***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction The Appalachian region of the United States has disproportionately high colorectal cancer ( CRC ) death rates and low screening rates . The purpose of this pilot study was to assess acceptability of a take-home fecal immunochemical test ( FIT ) and the effect of follow-up telephone counseling for increasing  CRC screening  in rural Appalachia . Methods We used a prospect i ve , single-group , multiple-site design , with central ized laboratory reports of screening adherence and baseline and 3-month question naires . Successive patients , aged 50 or older , at average CRC risk and due for screening were enrolled during a routine visit to 3 primary care practice s in rural Appalachian Pennsylvania and received a free take-home FIT and educational brochure . Those who had not returned the test 2 weeks later were referred for telephone counseling . Results Of 232 patients approached , 200 ( 86.2 % ) agreed to participate . Of these , 145 ( 72.5 % ) completed the FIT as recommended ( adherent ) and 55 ( 27.5 % ) were referred for telephone counseling ( nonadherent ) , of whom 23 ( 41.8 % ) became adherent after 1 to 2 counseling sessions , an 11.5 percentage-point increase in screening after telephone counseling and 84 % FIT adherence overall . Lack of CRC-related knowledge and perceived CRC risk were the screening barriers most highly associated with nonadherence . Although not statistically significant , the rate of conversion to screening adherence was higher among participants who received telephone counseling compared to an answering machine reminder . Conclusion If confirmed in future r and omized trials , provider-recommended take-home FIT and follow-up telephone counseling may be methods to increase CRC screening in Appalachia Background Colorectal cancer screening ( CRCS ) is the only type of cancer screening where both genders reduce risks by similar proportions with identical procedures . It is an important context for examining gender differences in disease-prevention , as CRCS significantly reduces mortality via early detection and prevention . In efforts to increase screening adherence , there is increasing acknowledgment that obstructive attitudes prevent CRCS uptake . Precise identification of the gender differences in obstructive attitudes is necessary to improve uptake promotion . This study r and omly sample d unscreened , screening - eligible individuals in Ontario , employing semi-structured interviews to elicit key differences in attitudinal obstructions towards colorectal cancer screening with the aim of deriving informative differences useful in planning promotions of screening uptake . Methods N = 81 participants ( 49 females , 32 males ) , 50 years and above , with no prior CRCS , were contacted via r and om-digit telephone dialing , and consented via phone-mail contact . Altogether , N = 4,459 calls were made to yield N = 85 participants ( 1.9 % response rate ) of which N = 4 participants did not complete interviews . All subjects were eligible for free-of-charge CRCS in Ontario , and each was classified , via st and ard interview by CRCS screening decision-stage . Telephone-based , semi-structured interviews ( SSIs ) were employed to investigate gender differences in CRCS attitudes , using questions focused on 5 attitudinal domains : 1 ) Screening experience at the time of interview ; 2 ) Barriers to adherence ; 3 ) Predictors of Adherence ; 4 ) Pain-anxiety experiences related to CRCS ; 5 ) Gender-specific experiences re : CRCS , addressing all three modalities accessible through Ontario ’s program : a ) fecal occult blood testing ; b ) flexible sigmoidoscopy ; c ) colonoscopy . Results Interview transcript analyses indicated divergent themes related to CRCS for each gender : 1 ) bodily intrusion , 2 ) perforation anxiety , and 3 ) embarrassment for females and ; 1 ) avoidant procrastination with underlying fatalism , 2 ) unnecessary health care and 3 ) uncomfortable vulnerability for males . Respondents adopted similar attitudes towards fecal occult blood testing , flexible sigmoidoscopy and colonoscopy , and were comparable in decision stage across tests . Gender differences were neither closely tied to screening stage nor modality . Women had more consistent physician