The colorectal cancer screening kit placed on a shelf, then forgotten… The scene is familiar. Too intimate, not a priority, a little embarrassing: this simple test can easily take a back seat. A test carried out in London raises a very concrete question: Can an SMS reminder bring more tests back to the laboratory?
The answer seems positive, but modestly and within a specific framework. The protocol studied is not the French program: it was based on four SMS messages sent to people who had not responded 18 weeks after their invitation.
Text messages after 18 weeks of silence: what does the test show?
The study included 3,129 people who had still not participated in colorectal cancer screening 18 weeks after being invited. They were divided into three groups: no additional reminder, reminders by SMS at weeks 19, 21, 23 and 25, or SMS then telephone support, called “navigation”, at weeks 21, 23 and 25.
The primary endpoint was participation in screening within 26 weeks of invitation, i.e. completing or returning the test. In the so-called intention-to-treat analysis, the authors report 2.0% participation without reminder, 6.5% with SMS and 7.5% with SMS then phone call. Both reminder strategies did better than no reminder, with no clear difference between SMS alone and SMS plus telephone support in this analysis.
This signal is interesting because it targets a very concrete obstacle: some people do not necessarily refuse screening, but forget it, put it off or do not dare to do it. The SMS then acts as a reminder. To better understand this action, colorectal cancer screening in practice is also based on a test to be done at home, but according to an organization specific to each country.
“A simple text message sent at the right time can prompt someone to take a potentially life-saving test, and it costs less than a coffee per person. We were particularly impressed by the effectiveness of the telephone support for men. When you could talk to them directly, they were much more likely to take action, especially if they had simply forgotten or thought they were up to date on their screenings. This is valuable information for the design of our services. More importantly, neither approach worsened existing inequalities. They have been just as effective for people living in deprived areas as anywhere else. When seeking to reduce the testing gap, this is a crucial point” specifies Dr. Robert Kerrison, associate professor and co-leader of cancer care.
The test measures the test return rate. It does not, on its own, show a reduction in the number of colorectal cancers or mortality. But if this approach were widespread in London, the increased participation rate would result in 18,000 additional colorectal cancer screenings each year, resulting in an average of 50 additional colorectal cancers being detected at an earlier and therefore generally easier to treat stage. From an economic point of view, SMS proved to be particularly profitable, with a cost of £1.82 (2.20 euros) per additional person screened.
In France, what to do if you receive an invitation?
In France, the National Cancer Institute recalls that organized screening concerns women and men aged 50 to 74, every two years, when they do not present symptoms, a particular personal or family history, or specific risk factors. The immunological test looks for the presence of invisible blood in the stool. It is carried out at home, then sent to the laboratory in the envelope provided.
According to Health Insurance, the kit can be obtained free of charge from a doctor, pharmacist or nurse, or ordered online with the invitation. Its analysis is 100% covered, with no advance costs. The INCa also indicates that the CNAM can rely on several contact methods, including mail, email and SMS, and that the CPAMs follow up with people who have not taken the test; on the other hand, the pages consulted do not describe a national protocol identical to the London trialcentered on four text messages sent after 18 weeks of no response.
If the test is negative, it must be repeated two years later. The INCa indicates that this result concerns approximately 96% of cases. But a negative test should never cause symptoms to be ignored: red or black blood in the stools, persistent bowel problems, persistent abdominal pain of recent onset or unexplained weight loss should lead to a consultation. You can find the signs of colorectal cancer which should alert you.
If the test is positive, it does not automatically mean cancer. It states that bleeding has been detected and a colonoscopy is needed to investigate the cause. According to the INCa, after a positive test, colonoscopy does not detect any abnormality in more than half of cases; it detects a polyp in 30 to 40% of cases and cancer in 8% of cases. To understand colorectal cancer, the issue remains the same:
act early, before symptoms or before a lesion develops.
An SMS can therefore help certain kits not to remain at the bottom of a drawer. But the most useful message remains very concrete: if you are affected by the French invitation, take the test without delay; and if you are in doubt about your eligibility, your history or a symptom, seek advice from a healthcare professional.