A New Role for the Postal Service?

iStock_000068289239_MediumMany people really aren't interested in having screening colonoscopy, even though the procedure has been shown to catch many cases of colorectal cancer as well as precancerous polyps early, so treatment is facilitated and survival improves.  But now a study Rick and I discuss on PodMed this week and published in Annals of Internal Medicine demonstrates the utility of a mail-in fecal sample to perform initial screening for colorectal cancer in a large group of adults, with impressive results.  As I quip in the podcast, here's a potential role for the United States Postal Service in health care!

Over 300,000 people fifty to seventy years of age were offered initial screening using fecal immunochemical testing (FIT), using a mail-in card with a self-collected fecal specimen.  The majority remained in the program for up to four subsequent rounds for up to four years of follow-up.  The technique was able to detect just over 80% of those with colorectal cancer after the first round of screening, with slightly reduced detection rates in subsequent rounds. Rick and I opine that over the years we've seen detection improve with fecal specimens and different techniques, and predict that trajectory will continue, rendering such a method for screening much less invasive, expensive and time-consuming for all concerned.  Taken together with another study we discussed this week in JAMA Internal Medicine on mailed nicotine patches and their efficacy in helping smoking cessation, the US Postal Service might stay afloat!

The other two studies we discuss this week are in JAMA: the USPSTF guidelines on depression screening, and malpractice claims in NEJM.  until next week, y'all live well.

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