relationships , were more screening-knowledgeable and better able to articulate views on screening . Men reported less consistent physician relationships , were less knowledgeable and kept decision-making processes vague and emotionally distanced ( i.e. at ‘ arm ’s length ’ ) . Conclusions Marked differences were observed in obstructive CRCS attitudes per gender . Females articulated reservations about CRCS-associated distress and males suppressed negative views while ambiguously procrastinating about the task of completing screening . Future interventions could seek to reduce CRCS-related stress ( females ) and address the need to overcome procrastination ( males ) BACKGROUND Colorectal cancer is the third most common cancer worldwide and has a high mortality rate . We tested the hypothesis that only one flexible sigmoidoscopy screening  between 55 and 64 years of age can substantially reduce colorectal cancer incidence and mortality . METHODS This r and omised controlled trial was undertaken in 14 UK centres . 170 432 eligible men and women , who had indicated on a previous question naire that they would accept an invitation for screening , were r and omly allocated to the intervention group ( offered flexible sigmoidoscopy screening ) or the control group ( not contacted ) . R and omisation by sequential number generation was done central ly in blocks of 12 , with stratification by trial centre , general practice , and household type . The primary outcomes were the incidence of colorectal cancer , including prevalent cases detected at screening , and mortality from colorectal cancer . Analyses were intention to treat and per protocol . The trial is registered , number IS RCT N28352761 . FINDINGS 113 195 people were assigned to the control group and 57 237 to the intervention group , of whom 112 939 and 57 099 , respectively , were included in the final analyses . 40 674 ( 71 % ) people underwent flexible sigmoidoscopy . During screening and median follow-up of 11.2 years ( IQR 10.7 - 11.9 ) , 2524 participants were diagnosed with colorectal cancer ( 1818 in control group vs 706 in intervention group ) and 20 543 died ( 13 768 vs 6775 ; 727 certified from colorectal cancer [ 538 vs 189 ] ) . In intention-to-treat analyses , colorectal cancer incidence in the intervention group was reduced by 23 % ( hazard ratio 0.77 , 95 % CI 0.70 - 0.84 ) and mortality by 31 % ( 0.69 , 0.59 - 0.82 ) . In per- protocol analyses , adjusting for self- selection bias in the intervention group , incidence of colorectal cancer in people attending screening was reduced by 33 % ( 0.67 , 0.60 - 0.76 ) and mortality by 43 % ( 0.57 , 0.45 - 0.72 ) . Incidence of distal colorectal cancer ( rectum and sigmoid colon ) was reduced by 50 % ( 0.50 , 0.42 - 0.59 ; secondary outcome ) . The numbers needed to be screened to prevent one colorectal cancer diagnosis or death , by the end of the study period , were 191 ( 95 % CI 145 - 277 ) and 489 ( 343 - 852 ) , respectively . INTERPRETATION Flexible sigmoidoscopy is a safe and practical test and , when offered only once between ages 55 and 64 years , confers a substantial and longlasting benefit . FUNDING Medical Research Council , National Health Service R&D , Cancer Research UK , KeyMed OBJECTIVES To investigate the effect on participation in colorectal cancer screening of testing for blood products in faeces using technologies that remove dietary restrictions ( i.e. immunochemical tests ) and simplify faecal sampling ( i.e. tests that use brush sampling ) . METHODS SETTING Urban residents ( n=1818 ) of Adelaide , Australia , aged between 50 and 69 years , r and omly selected from the electoral roll . DESIGN Three r and omised cohorts of 606 invitees were offered a screening test by mail in 2001 . The Hemoccult SENSA and FlexSure OBT cohorts were instructed to sample three stools using a spatula while the InSureTM cohort sample d two stools using a brush . The Hemoccult SENSA cohort was asked to restrict certain ( high-peroxidase ) foods and drugs . MAIN OUTCOME MEASURES Participation ( i.e. return of completed sample kits within 12 weeks ) and generalised linear modelling ( GLM ) of relationships between participation , test technologies and demographic variables . RESULTS Participation was 23.4 % , 30.5 % and 39.6 % for the Hemoccult , FlexSure and