Randomized trial of colorectal cancer screening strategies in adults aged 45 to 49 years

In the US, colorectal cancer screening is now recommended at age 45 years for average-risk individuals; however, optimal outreach strategies to screen younger adults are unknown. A randomized clinical trial with 20,509 participants aged 45 to 49 years compared 4 outreach strategies: (1) FIT-only active choice through the electronic patient portal, (2) colonoscopy-only active choice, (3) dual-modality (FIT or colonoscopy active choice, or (4) usual care default mailed FIT outreach. The 3 strategies requiring active choice through the electronic patient portal were significantly less effective than the default unsolicited mailed FIT outreach: 16.4% versus 14.5% versus 17.5% versus 26.2%. The authors conclude that the default unsolicited mailed FIT outreach was the most effective population health screening strategy for adults aged 45 to 49 years. Overall screening rates were low, underscoring the need for more effective strategies to engage this age group (visual abstract).