Uptake and positive predictive value of fecal occult blood tests: A randomized controlled trial

Objective. The aim of this study is to compare the uptake of three mailed high-sensitivity fecal occult blood tests (FOBTs). Methods. We conducted a parallel 3-arm randomized controlled trial in an integrated healthcare delivery system in Washington State. From January 2010 through February 2011, automated data were used to identify potentially eligible patients aged 50-74 due for colorectal cancer screening. Participants were mailed one of three FOBT kits (1-sample OC-Auto (R) fecal immunochemical test [FIT], 2-sample InSure (R) FIT, or 3-sample guaiac Hemoccult SENSA (R)), instructions, and a postage-paid return envelope. We performed a modified intent-to-treat analysis with return of any FOBT within 6 months of randomization as the primary outcome. Results. Of the 9922 people invited, 2873 returned surveys, 2263 were randomized, and 2234 were analyzed. FOBTs were returned by 1431 participants. At 6 months post-randomization, the proportions screened by any FOBT were 0.69 (95% confidence interval [CI] 0.66-0.72) for the OC-Auto arm, 0.64 (95% CI: 0.61-0.68) for the InSure arm, and 0.61 (95% CI: 0.58-0.65) for the Hemoccult SENSA arm (P < 0.001 for any difference). Pairwise comparisons showed significant differences between the OC-Auto group and each of the other groups after correction for multiple comparisons. Conclusion. Uptake of mailed FOBT kits varies by kit type. (C) 2013 Elsevier Inc. All rights reserved.