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Editor's Note
September 2018

Promoting FIT Colorectal Cancer Screening

Author Affiliations
  • 1University of California, San Francisco, San Francisco
JAMA Intern Med. 2018;178(9):1181. doi:10.1001/jamainternmed.2018.3654

Rates of colorectal cancer (CRC) screening are low, particularly among the underserved. Of the several available and equally effective CRC screening options,1 fecal-based testing, such as fecal immunochemical testing (FIT) is the most convenient because it does not require a clinical visit, taking time off from work, or being escorted back and forth from the procedure owing to the widespread use of anesthesia for colonoscopy.2 In this STOP CRC project the investigators randomized federally qualified health clinics to practice improvement efforts or usual care.3 For the practice improvement clinics, tools were built into the electronic medical record to identify eligible patients and mail them materials including the actual FIT tests. In the lagged data (which allowed enough time for the clinics to implement the new processes), the rates of FIT screening were 15.9% for usual care compared with 21.6% in the intervention clinics. The number needed to mail to achieve a completed FIT was 4.8 overall, and 4.0 in clinics that mailed a FIT reminder. Most (59%) of those with positive FIT completed a colonoscopy. The success of this intervention should encourage health centers to engage clinicians and patients to increase CRC screening efforts.

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