InSure cohorts , respectively ( chi(2)=37.1 , p<0.00001 ) . GLM demonstrated that participation was increased by 28 % by removal of restrictions ( p=0.01 ) and by 30 % by simplification of sampling ( p=0.001 ) ; both together increased participation by 66 % ( p<0.001 ) . The differences in participation between tests occurred in the first three weeks . Socio-economic status , gender or age did not significantly influence technology-based improvements in participation . CONCLUSIONS The brush-sampling faecal immunochemical test for haemoglobin ( InSure ) achieves the best participation rates by simplifying sampling and removing the need for restrictions of diet and drugs . Because participation in screening is vital to detection , this new technology should contribute to better detection of neoplasia at the population level IMPORTANCE Colorectal cancer ( CRC ) screening saves lives , but participation rates are low among underserved population s. Knowledge on effective approaches for screening the underserved , including best test type to offer , is limited . OBJECTIVE To determine ( 1 ) if organized mailed outreach boosts CRC screening compared with usual care and ( 2 ) if FIT is superior to colonoscopy outreach for CRC screening participation in an underserved population . DESIGN , SETTING , AND PARTICIPANTS We identified uninsured patients , not up to date with CRC screening , age 54 to 64 years , served by the John Peter Smith Health Network , Fort Worth and Tarrant County , Texas , a safety net health system . INTERVENTIONS Patients were assigned r and omly to 1 of 3 groups . One group was assigned to fecal immunochemical test ( FIT ) outreach , consisting of mailed invitation to use and return an enclosed no-cost FIT ( n = 1593 ) . A second was assigned to colonoscopy outreach , consisting of mailed invitation to schedule a no-cost colonoscopy ( n = 479 ) . The third group was assigned to usual care , consisting of opportunistic primary care visit – based screening ( n = 3898 ) . In addition , FIT and colonoscopy outreach groups received telephone follow-up to promote test completion . MAIN OUTCOME MEASURES Screening participation in any CRC test within 1 year after r and omization . RESULTS Mean patient age was 59 years ; 64 % of patients were women . The sample was 41 % white , 24 % black , 29 % Hispanic , and 7 % other race/ethnicity . Screening participation was significantly higher for both FIT ( 40.7 % ) and colonoscopy outreach ( 24.6 % ) than for usual care ( 12.1 % ) ( P < .001 for both comparisons with usual care ) . Screening was significantly higher for FIT than for colonoscopy outreach ( P < .001 ) . In stratified analyses , screening was higher for FIT and colonoscopy outreach than for usual care , and higher for FIT than for colonoscopy outreach among whites , blacks , and Hispanics ( P < .005 for all comparisons ) . Rates of CRC identification and advanced adenoma detection were 0.4 % and 0.8 % for FIT outreach , 0.4 % and 1.3 % for colonoscopy outreach , and 0.2 % and 0.4 % for usual care , respectively ( P < .05 for colonoscopy vs usual care advanced adenoma comparison ; P > .05 for all other comparisons ) . Eleven of 60 patients with abnormal FIT results did not complete colonoscopy . CONCLUSIONS AND REVELANCE : Among underserved patients whose CRC screening was not up to date , mailed outreach invitations result ed in markedly higher CRC screening compared with usual care . Outreach was more effective with FIT than with colonoscopy invitation . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01191411 OBJECTIVES : To investigate the influence of general practitioner ( GP ) endorsement on participation in screening for colorectal cancer based on a faecal occult blood test ( FOBT ) . SETTING : South Australian residents ( n=2400 ) , in 1999 , aged > 50 years . METHODS : R and om selection of three groups ( GP1 , GP2 , GP3 ) from two general practice s and of one group ( ER ) from the federal electoral roll ; n=600 per group . Without previous communication or publicity , subjects were posted an offer of screening by immunochemical FOBT . The GP1 and ER groups were invited without indication that their GP was involved ; GP2 received an 
    Output:
    
Meta analysis of FIT screening studies indicates significantly lower uptake among men .