National Healthcare Quality and Disparities Report
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Topics
- (-) Cancer (22)
- Cancer: Breast Cancer (8)
- Cancer: Cervical Cancer (2)
- Cancer: Colorectal Cancer (5)
- Cancer: Lung Cancer (2)
- Cancer: Ovarian Cancer (1)
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- Case Study (1)
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- Human Immunodeficiency Virus (HIV) (1)
- Imaging (7)
- Implementation (1)
- Men's Health (1)
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- Prevention (7)
- Primary Care (2)
- Racial and Ethnic Minorities (1)
- Research Methodologies (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 22 of 22 Research Studies DisplayedKim HS, Hernaez R, Sansgiry S
Comparative effectiveness of surveillance colonoscopy intervals on colorectal cancer outcomes in a national cohort of patients with inflammatory bowel disease.
The purpose of this study was to determine the comparative effectiveness of varying colonoscopy intervals on colorectal cancer (CRC) outcomes among patients with inflammatory bowel disease (IBD). Data was from the National Veterans Health Administration. Findings showed that, in a national cohort of patients with CRC-IBD, colonoscopy within 3 years prior to CRC diagnosis was associated with early tumor stage at diagnosis, and colonoscopy within 1 year was associated with a reduced all-cause mortality compared with no colonoscopy, supporting colonoscopy intervals of 1 to 3 years in patients with IBD in order to reduce late-stage CRC and all-cause mortality.
AHRQ-funded; HS024122.
Citation: Kim HS, Hernaez R, Sansgiry S .
Comparative effectiveness of surveillance colonoscopy intervals on colorectal cancer outcomes in a national cohort of patients with inflammatory bowel disease.
Clin Gastroenterol Hepatol 2022 Dec;20(12):2848-57.e2. doi: 10.1016/j.cgh.2022.02.048..
Keywords: Cancer: Colorectal Cancer, Cancer, Digestive Disease and Health, Imaging, Screening, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research
Dalton AF, Golin CE, Morris C
Effect of a patient decision aid on preferences for colorectal cancer screening among older adults: a secondary analysis of a randomized clinical trial.
This research studied the effects of a patient decision aid on preferences for colorectal cancer (CRC) screening among adults aged 76 to 84 years. Participants were recruited from 14 community-based primary care practices who were not up to date with screening and had an appointment within 6 weeks. They were randomized to receive the intervention or control. Among the 424 participants, mean age was 76.8, 248 were women, and 333 were White. There were no statistically significant differences found in patient preferences between the health groups. Additional studies that are appropriately powered were recommended.
AHRQ-funded; HS021133.
Citation: Dalton AF, Golin CE, Morris C .
Effect of a patient decision aid on preferences for colorectal cancer screening among older adults: a secondary analysis of a randomized clinical trial.
JAMA Netw Open 2022 Dec;5(12):e2244982. doi: 10.1001/jamanetworkopen.2022.44982..
Keywords: Elderly, Decision Making, Screening, Cancer: Colorectal Cancer, Cancer
Ross RL, Rubio K, Rodriguez HP
Mammography and decision aid use for breast cancer screening in older women.
This study examines the association between practice-level decision-aid use and mammography use among older women. Physician practice responses to the 2017/2018 National Survey of Healthcare Organizations and Systems were linked to 2016-17 Medicare fee-for-service beneficiary data from eligible beneficiaries aged 65-74 years. Findings showed that health information technology-enabled automation of mammography reminders and other advanced health information technology functions may support mammography, whereas breast cancer decision aids may reduce patients' propensities to be screened through the alignment of their preferences and screening decision.
AHRQ-funded; HS022241; HS024075.
Citation: Ross RL, Rubio K, Rodriguez HP .
Mammography and decision aid use for breast cancer screening in older women.
Am J Prev Med 2022 Oct;63(4):630-35. doi: 10.1016/j.amepre.2022.04.014..
Keywords: Imaging, Screening, Decision Making, Cancer: Breast Cancer, Women, Prevention, Cancer, Elderly
Hicklin K, O'Leary MC, Nambiar S
Assessing the impact of multicomponent interventions on colorectal cancer screening through simulation: what would it take to reach national screening targets in North Carolina?
