Mail and Electronic Reminders May Increase Colon Cancer Screening

Mailed reminders to patients appear to promote colon cancer screening, according to a report in the February 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. In addition, electronic reminders to physicians appear to increase screening among patients with more frequent primary care visits.

“Colorectal cancer is the secondary leading cause of cancer mortality [death] in the United States,” according to background information in the article. “Screening programs involving fecal occult blood testing, flexible sigmoidoscopy and colonoscopy lower the incidence of colorectal cancer by removing precancerous adenomas, detect cancers at more curable early stages and reduce colorectal cancer mortality.” Although national guidelines suggest that average-risk adults age 50 and older should be screened for colorectal cancer, only 60 percent report up-to-date testing.

Thomas D. Sequist, M.D., M.P.H., of Brigham and Women’s Hospital, Harvard Vanguard Medical Associates and Harvard Medical School, Boston, and colleagues studied screening rates and colorectal adenoma (tumor) detection for 21,860 patients (age 50 to 80) of 110 physicians from April 2006 to June 2007.

Fifty-five physicians were randomly assigned to receive electronic reminders during office visits with patients overdue for screening. Additionally, 10,930 patients were randomly assigned to receive mailings containing an educational pamphlet, a fecal occult blood test kit and instructions for direct scheduling of flexible sigmoidoscopy or colonoscopy. Screening rates and detection of colorectal adenomas (tumors) were noted 15 months after the start of the intervention.

Screening rates for patients who received mailings were higher than for those who did not (44 percent vs. 38.1 percent). The mailings were more effective among older patients—patients age 50 to 59 experienced a 3.7 percent increase, patients age 60 to 69 had a 7.3 percent increase and patients age 70 to 80 experienced a 10.1 percent increase in screening rates. While patients of physicians receiving electronic reminders had screening rates similar to patients of physicians who did not receive reminders (41.9 percent vs. 40.2 percent), electronic reminders tended to increase screening rates among patients with three or more primary care visits (59.5 percent vs. 52.7 percent).

“Detection of adenomas tended to increase with patient mailings (5.7 percent vs. 5.2 percent) and physician reminders (6 percent vs. 4.9 percent),” the authors write, but these increases were not statistically significant.

“Patient mailings produced modest increases in rates of colorectal cancer screening, whereas electronic physician reminders tended to promote screening only among patients who have more frequent primary care visits,” they conclude. “These complementary approaches have the potential to promote the overarching goal of widespread screening to reduce the incidence, morbidity and mortality of colorectal cancer.”(Arch Intern Med. 2009;169[4]:364-371. Available pre-embargo to the media at www.jamamedia.org.)