Impact of Personalized Risk Messages on CRC Screening Uptake: Findings from a Recent Trial

The pressing question of how personalized risk messages impact colorectal cancer screening uptake is captivating clinicians across primary care and gastroenterology, along with public health leaders.

A recent study provides a startling insight: despite high hopes, personalized communication may not always enhance screening participation. Current U.S. recommendations from groups such as the USPSTF and ACS continue to advise routine colorectal cancer screening for average-risk adults beginning at age 45 through 75 using any of several approved modalities; messaging strategies are meant to support these decisions, not change who should be screened or how often.

As demonstrated in a recent randomized trial of personalized risk communication, researchers investigated how specific information on individual CRC-related risk translated to patient actions. Participants were randomly assigned to receive personalized or generic risk messages, a method designed to measure direct impact on screening behavior. The primary outcome was completed screening within a predefined follow-up period, with intention to screen assessed as a secondary endpoint.

Surprisingly, the data revealed no statistically significant increase in screening uptake from these personalized communications (the estimated difference in completion rates was small and imprecise, with wide confidence intervals), underscoring that absence of evidence is not evidence of no effect—particularly if the study was not powered to detect modest differences.

For those receiving tailored risk messages, self-reported intention to screen improved, but completed screening within the follow-up window did not rise to the same degree. This patient experience lens highlights complexities in behavior—personalized messages intend to make decisions straightforward, yet emotional and logistical hurdles can dilute their impact.

Managing patient participation remains challenging when tailored risk information fails to propel action. Clinicians involved in screening programs should consider these dynamics when refining communication strategies and align efforts with established shared decision-making principles and patient-centered communication guidance already used in screening programs.

Even with a largely null effect on completed screening, these results help map where friction occurs; thoughtfully designed, technology-enabled approaches—such as tailored nudges, multimodal reminders, and patient navigation—may better translate intention into action. Future research should test multicomponent strategies that combine tailored messages with reminders and navigation support in randomized trials, and examine whether segmenting by health literacy, language, and cultural factors improves completed screening rates.

Beyond trial design, implementation matters. Health systems will need to integrate messaging with practical supports—easy scheduling, cost transparency, culturally and linguistically appropriate materials, and navigation for colonoscopy follow-up after positive noninvasive tests. These operational details often determine whether a stated intention becomes a completed test.

Equity considerations are central. Populations facing structural barriers—limited paid time off, transportation challenges, lower digital access, or lower health literacy—may benefit most from multicomponent outreach that pairs tailored content with human support. Segmenting outreach by language and cultural context, and co-designing messages with community partners, can increase trust and relevance.

Measurement also deserves attention. Trials should predefine completion within a clear time horizon, track intermediate steps (ordering a kit, returning a sample, completing colonoscopy), and report effect sizes with confidence intervals to inform power calculations for future studies. Process metrics can reveal where drop-offs occur and which components drive gains.

Finally, practice change should remain anchored to screening guidelines. Personalized messaging is a tool to help eligible adults initiate and maintain screening on the recommended cadence; it does not replace guideline-driven decisions about modality or interval. Clear alignment with programmatic goals can prevent message fatigue and keep efforts focused on outcomes that matter—completed, timely screening and appropriate follow-up.

Key Takeaways:

• Personalized risk communications did not produce a statistically significant rise in completed screening in the referenced trial; the estimated effect was small with wide uncertainty, highlighting that a null finding is not proof of no benefit without adequate power.
• Communication strategies should complement—not replace—guideline-based eligibility and cadence (e.g., routine screening for average-risk adults aged 45–75 using approved modalities).
• Next steps include testing multicomponent, technology-enabled approaches (tailored messages plus reminders and navigation) and tailoring by health literacy, language, and cultural context to improve completed screening.