{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T19:30:52Z","timestamp":1790019052037,"version":"4.0.1"},"reference-count":53,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2025,9,2]]},"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p>Colorectal cancer screening is now recommended at age 45 years for average-risk individuals; however, optimal outreach strategies to screen younger adults are unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the most effective population health outreach strategy to promote colorectal cancer screening in adults aged 45 to 49 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>Randomized clinical trial with 20\u202f509 participants conducted in a large health system (UCLA Health). Primary care patients aged 45 to 49 years at average risk for colorectal cancer were randomized 1:1:1:1 to 1 of 4 outreach strategies. The trial ran May 2, 2022, to May 13, 2022, with follow-up through November 13, 2022.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Colorectal cancer screening via 1 of 4 strategies: (1) fecal immunochemical test (FIT)\u2013only active choice; (2) colonoscopy-only active choice; (3) dual-modality (FIT or colonoscopy) active choice; and (4) usual care default mailed FIT outreach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome and Measures<\/jats:title><jats:p>Primary outcome was participation in screening (FIT or colonoscopy) at 6 months. Secondary outcome was screening modality completed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 20\u202f509 participants (53.9% female, 4.2% Black and 50.8% non-Hispanic White; mean [SD] age, 47.4 [1.5] years), 3816 (18.6%) underwent screening. Participation was significantly lower in each of the 3 active choice groups (FIT only, 841 of 5131 [16.4%; rate difference, \u22129.8%; 95% CI, \u221211.3% to \u22128.2%]; colonoscopy only, 743 of 5127 [14.5%; rate difference, \u221211.7%; 95% CI, \u221213.2% to \u221210.1%]; dual-modality FIT or colonoscopy, 890 of 5125 [17.4%; rate difference, \u22128.9%; 95% CI, \u221210.5% to \u22127.4%]) than in the usual care default mailed FIT group (1342 of 5126 [26.2%]; all <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). Participants offered dual-modality active choice more likely completed any screening than those offered a single active choice modality (17.4% [dual-modality FIT or colonoscopy] vs 15.4% [FIT only and colonoscopy only combined]; rate difference, \u22121.8%; 95% CI, \u22123.0% to \u22120.1%; <jats:italic>P<\/jats:italic>\u2009=\u2009.004]). Among 5125 participants offered a choice between 2 modalities (dual-modality active choice FIT or colonoscopy), colonoscopy was more common than FIT (616 [12.0%] vs 288 [5.6%]; rate difference, \u22126.4%; 95% CI, \u22127.5% to \u22125.3%; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). There was notable crossover in the FIT-only groups to colonoscopy (502 of 5131 [9.8%; FIT-only active choice] and 501 of 5126 [9.8%; usual care default mailed FIT]). Crossover from colonoscopy to FIT was modest (137 of 5127 [2.7%; colonoscopy-only active choice]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this randomized clinical trial, 3 different active choice interventions had lower colorectal cancer screening completion rates among individuals aged 45 to 49 years compared with usual care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/search?id=NCT05275530\">NCT05275530<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jama.2025.12049","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T15:00:31Z","timestamp":1754319631000},"page":"778","source":"Crossref","is-referenced-by-count":12,"title":["Population Health Colorectal Cancer Screening Strategies in Adults 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