SCREEN Yourself for Cancer

In the US, tens of thousands of people die from screen-preventable cancers each year. Failures occur across the entire cancer screening process, from screening initiation, to screening completion (i.e., receipt of a normal screening result or diagnostic resolution after an abnormal result), to repeat screening. Providing patients with self-sampling tools can improve these outcomes. These self-sampling tools (fecal immunochemical test [FIT] for colorectal cancer [CRC] screening and self-collected human papillomavirus [HPV] test for cervical cancer screening) enable patients to collect a sample at home and send it to a lab for testing. These tests are highly accurate and acceptable but not well-integrated into clinical care. Further, their impacts on screening completion and repeat screening are not well-studied. The proposed study is a rigorous, two-arm, parallel-groups randomized controlled trial to assess screening initiation, screening completion, and repeat screening among patients who are eligible but out-of-date with screening for CRC and/or cervical cancer. The study team will generate a census of patients in our healthcare system who meet study inclusion criteria and undertake stratified random selection to select patients for inclusion in the study. Patients will be randomized (1:1) to study arm: Usual practice arm, in which patients receive a letter informing them that they are out-of-date with cancer screening and encouraging them to make an appointment to get screened, and Self-sampling arm, in which patients receive self-sampling tool(s) and are encouraged to use it for cancer screening. As appropriate, patients will receive screening reminders, diagnostic resolution follow-up procedures, and 1-year repeat FIT for CRC screening. The study team will collect data from electronic health records and surveys. The study Aims are as follows:

Aim 1: Investigate between-arms differences in screening initiation. Aim 2: Examine between-arms differences in downstream screening outcomes. Aim 3: Identify mediators and moderators that impact the cancer screening process.

The recruitment goal for this study is 852 patients, including 542 who are eligible but out-of-date for CRC screening; 110 who are eligible but out-of-date for cervical cancer screening; and 200 who are eligible but out-of-date for both screenings. This sample will support rigorous, well-powered analyses of our Aims and hypotheses, using bivariate and multivariable analyses (including mediation and moderation analysis). This study will demonstrate the impact of self-sampling tools for the entire cancer screening process, which has significant implications for clinical care, public health, and behavioral research. The findings from the proposed study will support our long-term goal of identifying strategies to increase participation in the cancer screening process and to reduce screen-preventable cancer mortality in the US.