Background & Aims Colorectal cancer (CRC) screening relies primarily on colonoscopy and fecal immunochemical testing (FIT). Aligning utilization of these options with individual CRC risk (i.e. personalized screening) may maximize benefit with lower risks, individual burdens, and societal costs. We studied the effect of communicating personalized CRC risk and corresponding screening recommendations on appropriate screening uptake in an organized screening setting.

Methods Pilot randomized controlled trial among residents aged 50-69 years old not yet invited for screening in Vaud, Switzerland. The intervention was a mailed brochure communicating individual 15-year CRC risk and corresponding screening recommendation. The control group received a brochure comparing FIT and colonoscopy. The primary outcome was self-reported risk-appropriate screening (FIT if <3% risk, FIT or colonoscopy if ≥3% and <6%, colonoscopy if ≥6%), assessed by a mailed questionnaire at 6 months. A secondary outcome was overall screening uptake.

Results Of 5396 invitations, 1059 people responded (19%), of whom 258 were randomized to intervention and 257 to control materials (average 15-year risk 1.4% (SD 0.5), age 52.2 years (SD 2.2), 51% women). Risk-appropriate screening completion was 37% in the intervention group and 23% in the control group (absolute difference 14%, 95%CI 6%-22%, p<0.001). Overall screening uptake was 50% in the intervention and 49% in the control group (absolute difference 1%, 95CI −7%−10%, p=0.758).

Conclusions In a population not known to be at elevated CRC risk, brochures providing personalized CRC risk and screening recommendations improved risk-appropriate screening without impacting overall screening uptake. This approach could be helpful for aligning screening methods, risks, and benefits with cancer risk. Trial registration: Clinicaltrials.gov NCT05357508.

Background Colorectal cancer can be effectively prevented by screening using colonoscopy or fecal immunochemical test (FIT). Optimizing use of colonoscopy resources is crucial to reduce screening burden for patients and society.

Findings After reading our intervention brochure, participants were 14% more likely to choose the screening test appropriate to their risk level. This result did not impact overall screening participation.

Implications for patient care Risk-based screening recommendations for FIT or colonoscopy could be a means of better allocating colonoscopy resources in countries relying heavily on colonoscopy for screening, thus decreasing the burden of CRC screening for low-risk participants.

Marie-Anne Durand has contributed to the development of Option Grid patient decision aids. EBSCO Information Services sells subscription access to Option Grid patient decision aids. She receives consulting income from EBSCO Health, and royalties. No other competing interests declared from her or the other investigators.

NCT05357508

https://www.researchprotocols.org/2023/1/e46865

This study was financed by a grant from the Swiss Cancer Research Foundation (KLS 5111-08-2020). The salary of Kevin Selby is paid in part by the Fondation Leenaards.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The trial was monitored by an institutional monitoring team and received approval from the Ethics committee of the canton of Vaud on March 2, 2022 (project ID 2021-02431).

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The data generated and analyzed during this study are available from the corresponding author on reasonable request.