A randomized trial to increase colonoscopy screening in members of high risk families in the Colorectal Cancer Family Registry and Cancer Genetics Network.

Lowery JT, Horick N, Kinney AY, Finkelstein DM, Garrett K, Haile RW, Lindor NM, Newcomb PA, Sandler RS, Burke CA, Hill DA, Ahnen DJ.

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Abstract

Background: Individuals with a strong family history of colorectal cancer (CRC) have significant risk for CRC, though adherence to colonoscopy screening in these groups remains low. This study assessed whether a tailored, telephone counseling intervention can increase adherence to colonoscopy in members of high risk families in a randomized, controlled trial. Methods: Eligible participants were recruited from two national cancer registries if they had a first-degree relative with CRC under age 60 or multiple affected family members, which included families that met Amsterdam criteria for Hereditary Non-Polyposis Colon Cancer, and if they were due for colonoscopy within 24-months. Participants were randomized to receive a tailored, telephone intervention grounded in behavioral theory or a mailed packet with general information about screening. Colonoscopy status was assessed through follow-up surveys and endoscopy reports. Cox-proportional hazards models were used to assess intervention effect. Results: Of the 632 participants (aged 25-80), 60% were female, the majority were White, non-Hispanic, educated and had health insurance. Colonoscopy adherence increased 11 percentage points in the tailored, telephone intervention group, compared to no significant change in the mailed group. The telephone intervention was associated with a 32% increase in screening adherence compared to the mailed intervention (Hazard Ratio=1.32; p=0.01). Conclusions: A tailored, telephone intervention can effectively increase colonoscopy adherence in high risk persons. This intervention has the potential for broad dissemination to health-care organizations or other high risk populations. Impact: Increasing adherence to colonoscopy among persons with increased CRC risk could effectively reduce incidence and mortality from this disease.