force (colonoscopy, FIT, Cologuard, Sigmoidoscopy or CT Colonography) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of Abnormal stool blood test results | Within 12 months of randomization | Among those completing designed interventions (Cologuard or FIT), the proportion of test results yielding an abnormal result. |
| Proportion of Follow-up colonoscopy after abnormal stool blood test result | Within 24 months after randomization | Among those with positive stool blood test results, the proportion who complete diagnostic follow-up colonoscopy |
| Colorectal cancer incidence | Within 24 months after randomization | Number of colorectal cancers detected during study period |
Countries
United States
Outcome results
None listed