The authors simulated the impact of multicomponent interventions in North Carolina over 5 years to assess the potential for meeting national screening targets for colorectal cancer (CRC). They reported that each multicomponent intervention was associated with increased CRC screening and averted both CRC cases and deaths, while three had the potential to reach screening targets.
AHRQ-funded; HS022981.
Citation: Hicklin K, O'Leary MC, Nambiar S .
Assessing the impact of multicomponent interventions on colorectal cancer screening through simulation: what would it take to reach national screening targets in North Carolina?
Prev Med 2022 Sep;162:107126. doi: 10.1016/j.ypmed.2022.107126..
Keywords: Cancer: Colorectal Cancer, Cancer, Screening, Colonoscopy, Prevention
Golmakani MK, Hubbard RA, Miglioretti DL
Nonhomogeneous Markov chain for estimating the cumulative risk of multiple false positive screening tests.
This study addressed the general challenge of estimating the cumulative risk of multiple false positive test results. The authors proposed a nonhomogeneous multistate model to describe the screening process including competing events and developed alternative approaches for estimating the cumulative risk of multiple false positive results using this multistate model based on existing estimators for the cumulative risk of a single false positive. The multistate model was based on existing estimators for the cumulative risk of a single false positive. They compared the performance of the newly proposed models through simulation studies and illustrated model performance using data on screening mammography from the Breast Cancer Surveillance Consortium. They found that in the context of screening mammography that the cumulative risk of multiple false positive results is high. For a high-risk individual, the cumulative probability of at least two false positive mammography results after 10 rounds of annual screening is 40.4.
AHRQ-funded; HS018366.
Citation: Golmakani MK, Hubbard RA, Miglioretti DL .
Nonhomogeneous Markov chain for estimating the cumulative risk of multiple false positive screening tests.
Biometrics 2022 Sep;78(3):1244-56. doi: 10.1111/biom.13484..
Keywords: Research Methodologies, Screening, Imaging, Cancer: Breast Cancer, Cancer
Singal AG, Chen Y, Sridhar S
Novel application of predictive modeling: a tailored approach to promoting hcc surveillance in patients with cirrhosis.
Researchers conducted a secondary analysis of a randomized clinical trial evaluating a mailed outreach strategy to promote hepatocellular carcinoma (HCC) surveillance among cirrhosis patients at a safety-net health system. They found that predictive models can help stratify patients' likelihood to respond to surveillance outreach invitations, facilitating tailored strategies to maximize effectiveness and cost-effectiveness of HCC surveillance population health programs.
AHRQ-funded; HS022418.
Citation: Singal AG, Chen Y, Sridhar S .
Novel application of predictive modeling: a tailored approach to promoting hcc surveillance in patients with cirrhosis.
Clin Gastroenterol Hepatol 2022 Aug;20(8):1795-802.e2. doi: 10.1016/j.cgh.2021.02.038..
Keywords: Cancer, Chronic Conditions, Screening
Danan ER, Brunner J, Bergman A
The relationship between sexual assault history and cervical cancer screening completion among women veterans in the Veterans Health Administration.
The purpose of this study was to determine whether a history of sexual assault in women Veterans is associated with decreased cervical cancer screening completion. The researchers analyzed data from a 2015 survey of 1049 women Veterans who accessed primary care services at 12 Veterans health administration facilities (VA’s) in nine states, and linked responses with electronic health data from the VA system. Fifty-seven percent (616) of women Veterans reported lifetime sexual assault, and those who did so had a greater likelihood of reporting a high level of distress associated with pelvic examinations and delaying a gynecologic exam due to distress. However, in the final adjusted model, there was not a significant association between lifetime sexual assault and reduced odds of cervical cancer screening completion. The study concluded that there was no significant association between sexual assault and gaps in cervical cancer screening completion.
AHRQ-funded; HS026379.
Citation: Danan ER, Brunner J, Bergman A .
The relationship between sexual assault history and cervical cancer screening completion among women veterans in the Veterans Health Administration.
