Gastroenterology. 2026 Apr 1:S0016-5085(26)00303-3. doi: 10.1053/j.gastro.2026.02.047. Online ahead of print.
ABSTRACT
BACKGROUND AND AIMS: Colorectal cancer screening reduces mortality, yet uptake remains suboptimal. Various interventions aim to improve screening rates, but their comparative effectiveness is unclear. We aim to evaluate the effectiveness of colorectal cancer screening uptake interventions using a systematic review and network meta-analysis.
METHODS: We analyzed data from 76 randomized clinical trials across eight intervention strategies: patient navigation, mailed FIT outreach, educational multimedia, reminder-only, choice-based outreach, colonoscopy outreach, multistep, and usual care. Network meta-analysis compared interventions using risk ratios (RRs) and 95% confidence intervals (CIs). P-scores and rankograms assessed intervention rankings. Risk of bias was assessed, and certainty of evidence was graded using the GRADE framework.
RESULTS: Patient navigation (RR 1.58, 95% CI 1.23-2.02; P-score 0.81) and mailed FIT outreach (RR 1.36, 95% CI 1.07-1.74; P-score 0.79) were the most effective strategies, significantly outperforming usual care. Educational multimedia (RR 1.27, 95% CI 0.91-1.78) and reminder-only interventions (RR 1.24, 95% CI 0.98-1.57) showed modest effects. Choice-based outreach and colonoscopy outreach were not significantly more effective than usual care. Mailed FIT outreach was superior to colonoscopy outreach (RR 1.35, 95% CI 1.11-1.63), and patient navigation outperformed reminder-only interventions (RR 1.48, 95% CI 1.14-1.94). In low baseline uptake settings (<30%), mailed FIT outreach was most effective (RR 3.12, 95% CI 1.70-5.71), while educational multimedia performed best in higher uptake populations (≥30%) and in recent studies (2021-2024). Majority of studies were at low risk of bias while the certainty of evidence mostly ranged from moderate to low.
CONCLUSION: Patient navigation and mailed FIT outreach are the most effective strategies for increasing colorectal cancer screening uptake, particularly in low baseline uptake populations. Educational multimedia shows promise in recent years and high baseline uptake settings, offering a scalable alternative.
PMID:41932450 | DOI:10.1053/j.gastro.2026.02.047