Interventions for Increasing Colorectal Cancer Screening Uptake: A Systematic Review and Network Meta-Analysis

BACKGROUND & AIMS: Colorectal cancer screening reduces mortality, yet uptake remains suboptimal. Various interventions aim to improve screening rates, but their comparative effectiveness is unclear. We aimed to evaluate the effectiveness of colorectal cancer screening uptake interventions using a systematic review and network meta-analysis. METHODS: We analyzed data from 76 randomized clinical trials across 8 intervention strategies: patient navigation, mailed fecal immunochemical testing (FIT) outreach, educational multimedia, reminder only, choice-based outreach, colonoscopy outreach, multistep, and usual care. Network meta-analysis compared interventions using risk ratios (RRs) and 95% CIs. P scores and rankograms assessed intervention rankings. Risk of bias was assessed, and certainty of evidence was graded using the Grading of Recommendations Assessment, Development and Evaluation framework. RESULTS: Patient navigation (RR, 1.58; 95% CI, 1.23-2.02; P score .81) and mailed FIT outreach (RR, 1.36; 95% CI, 1.07-1.74; P score = .79) were the most effective strategies, significantly outperforming usual care. Educational multimedia (RR, 1.27; 95% CI, 0.91-1.78) and reminder-only interventions (RR, 1.24; 95% CI, 0.98-1.57) showed modest effects. Choice-based outreach and colonoscopy outreach were not significantly more effective than usual care. Mailed FIT outreach was superior to colonoscopy outreach (RR, 1.35; 95% CI, 1.11-1.63), and patient navigation outperformed reminder-only interventions (RR, 1.48; 95% CI, 1.14-1.94). In low baseline uptake settings (