Interventions for Increasing Colorectal Cancer Screening Uptake: A Systematic Review and Network Meta-Analysis.
Daryl Ramai, Chun-Wei Pan, Bjorn Rodriguez et al.
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In 30 seconds
This systematic review and network meta-analysis compared eight strategies for increasing colorectal cancer screening uptake across 76 randomized clinical trials. Patient navigation and mailed fecal immunochemical test (FIT) outreach significantly outperformed usual care: navigation had an RR of 1.58 (95% CI, 1.23-2.02), and mailed FIT outreach an RR of 1.36 (95% CI, 1.07-1.74). Mailed FIT outreach was particularly effective where baseline uptake was below 30%. Evidence certainty was mostly moderate to low, and educational multimedia showed promise in higher-uptake settings and recent studies.
Key findings
- Patient navigation increased screening uptake versus usual care (RR, 1.58; 95% CI, 1.23-2.02).
- Mailed FIT outreach increased uptake versus usual care (RR, 1.36; 95% CI, 1.07-1.74) and outperformed colonoscopy outreach (RR, 1.35; 95% CI, 1.11-1.63).
- In settings with baseline uptake below 30%, mailed FIT outreach had an RR of 3.12 (95% CI, 1.70-5.71).
- Choice-based and colonoscopy outreach were not significantly more effective than usual care; evidence certainty was mostly moderate to low.
Why it matters
Screening uptake remains suboptimal despite its role in reducing colorectal cancer mortality. These comparative findings suggest that navigation and mailed FIT outreach can improve participation, while the relative performance of strategies may depend on baseline uptake. The review also highlights uncertainty in the evidence, which matters when interpreting rankings and considering how broadly results apply.
What to keep in mind
The certainty of evidence was mostly moderate to low, limiting confidence in comparative rankings. The abstract does not report participant totals or follow-up duration.