The incidence of colorectal cancer fell by more than one-third in the United States between 1985 and 2005—mostly because more people were screened for the disease.

Yet colorectal cancer remains the second-leading cause of cancer deaths, claiming the lives of nearly 50,000 Americans each year. The vast majority of these cases could be averted or caught in an early, curable stage if people simply started getting regular screenings when they hit the age of 50 (or possibly earlier if a family member has had the disease). Indeed, about 45% of Americans 50 or older have never been screened for colorectal cancer.

Many experts consider a colonoscopy to be the most sensitive and specific cancer-screening tool available. In the procedure, doctors guide an endoscope (a long, flexible tube equipped with a tiny camera) through the entire colon. This enables them to detect and remove polyps and lesions before they turn cancerous.

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The Medicare program is not changing the frequency with which it covers these tests, according to Donald McLeod, a spokesman for the federal Centers for Medicare and Medicaid Services. That means that a screening colonoscopy generally will be covered once every 10 years. It will be covered once every two years if the patient has had colorectal cancer, has a family history of the disease or is at high risk for some other reason.

A flexible sigmoidoscopy will be covered once every four years to screen for cancer, and a fecal occult blood test will be covered annually. Medicare will continue to cover colonoscopies for beneficiaries over age 75, according to Mr. McLeod.

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Background 

Automated telephone outreach with speech recognition (ATO-SR) is used extensively by health plans. Whether ATO-SR can increase rates of colorectal cancer (CRC) screening is unknown.

Methods 

We randomly allocated 40 000 health plan members to ATO-SR and 40 000 to usual care, of whom 10 432 and 10 506 in the intervention and usual care groups, respectively, had not been previously screened and were therefore eligible for analysis. The intervention was a single interactive outreach call using speech recognition to engage participants in conversation about the importance of CRC screening and options for and barriers to screening. The intervention directed participants to contact their primary care provider to schedule screening. The primary end point was any CRC screening in the year following intervention. Colonoscopy in the year following intervention was a secondary outcome.

Results 

The incidence of any CRC screening was 30.6% in the intervention group and 30.4% in the usual care group (P = .76). After adjustment for available covariates, there remained no intervention effect (adjusted odds ratio [OR], 1.01; 95% confidence interval [CI], 0.94-1.07). A total of 21.4% of members in the intervention group and 20.3% in the usual care group underwent colonoscopy (P = .04). In multivariate analysis, there was a small intervention effect on colonoscopy (OR, 1.08; 95% CI, 1.00-1.16).

Conclusions 

This study showed that ATO-SR failed to improve rates of CRC screening. Future studies should examine approaches that combine efforts to target patients and their health care providers to overcome the barriers to CRC screening.

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