J Womens Health 2022 Jul;31(7):1040-47. doi: 10.1089/jwh.2021.0237.AHRQ-funded; HS026379..
Keywords: Women, Cancer: Cervical Cancer, Cancer, Screening, Trauma
Kerlikowske K, Su YR, Sprague BL
Association of screening with digital breast tomosynthesis vs digital mammography with risk of interval invasive and advanced breast cancer.
The purpose of this study was to compare digital breast tomosynthesis (DBT) with digital mammography to determine whether DBT was correlated with lower rates of internal invasive cancer and advanced breast cancer, taking into consideration breast density and breast cancer risk. From 2011 through 2018, the researchers studied a cohort of 504,427 women between the ages of 40 and 79 who underwent 375,189 screening DBT exams and 1,003,900 screening digital mammography exams, and who were then followed up for cancer diagnoses between 2011 and 2019 after being identified via linkage to state or regional cancer registries. The median age at the time of screening was 58 years (IQR 50-65 years) and the diagnostic screenings took place at 44 Breast Cancer Surveillance Consortium (BCSC) facilities in the United States. The study found that among women at low to average risk, or at high risk with almost entirely fatty, scattered fibroglandular densities, or heterogeneously dense breasts, advanced cancer rates were not significantly different for DBT vs digital mammography. There was no significant difference between DBT and digital mammography for interval cancer rates per 1000 exams. Interval invasive cancer rates were also not significantly different among the 413,061 examinations with BCSC 5-year risk of 1.67% or higher (high risk) across breast density categories, or among all the 836,250 examinations with BCSC 5-year risk less than 1.67% (low to average-risk). For the 3.6% of women with extremely dense breasts and at high risk of breast cancer (13,291 examinations in the DBT group and 31,300 in the digital mammography group) advanced cancer rates per 1000 examinations were significantly lower for DBT vs digital mammography, but not for women at low to average risk (10,611 examinations in the DBT group and 37,796 in the digital mammography group). The researchers reported that there was no significant difference in the 96.4% of women with extremely dense breasts not at high risk, heterogeneously dense breasts, or nondense breasts, and concluded that screening with DBT vs digital mammography was associated with a significantly lower risk of advanced breast cancer among the 3.6% of women with extremely dense breasts and at high risk of breast cancer, and was not associated with a significant difference in risk of interval invasive cancer.
AHRQ-funded; HS018366.
Citation: Kerlikowske K, Su YR, Sprague BL .
Association of screening with digital breast tomosynthesis vs digital mammography with risk of interval invasive and advanced breast cancer.
JAMA 2022 Jun 14;327(22):2220-30. doi: 10.1001/jama.2022.7672..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Women, Imaging, Risk
Kukhareva PV, Caverly TJ, Li H
Inaccuracies in electronic health records smoking data and a potential approach to address resulting underestimation in determining lung cancer screening eligibility.
The authors sought to characterize EHR smoking data issues and to propose an approach to addressing these issues using longitudinal smoking data. They found that over 80% of evaluated records had inaccuracies, including missing packs-per-day or years-smoked, outdated data, missing years-quit, and a recent change in packs-per-day resulting in inaccurate lifetime pack-years estimation. Further, addressing these issues by using longitudinal data enabled the identification of 49.4% more patients potentially eligible for lung cancer screening.
AHRQ-funded; HS026198.
Citation: Kukhareva PV, Caverly TJ, Li H .
Inaccuracies in electronic health records smoking data and a potential approach to address resulting underestimation in determining lung cancer screening eligibility.
J Am Med Inform Assoc 2022 Apr 13;29(5):779-88. doi: 10.1093/jamia/ocac020..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Screening, Cancer: Lung Cancer, Cancer
Reese TJ, Schlechter CR, Kramer H
Implementing lung cancer screening in primary care: needs assessment and implementation strategy design.
