About 148,000 Americans are diagnosed with colorectal cancer each year and 56,600 die from the disease. Several studies have shown that screening reduces deaths from colorectal cancer. National guidelines recommend one of four screening methods for colorectal cancer for people aged 50 and older: an annual FOBT, a flexible sigmoidoscopy every 5 years, a colonoscopy every 10 years, or a double-contrast barium enema x-ray every 5 years.
Half of the U.S. population, however, does not take advantage of colorectal cancer screening. To investigate ways to increase the rate of colorectal cancer screening, Timothy R. Church, Ph.D., of the University of Minnesota in Minneapolis, and colleagues conducted a randomized trial of 1451 people aged 50 and older from Wright County, Minn. Participants were placed into three groups: the control group received only a questionnaire that asked about their use of colorectal cancer screening tests; a second group received a questionnaire followed by an FOBT kit; and the third group received a questionnaire followed by an FOBT kit and additional reminders to complete the test. One year later, the researchers sent participants a follow-up questionnaire again asking about their screening use. The trial took place within the context of a county-wide campaign to educate the community about colorectal cancer screening.
In the first questionnaire, 21.5% of the people reported that they followed the guidelines for fecal occult blood testing and 55.8% reported that they followed at least one of the national guidelines for colorectal cancer screening. After a year had passed, the percentage of people who reported following the FOBT guidelines increased, in absolute percentage points, by 1.5% in the control group, 16.9% among those who received FOBT kits, and 23.2% among those who received kits with reminders. The percentage who reported that they followed any of the screening guidelines increased by 7.8% in the control group, 13.2% among those who received kits, and 14.1% among those who received kits and reminders.
These results "suggest that direct mailing of FOBT kits can be used to effect a change in the screening behavior of a large number of people who could benefit from regular colorectal cancer screening," the authors write.
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JNCI Journal of the National Cancer Institute