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Cancer Epidemiol Biomarkers Prev. 2014 Apr;23(4):601-10. doi: 10.1158/1055-9965.EPI-13-1085. Epub 2014 Feb 5.

A randomized trial to increase colonoscopy screening in members of high-risk families in the colorectal cancer family registry and cancer genetics network.

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  • 1Authors' Affiliations: Colorado School of Public Health, University of Colorado; University of Colorado Cancer Center, Division of Cancer Prevention and Control, Aurora; Department of Medicine, Department of Veterans Affairs Eastern Colorado Health Care System and University of Colorado School of Medicine, Denver, Colorado; Massachusetts General Hospital Biostatistics Center; Harvard University, Boston, Massachusetts; Division of Epidemiology, Biostatistics, and Prevention, Department of Internal Medicine; Cancer Center, University of New Mexico, Albuquerque, New Mexico; Stanford University, Population Sciences, Stanford, California; Department of Health Science Research, Mayo Clinic Arizona, Scottsdale, Arizona; Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; and Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio.



Individuals with a strong family history of colorectal cancer have significant risk for colorectal cancer, although adherence to colonoscopy screening in these groups remains low. This study assessed whether a tailored telephone counseling intervention can increase adherence to colonoscopy in members of high-risk families in a randomized, controlled trial.


Eligible participants were recruited from two national cancer registries if they had a first-degree relative with colorectal cancer under age 60 or multiple affected family members, which included families that met the Amsterdam criteria for hereditary non-polyposis colon cancer (HNPCC), and if they were due for colonoscopy within 24 months. Participants were randomized to receive a tailored telephone intervention grounded in behavioral theory or a mailed packet with general information about screening. Colonoscopy status was assessed through follow-up surveys and endoscopy reports. Cox proportional hazards models were used to assess intervention effect.


Of the 632 participants (ages 25-80), 60% were female, the majority were White, non-Hispanic, educated, and had health insurance. Colonoscopy adherence increased 11 percentage points in the tailored telephone intervention group, compared with no significant change in the mailed group. The telephone intervention was associated with a 32% increase in screening adherence compared with the mailed intervention (HR, 1.32; P = 0.01).


A tailored telephone intervention can effectively increase colonoscopy adherence in high-risk persons. This intervention has the potential for broad dissemination to healthcare organizations or other high-risk populations.


Increasing adherence to colonoscopy among persons with increased colorectal cancer risk could effectively reduce incidence and mortality from this disease.

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[Available on 2015/4/1]
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