Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Sep 2;334(9):778-787.
doi: 10.1001/jama.2025.12049.

Population Health Colorectal Cancer Screening Strategies in Adults Aged 45 to 49 Years: A Randomized Clinical Trial

Artin Galoosian  1   2 , Hengchen Dai  3 , Daniel Croymans  1 , Silvia Saccardo  4 , Craig R Fox  1   3   5 , Gregory Goshgarian  1   6 , Sadie De Silva  1   2 , Maria A Han  1 , Sitaram Vangala  1 , Folasade P May  1   2   7   8
Affiliations
Randomized Controlled Trial

Population Health Colorectal Cancer Screening Strategies in Adults Aged 45 to 49 Years: A Randomized Clinical Trial

Artin Galoosian et al. JAMA. .

Abstract

Importance: Colorectal cancer screening is now recommended at age 45 years for average-risk individuals; however, optimal outreach strategies to screen younger adults are unknown.

Objective: To determine the most effective population health outreach strategy to promote colorectal cancer screening in adults aged 45 to 49 years.

Design, setting, and participants: Randomized clinical trial with 20 509 participants conducted in a large health system (UCLA Health). Primary care patients aged 45 to 49 years at average risk for colorectal cancer were randomized 1:1:1:1 to 1 of 4 outreach strategies. The trial ran May 2, 2022, to May 13, 2022, with follow-up through November 13, 2022.

Interventions: Colorectal cancer screening via 1 of 4 strategies: (1) fecal immunochemical test (FIT)-only active choice; (2) colonoscopy-only active choice; (3) dual-modality (FIT or colonoscopy) active choice; and (4) usual care default mailed FIT outreach.

Main outcome and measures: Primary outcome was participation in screening (FIT or colonoscopy) at 6 months. Secondary outcome was screening modality completed.

Results: Among 20 509 participants (53.9% female, 4.2% Black and 50.8% non-Hispanic White; mean [SD] age, 47.4 [1.5] years), 3816 (18.6%) underwent screening. Participation was significantly lower in each of the 3 active choice groups (FIT only, 841 of 5131 [16.4%; rate difference, -9.8%; 95% CI, -11.3% to -8.2%]; colonoscopy only, 743 of 5127 [14.5%; rate difference, -11.7%; 95% CI, -13.2% to -10.1%]; dual-modality FIT or colonoscopy, 890 of 5125 [17.4%; rate difference, -8.9%; 95% CI, -10.5% to -7.4%]) than in the usual care default mailed FIT group (1342 of 5126 [26.2%]; all P < .001). Participants offered dual-modality active choice more likely completed any screening than those offered a single active choice modality (17.4% [dual-modality FIT or colonoscopy] vs 15.4% [FIT only and colonoscopy only combined]; rate difference, -1.8%; 95% CI, -3.0% to -0.1%; P = .004]). Among 5125 participants offered a choice between 2 modalities (dual-modality active choice FIT or colonoscopy), colonoscopy was more common than FIT (616 [12.0%] vs 288 [5.6%]; rate difference, -6.4%; 95% CI, -7.5% to -5.3%; P < .001). There was notable crossover in the FIT-only groups to colonoscopy (502 of 5131 [9.8%; FIT-only active choice] and 501 of 5126 [9.8%; usual care default mailed FIT]). Crossover from colonoscopy to FIT was modest (137 of 5127 [2.7%; colonoscopy-only active choice]).

Conclusions and relevance: In this randomized clinical trial, 3 different active choice interventions had lower colorectal cancer screening completion rates among individuals aged 45 to 49 years compared with usual care.

Trial registration: ClinicalTrials.gov Identifier: NCT05275530.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Dai reported grants from the National Science Foundation during the conduct of the study and grants from NBER Roybal Center for Behavior Change in Health and USC Roybal Center for Behavioral Interventions in Aging outside the submitted work. Dr Saccardo reported grants from the National Science Foundation during the conduct of the study and grants from NBER Roybal Center for Behavior Change in Health and USC Roybal Center for Behavioral Interventions in Aging outside the submitted work. Dr May reported serving on the advisory board for Exact Sciences, Medtronic, and Geneoscopy outside the submitted work. No other disclosures were reported.

Comment in

References

    1. Davidson KW, Barry MJ, Mangione CM, et al. ; US Preventive Services Task Force . Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965-1977. doi: 10.1001/jama.2021.6238 - DOI - PubMed
    1. Procedure manual appendix I: congressional mandate establishing the US Preventive Services Task Force. US Preventive Services Task Force. Accessed June 5, 2024. https://www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/method...
    1. Montminy EM, Zhou M, Maniscalco L, et al. Contributions of adenocarcinoma and carcinoid tumors to early-onset colorectal cancer incidence rates in the United States. Ann Intern Med. 2021;174(2):157-166. doi: 10.7326/M20-0068 - DOI - PubMed
    1. Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin. 2023;73(3):233-254. doi: 10.3322/caac.21772 - DOI - PubMed
    1. Bretthauer M, Løberg M, Wieszczy P, et al. ; NordICC Study Group . Effect of colonoscopy screening on risks of colorectal cancer and related death. N Engl J Med. 2022;387(17):1547-1556. doi: 10.1056/NEJMoa2208375 - DOI - PubMed

Publication types

MeSH terms

Associated data