Inviting adults to screening programmes
Letter including self-sampling FIT kit
Issued on: June 2025
This recommendation has been updated during the latest ECICC Working Group meeting, considering available evidence until 2024. The complete details, including the supporting documents for healthcare professionals, will be available soon.
Healthcare question
Should a letter including the self-sampling stool-based test vs. a letter alone (with instructions on how to obtain the kit) be used for inviting asymptomatic adults to an organised, population-based, colorectal cancer screening programme?
Recommendation
The ECICC Working Group suggests using a letter including the self-sampling FIT kit over using a letter alone to invite eligible asymptomatic adults to an organised, population-based, colorectal cancer screening programme.
Recommendation strength
| Conditional recommendation |
| Low certainty of the evidence |
Justification
The WG judged that the balance between desirable and undesirable effects probably favours using a letter including the self-sampling FIT kit, that there is probably no important uncertainty or variability in how much people value the main outcomes, and that the intervention is probably cost-effective and acceptable.
The evidence shows that with a letter including the self-sampling FIT kit, there might be an increase in participation , which would translate into a small reduction in colorectal cancer mortality (21 deaths fewer per 100,000 people screened) and incidence (65 cases fewer per 100,000 people screened). The overall certainty in the evidence is low because of the inconsistency in results, which leads to some uncertainty about the magnitude of the effect. This inconsistency arises partly from differences in how studies compared access methods to the FIT kit and from focusing primarily on responders. The Working Group also considered that using a letter including the self-sampling FIT kit will probably increase equity and is probably feasible to implement.
This recommendation is conditional, as its applicability depends on the specific context and setting in which it is implemented. The intervention is aimed at increasing the accessibility by mailing the FIT kit directly, thereby reducing the logistical barriers associated with picking up the kit. However, its effectiveness is conditional on the existing system for obtaining the kit. The importance of reducing logistical barriers is context-dependent; as such barriers may vary in significance depending on the local circumstances. Programmes can implement this intervention in different ways, and the need to address logistical barriers should be assessed locally, considering organisational factors and the relevance of these barriers in the given context.
The ECICC Working Group agreed on this recommendation by consensus.