Direct mailing of faecal occult blood tests for colorectal cancer screening: a randomized population study from Central Italy

Background Sending faecal occult blood tests (FOBT) by mail has been proposed both as a method to increase participation and a way to reduce staff costs in colorectal cancer screening. Methods Two multicentre randomized controlled trials (ISRCTN10351276) were performed: one randomly assigned 3196 individuals who had previously participated in colorectal screening to receive a FOBT kit at home or a standard invitation; in the second, 4219 people aged 50-69 years who did not respond to a screening invitation were either sent a FOBT or a standard recall letter. The cost per returned kit was calculated in each arm. Results Participation was higher with direct FOBT mailing in both trials: relative risk 1.11 (95% Cl 1.06-1.17) and 1.36 (95% Cl 1.16-1.60) for previous responders and non-responders, respectively. The cost per returned kit for previous responders ranged from 4.24(sic) to 16.10(sic), and from 3.29(sic) to 7.36(sic) with FOBT mailing and standard invitation, respectively, not including staff costs; for non-responders it ranged from 17.13(sic) to 46.80(sic), and from 7.36(sic) to 18.30(sic) with FOBT mailing and standard recall, respectively. Conclusions The FOBT mailing strategy modestly increased participation. This method can be used on a population of previous responders to reduce personnel costs and workload. When used as a reminder to non-responders, this method increases costs.