This study explored the implementation of lung cancer screening with low-dose computed tomography (CT) in primary care. The study’s two goals included exploring the implementation of lung cancer screening primary care in the context of integrating a decision aid into the electronic health record and a designing of implementation strategies that target hypothesized mechanics of change and context-specific barriers. The two phases included a Qualitative Analysis phase including semi-structured interviews with primary care physicians to elicit key task behaviors, and an Implementation Strategy Design phase consisting of defining implementation strategies and hypothesizing causal pathways to improve screening with a decision aid. Fourteen interviews were conducted and out of that 3 key task behaviors and four behavioral determinants emerged. Strategies included increasing provider self-efficacy toward performing shared decision making and using the decision aid, improving provider performance expectancy, increasing social influence, and addressing key facilitators to using the decision aid.
AHRQ-funded; HS026198.
Citation: Reese TJ, Schlechter CR, Kramer H .
Implementing lung cancer screening in primary care: needs assessment and implementation strategy design.
Transl Behav Med 2022 Feb 16;12(2):187-97. doi: 10.1093/tbm/ibab115..
Keywords: Cancer: Lung Cancer, Cancer, Primary Care, Screening, Implementation, Decision Making
Higashi RT, Rodriguez SA, Betts AC
Anal cancer screening among women with HIV: provider experiences and system-level challenges.
This article described current practices and barriers met in conducting anal cancer screenings for women living with HIV (WLWH) in an urban integrated safety-net system and in a non-profit community-based HIV clinic. Semi-structured interviews with clinical and administrative stakeholders were conducted to assess their screening for anal cancer experiences, knowledge, clinic practices and procedures. Barriers included limited knowledge of guidelines by providers and system-level issues such as lack of coordination between clinics and limitations on available resources. The authors concluded that screenings and follow-up require organization and coordination between multiple care teams, as well as improved clinical information systems to facilitate communication and infrastructure for managing abnormal results.
AHRQ-funded; HS022418.
Citation: Higashi RT, Rodriguez SA, Betts AC .
Anal cancer screening among women with HIV: provider experiences and system-level challenges.
AIDS Care 2022 Feb; 34(2):220-26. doi: 10.1080/09540121.2021.1883512..
Keywords: Cancer, Human Immunodeficiency Virus (HIV), Women, Screening
Tice JA, Gard CC, Miglioretti DL
Comparing mammographic density assessed by digital breast tomosynthesis or digital mammography: the Breast Cancer Surveillance Consortium.
This study’s purpose was to assess the consistency of Breast Imaging Reporting and Data System (BI-RADS) breast density reporting comparing digital breast tomosynthesis (DBT) with digital mammography (DM) and to evaluate density as a breast cancer risk factor when assessed using DM versus DBT. A secondary analysis of data from the Breast Cancer Surveillance Consortium was used from 342,149 women aged 40-79 years who underwent at least two screening mammography examinations less than 36 months apart. There were no significant differences in breast density assessment in pairs consisting of one DM and one DBT examination (57,516 of 74,729 [77%]), two DM examinations (238,678 of 301,743 [79%]), and two DBT examinations (20,763 of 26,854). Results were similar when pair analysis was restricted to readings by the same radiologist. The breast cancer hazard ratios (HRs) for breast density were similar for DM and DBT. The HRs for density acquired using DM and DBT, respectively, were 0.55 and 0.37 for almost entirely fat, 1.47 and 1.36 for heterogeneously dense, and 1.72 and 2.05 for extremely dense breasts.
AHRQ-funded; HS018366.
Citation: Tice JA, Gard CC, Miglioretti DL .
Comparing mammographic density assessed by digital breast tomosynthesis or digital mammography: the Breast Cancer Surveillance Consortium.
Radiology 2022 Feb; 302(2):286-92. doi: 10.1148/radiol.2021204579..
Keywords: Cancer: Breast Cancer, Cancer, Women, Imaging, Screening, Diagnostic Safety and Quality
Cham S, Landrum MB, Keating NL
Use of germline BRCA testing in patients with ovarian cancer and commercial insurance.
The authors examined commercially insured populations to identify patient-, physician-, and practice-level characteristics associated with ovarian cancer testing rates. They found that only 33.9% of patients with commercial insurance were tested during the time period studied. Medical and gynecologic oncologists had similar rates of testing, while other physicians tested less often. Although independent practices often lack access to genetic counselors, women in this study had insurance coverage for in-person and telephonic counseling.
AHRQ-funded; HS024072.
