A Comprehensive Approach Including Mailed FITs and Nurse Navigation for Colorectal Cancer Screening
Author(s)
Chisato Hamashima, PhD, MD1, Osamu Ishida, BA2, Yoko Saito, PhD, MD3.
1Professor, Teikyo University, Tokyo, Japan, 2Teikyo University, Hachioji, Japan, 3Ibaraki Medical Center, Mito, Japan.
1Professor, Teikyo University, Tokyo, Japan, 2Teikyo University, Hachioji, Japan, 3Ibaraki Medical Center, Mito, Japan.
OBJECTIVES: Although colorectal cancer (CRC) screening using fecal immunochemical testing (FIT) has been available in Japan since 1992, both the low participation rate and the follow-up rate after positive results remain significant challenges. To address these issues, we implemented a comprehensive approach that included mailing FITs and providing nurse navigation support.
METHODS: A total of 13,855 subjects were selected from individuals in Mito City, Japan, who had no history of CRC screening in the previous two years. Individuals were invited to participate in research-based screening in two rounds. The first round of invitations was sent in 2021 to individuals aged 62 and 63, respectively. In 2022, individuals aged 67 to 69 were invited. After obtaining informed consent and reconfirming the screening history, a one-sample FIT kit was mailed to 1,064 participants. Nurses provided navigation support to individuals with positive FIT results, and the follow-up colonoscopy rate was compared with that of the subsequent year using the chi-square test. For those with negative FIT results, the repeat participation rate was assessed in the following year.
RESULTS: Among the 1,064 individuals who returned FIT kits, 83 (8.0 %) had positive results, and 73 (88.0%) underwent a follow-up colonoscopy. As a result, ten cases of CRC and seven advanced adenomas were diagnosed. In subsequent years, the total number of participants remained at 168 (16.8%), representing a decrease of 83.2 percentage points among individuals with negative FIT results from the first year. The positive rate reached 6.9% (11/160). The follow-up colonoscopy rate was 72.7% (8/11), which decreased in the absence of nurse navigation, but this was not statistically significant (p = 0.169).
CONCLUSIONS: The results suggest that mailed FITs increase participation in CRC compared to routine invitation. Nurse navigation may be effective in encouraging individuals with positive FIT results to undergo a follow-up colonoscopy.
METHODS: A total of 13,855 subjects were selected from individuals in Mito City, Japan, who had no history of CRC screening in the previous two years. Individuals were invited to participate in research-based screening in two rounds. The first round of invitations was sent in 2021 to individuals aged 62 and 63, respectively. In 2022, individuals aged 67 to 69 were invited. After obtaining informed consent and reconfirming the screening history, a one-sample FIT kit was mailed to 1,064 participants. Nurses provided navigation support to individuals with positive FIT results, and the follow-up colonoscopy rate was compared with that of the subsequent year using the chi-square test. For those with negative FIT results, the repeat participation rate was assessed in the following year.
RESULTS: Among the 1,064 individuals who returned FIT kits, 83 (8.0 %) had positive results, and 73 (88.0%) underwent a follow-up colonoscopy. As a result, ten cases of CRC and seven advanced adenomas were diagnosed. In subsequent years, the total number of participants remained at 168 (16.8%), representing a decrease of 83.2 percentage points among individuals with negative FIT results from the first year. The positive rate reached 6.9% (11/160). The follow-up colonoscopy rate was 72.7% (8/11), which decreased in the absence of nurse navigation, but this was not statistically significant (p = 0.169).
CONCLUSIONS: The results suggest that mailed FITs increase participation in CRC compared to routine invitation. Nurse navigation may be effective in encouraging individuals with positive FIT results to undergo a follow-up colonoscopy.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HSD2
Topic
Health Service Delivery & Process of Care
Disease
Gastrointestinal Disorders, Oncology