Colorectal cancer (CRC) is the third most common cancer in the United States, with more than 102,000 new patients diagnosed per year. 1 It is, however, one of the few cancers that is highly preventable through the use of routine screening, 2 which can also prevent death resulting from CRC. 3,4 CRC is also one cancer that continues to demonstrate widening incidence and survival disparities between whites and African Americans. 1,5 Although the reasons for these disparities are multifactorial, advanced stage at diagnosis may explain up to 50% of the survival disparity. 6 This reality is not unique to CRC. Those who are poor, underserved, or minorities are more likely to get cancer and die as a result of it than those who are rich or white. This is a fact, and it is the current reality of cancer care in the United States, as documented in thousands of peer-reviewed articles, including the focus of an Institute of Medicine report. 6a The shame for CRC is that the higher incidence rates and advanced stage of diagnosis are likely affected by differences in screening rates between whites and racial and ethnic minority populations. Multiple studies have documented lower rates of up-to-date screening among minority patients as well as lower rates of screening with colonoscopy. 7-11 Other studies have also found lower rates of follow-up for abnormalities detected on screening among minorities. 12 Lack of insurance and usual sources of care certainly contribute to these disparities, but even when screening is universally provided, such as in the Medicare program, screening rates and follow-up after abnormal findings are still lower among African Americans compared with whites. 7,13,14 Several randomized trials have demonstrated that provision of CRC screening combined with outreach efforts can significantly increase CRC screening rates among minority populations. 15-19 Moreover, patient navigation can increase the proportion of patients who receive appropriate and timely follow-up for abnormalities and facilitate the timely start of treatment. 20-22 In Journal of Clinical Oncology, Robbins et al 23 reported on a study that identified disparities in CRC mortality rates among African American patients with late-stage disease. In an editorial, Paskett 24 suggested three steps to reduce CRC disparities: one, increase CRC

Study participant screening use and preference increased. Age and attitudes predicted outcomes. Randomized trials are needed to determine intervention impact at the population level.

Background This randomized, controlled trial assessed the impact of a tailored navigation intervention versus a standard mailed intervention on colorectal cancer (CRC) screening adherence and screening decision stage (SDS). Methods Primary care patients (n=945) were surveyed and randomized to a Tailored Navigation Intervention (TNI) Group (n=312), Standard Intervention (SI) Group (n=316), or usual care Control Group (n=317). TNI Group participants were sent colonoscopy instructions and/or stool blood tests according to reported test preference, and received a navigation call. The SI Group was sent both colonoscopy instructions and stool blood tests. Multivariable analyses assessed intervention impact on adherence and change in SDS at 6 months. Results The primary outcome, screening adherence (TNI Group: 38%, SI Group: 33%, Control Group: 12%), was higher for intervention recipients than controls (p=0.001 and p=0.001, respectively), but the two intervention groups did not differ significantly (p=0.201). Positive SDS change (TNI Group: +45%, SI Group: +37%, and Control Group: +23%) was significantly greater among intervention recipients than controls (p=0.001 and p=0.001, respectively), and the intervention group difference approached significance (p=0.053). Secondary analyses indicate that tailored navigation boosted preferred test use, and suggest that intervention impact on adherence and SDS was attenuated by limited access to screening options. Conclusions Both interventions had significant, positive effects on outcomes compared to usual care. TNI versus SI impact had a modest positive impact on adherence and a pronounced effect on SDS. Impact Mailed screening tests can boost adherence. Research is needed to determine how preference, access, and navigation affect screening outcomes.