Citation: Cham S, Landrum MB, Keating NL .
Use of germline BRCA testing in patients with ovarian cancer and commercial insurance.
JAMA Netw Open 2022 Jan 4;5(1):e2142703. doi: 10.1001/jamanetworkopen.2021.42703..
Keywords: Cancer: Ovarian Cancer, Cancer, Screening, Genetics, Health Insurance, Women
Mojica CM, Gunn R, Pham R
An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees.
This study was conducted to describe clinical workflows for fecal immunochemical tests/fecal occult blood tests (FIT/FOBT) in Oregon primary care practices and to identify specific workflow processes that might be associated with higher colorectal cancer (CRC) screening rates. Findings showed that primary care practices with higher CRC screening rates among newly age-eligible Medicaid enrollees had more established visit-based and population outreach workflows to support identifying patients due for screening, FIT/FOBT distribution, reminders, and follow up. Higher CRC screening was associated with having medical assistants discuss and review FIT/FOBT screening and instructions with patients.
AHRQ-funded; HS022981.
Citation: Mojica CM, Gunn R, Pham R .
An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees.
BMC Cancer 2022 Jan 25;22(1):106. doi: 10.1186/s12885-021-09106-7..
Keywords: Workflow, Screening, Cancer: Colorectal Cancer, Cancer, Primary Care, Vulnerable Populations
Fendrick AM, Dalton VK, Tilea A
Out-of-pocket costs for colposcopy among commercially insured women from 2006 to 2019.
The objective of this study was to describe out-of-pocket costs for colposcopy and related services among age-appropriate, commercially insured women from 2006 to 2019. Findings suggested that out-of-pocket costs for colposcopy were very common and significant and have increased over time. Reported out-of-pocket costs for cervical cancer screening-related care, such as office visits, were not included, thus the findings may underestimate patients’ total financial burden.
AHRQ-funded; HS025465.
Citation: Fendrick AM, Dalton VK, Tilea A .
Out-of-pocket costs for colposcopy among commercially insured women from 2006 to 2019.
Obstet Gynecol 2022 Jan;139(1):113-15. doi: 10.1097/aog.0000000000004582..
Keywords: Healthcare Costs, Colonoscopy, Screening, Cancer: Cervical Cancer, Cancer, Prevention, Women
Goodwin JS, Sheffield K, Li S
Receipt of cancer screening is a predictor of life expectancy.
The researchers sought to determine the association between receipt of screening mammography or PSA and overall survival. They found that the subjects with prior cancer screening had actual median survivals higher than those who were not screened, with differences ranging from 1.7 to 2.1 years for women and 0.9 to 1.1 years for men.
AHRQ-funded; HS022134.
Citation: Goodwin JS, Sheffield K, Li S .
Receipt of cancer screening is a predictor of life expectancy.
J Gen Intern Med 2016 Nov;31(11):1308-14. doi: 10.1007/s11606-016-3787-y.
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Keywords: Cancer, Cancer: Breast Cancer, Cancer: Prostate Cancer, Screening, Women, Men's Health, Health Status
Scarinci IC, Garces-Palacio IC, Morales-Aleman MM
Sowing the seeds of health: training of community health advisors to promote breast and cervical cancer screening among Latina immigrants in Alabama.
The researchers sought to develop and evaluate a culturally relevant training for Community Health Advisors (CHA) to promote breast and cervical cancer screening among Latina immigrants in Alabama. They found that a knowledge and skills training increased the CHAs' (1) knowledge of cancer screening and other health topics and (2) their perceived confidence to communicate with women in their communities about cancer screening and to motivate them to attain screenings.
AHRQ-funded; HS013852.
Citation: Scarinci IC, Garces-Palacio IC, Morales-Aleman MM .
Sowing the seeds of health: training of community health advisors to promote breast and cervical cancer screening among Latina immigrants in Alabama.
J Health Care Poor Underserved 2016;27(4):1779-93. doi: 10.1353/hpu.2016.0162.
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Keywords: Cancer, Cancer: Breast Cancer, Racial and Ethnic Minorities, Screening, Women
Wernli KJ, Henrikson NB, Morrison CC
Screening for skin cancer in adults: Updated evidence report and systematic review for the US Preventive Services Task Force.
