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07-07-2011 | Gastroenterology | Article

Advance warning of CRC screening improves attendance


Free abstract

MedWire News: Sending advance notice of an invitation to colorectal cancer (CRC) screening can significantly increase attendance levels at little extra cost, findings from a randomized, controlled trial have demonstrated.

CRC is associated with a high burden of disease, and in the USA is the fourth most commonly diagnosed cancer and the second most common cause of cancer-related death.

Early identification through fecal occult blood analysis, and colonoscopy where indicated, effectively reduces mortality rates; however, screening programs are only effective when rates of attendance are adequate.

A small study conducted in Australia suggested that adherence to CRC screening is increased when the invitation letter is preceded by a notification.

To confirm this finding, Aafke van Roon (Erasmus University Medical Centre, Rotterdam, The Netherlands) and co-workers measured attendance at a screening program of 5000 individuals in The Netherlands, aged 50-74 years.

The participants were randomly selected to receive a standard invitation to screening, or an advance notification of invitation to screening followed by a standard invitation. Individuals from both groups who did not respond to their invitation were reminded of the appointment after 6 weeks.

Analysis showed that attendance was significantly higher when an advance notification was sent before the standard invitation, with rates of 64.4% versus 61.1%, a difference that was not related to age, gender, or socio-economic status.

The researchers also calculated the extra costs associated with sending an advance notification and the increasing attendance levels, including the cost of the notification itself, and the costs of the additional fecal immunochemical tests and colonoscopies. This gave an incremental cost for each additional neoplasia identified of approximately US$ 1384, which the authors suggest is "acceptable."

The authors summarize: "This large population-based randomized trial demonstrates that sending advance notification letters significantly increases adherence in colorectal cancer screening."

They conclude: "This simple intervention has low incremental cost per additional detected advanced neoplasia and we therefore advocate the implementation of an advance notification letter within the standard colorectal-screening invitation process."

The results are published in the journal Preventive Medicine.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Philip Ford

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