The researchers updated a systematic review for the US Preventive Services Task Force regarding clinical skin cancer screening among adults. No randomized clinical trials were identified. There was limited evidence on the association between skin cancer screening and mortality. Future research on skin cancer screening should focus on evaluating the effectiveness of targeted screening in those considered to be at higher risk for skin cancer.
AHRQ-funded.
Citation: Wernli KJ, Henrikson NB, Morrison CC .
Screening for skin cancer in adults: Updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2016 Jul 26;316(4):436-47. doi: 10.1001/jama.2016.5415.
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Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer, Screening, Prevention, Evidence-Based Practice
Croswell J, Owings J
Screening for breast cancer.
This case study involves a 47-year-old woman who presents to your office for a well-woman visit. She is healthy, takes no medications, and has no health concerns. She has never been diagnosed with breast cancer, nor have any of her first-degree relatives. Her digital mammography two years ago was negative, and she asks whether she should be screened again this year. The study poses three multiple choice questions together with the U.S. Preventive Services Task Force recommendations and related background information.
AHRQ-authored.
Citation: Croswell J, Owings J .
Screening for breast cancer.
Am Fam Physician 2016 Jul 15;94(2):143-4.
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Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Breast Cancer, Cancer, Screening, Prevention, Evidence-Based Practice, Women, Imaging, Case Study
Pollack CE, Blackford AL, Schoenborn NL
Comparing prognostic tools for cancer screening: considerations for clinical practice and performance assessment.
The researchers compared the agreement and rates of cancer screening using four prognostic tools that require different types of clinical information. They found high agreement among the four prognostic tools. They concluded that the high rates of cancer screening of individuals with limited life expectancy suggest the importance of incorporating tools into clinical decision-making.
AHRQ-funded; HS000029.
Citation: Pollack CE, Blackford AL, Schoenborn NL .
Comparing prognostic tools for cancer screening: considerations for clinical practice and performance assessment.
J Am Geriatr Soc 2016 May;64(5):1032-8. doi: 10.1111/jgs.14089.
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Keywords: Elderly, Cancer, Screening, Decision Making
Nelson HD, O'Meara ES, Kerlikowske K
Factors associated with rates of false-positive and false-negative results from digital mammography screening: an analysis of registry data.
The researchers sought to determine factors associated with false-positive and false-negative digital mammography results, additional imaging, and biopsies among a general population of women screened for breast cancer. They found that false-positive mammography results and additional imaging are common, particularly for younger women and those with risk factors, whereas biopsies occur less often. Rates of false-negative results are low.
AHRQ-funded; 290201200015I.
Citation: Nelson HD, O'Meara ES, Kerlikowske K .
Factors associated with rates of false-positive and false-negative results from digital mammography screening: an analysis of registry data.
Ann Intern Med 2016 Feb 16;164(4):226-35. doi: 10.7326/m15-0971.
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Keywords: Cancer: Breast Cancer, Cancer, Imaging, Diagnostic Safety and Quality, Women, Screening, Prevention
Singal AG, Gupta S, Tiro JA
Outreach invitations for FIT and colonoscopy improve colorectal cancer screening rates: a randomized controlled trial in a safety-net health system.
Among a racially diverse and socioeconomically disadvantaged cohort of patients, the researchers compared the effectiveness of fecal immunochemical test (FIT) outreach and colonoscopy outreach to increase screening participation rates, compared with usual visit-based care. Mailed outreach invitations appear to significantly increase colorectal cancer screening rates among underserved populations. In the current study, FIT-based outreach was found to be more effective than colonoscopy-based outreach.
AHRQ-funded; HS022418.
Citation: Singal AG, Gupta S, Tiro JA .
Outreach invitations for FIT and colonoscopy improve colorectal cancer screening rates: a randomized controlled trial in a safety-net health system.
Cancer 2016 Feb 1;122(3):456-63. doi: 10.1002/cncr.29770.
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Keywords: Cancer: Colorectal Cancer, Cancer, Screening, Prevention