Cancer Screening Outreach Guided by Machine Learning: The Benefits of Proactive Care

References

• Adams A, Kluender R, Mahoney N, Wang J, Wong F, Yin W (2022) The impact of financial assistance programs on health care utilization: Evidence from Kaiser Permanente. Amer. Econom. Rev. Insights 4(3):389–407.Crossref, Google Scholar
• Adjerid I, Ayvaci MU, Özer Ö (2023) Value of algorithm-enabled process innovation: The case of sepsis. Manufacturing Service Oper. Management 25(4):1545–1566.Link, Google Scholar
• Almond D, Doyle JJ Jr (2011) After midnight: A regression discontinuity design in length of postpartum hospital stays. Amer. Econom. J. Econom. Policy 3(3):1–34.Crossref, Google Scholar
• American Cancer Society (2023) Colorectal cancer facts & figures 2023–2025. Report, American Cancer Society, Atlanta.Google Scholar
• American Cancer Society National Colorectal Cancer Roundtable (2024) 80% in every community. Accessed April 1, 2025, https://nccrt.org/our-impact/80-in-every-community/.Google Scholar
• Basch CE, Wolf RL, Brouse CH, Shmukler C, Neugut A, DeCarlo LT, Shea S (2006) Telephone outreach to increase colorectal cancer screening in an urban minority population. Amer. J. Public Health 96(12):2246–2253.Crossref, Google Scholar
• Bertsimas D, Pauphilet J (2024) Hospital-wide inpatient flow optimization. Management Sci. 70(7):4893–4911.Link, Google Scholar
• Bharadwaj P, Løken KV, Neilson C (2013) Early life health interventions and academic achievement. Amer. Econom. Rev. 103(5):1862–1891.Crossref, Google Scholar
• Birks J, Bankhead C, Holt TA, Fuller A, Patnick J (2017) Evaluation of a prediction model for colorectal cancer: Retrospective analysis of 2.5 million patient records. Cancer Medicine 6(10):2453–2460.Crossref, Google Scholar
• Boutilier JJ, Jónasson JO, Yoeli E (2022) Improving tuberculosis treatment adherence support: The case for targeted behavioral interventions. Manufacturing Service Oper. Management 24(6):2925–2943.Link, Google Scholar
• Boutilier J, Jonasson JO, Li H, Yoeli E (2024) Operational dosage: Implications of capacity constraints for the design and interpretation of experiments. Preprint, submitted July 31, https://doi.org/10.48550/arXiv.2407.21322.Google Scholar
• Brenner H, Stock C, Hoffmeister M (2014) Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: Systematic review and meta-analysis of randomised controlled trials and observational studies. BMJ 348:g2467.Crossref, Google Scholar
• Bretthauer M, Kaminski MF, Løberg M, Zauber AG, Regula J, Kuipers EJ, Hernán MA, et al. (2016) Population-based colonoscopy screening for colorectal cancer: A randomized clinical trial. JAMA Internal Medicine 176(7):894–902.Crossref, Google Scholar
• Bretthauer M, Løberg M, Wieszczy P, Kalager M, Emilsson L, Garborg K, Rupinski M, et al. (2022) Effect of colonoscopy screening on risks of colorectal cancer and related death. New England J. Medicine 387(17):1547–1556.Crossref, Google Scholar
• Bundorf MK, Polyakova M, Tai-Seale M (2024) How do consumers interact with digital expert advice? Experimental evidence from health insurance. Management Sci. 70(11):7617–7643.Link, Google Scholar
• Calonico S, Cattaneo MD, Titiunik R (2014) Robust nonparametric confidence intervals for regression‐discontinuity designs. Econometrica 82(6):2295–2326.Crossref, Google Scholar
• Calonico S, Jawadekar N, Kezios K, Al Hazzouri AZ (2024) Regression discontinuity design studies: A guide for health researchers. BMJ 384:e072254.Crossref, Google Scholar
• Card D, Dobkin C, Maestas N (2009) Does Medicare save lives? Quart. J. Econom. 124(2):597–636.Crossref, Google Scholar
• Castells A, Quintero E (2015) Programmatic screening for colorectal cancer: The COLONPREV study. Digestive Diseases Sci. 60(3):672–680.Crossref, Google Scholar
• Cattaneo MD, Titiunik R (2022) Regression discontinuity designs. Annual Rev. Econom. 14(1):821–851.Crossref, Google Scholar
• Cattaneo MD, Idrobo N, Titiunik R (2020) A Practical Introduction to Regression Discontinuity Designs: Foundations (Cambridge University Press, Cambridge, UK).Google Scholar
• Chan TC, Mahmood R, O’Connor DL, Stone D, Unger S, Wong RK, Zhu IY (2025) Got (optimal) milk? Pooling donations in human milk banks with machine learning and optimization. Manufacturing Service Oper. Management 27(6):1721–1739.Link, Google Scholar
• Clark D, Royer H (2013) The effect of education on adult mortality and health: Evidence from Britain. Amer. Econom. Rev. 103(6):2087–2120.Crossref, Google Scholar
• DeGroff A, Gressard L, Glover-Kudon R, Rice K, Tharpe FS, Escoffery C, Gersten J, Butterly L (2019) Assessing the implementation of a patient navigation intervention for colonoscopy screening. BMC Health Services Res. 19(1):803.Crossref, Google Scholar
• Dominitz JA, Robertson DJ, Ahnen DJ, Allison JE, Antonelli M, Boardman KD, Ciarleglio M, et al. (2017) Colonoscopy vs. fecal immunochemical test in reducing mortality from colorectal cancer (CONFIRM): Rationale for study design. Amer. J. Gastroenterology 112(11):1736–1746.Crossref, Google Scholar
• Einav L, Finkelstein A, Oostrom T, Ostriker A, Williams H (2020) Screening and selection: The case of mammograms. Amer. Econom. Rev. 110(12):3836–3870.Crossref, Google Scholar
• Erenay FS, Alagoz O, Said A (2014) Optimizing colonoscopy screening for colorectal cancer prevention and surveillance. Manufacturing Service Oper. Management 16(3):381–400.Link, Google Scholar
• European Commission (2022) European Health Union: Commission welcomes adoption of new EU cancer screening recommendations. Accessed June 19, 2024, https://ec.europa.eu/commission/presscorner/detail/en/ip_22_7548.Google Scholar
• Fisher DA, Princic N, Miller-Wilson LA, Wilson K, Limburg P (2022) Healthcare costs of colorectal cancer screening and events following colonoscopy among commercially insured average-risk adults in the United States. Current Medical Res. Opinion 38(3):427–434.Crossref, Google Scholar
• Forsberg A, Westerberg M, Metcalfe C, Steele R, Blom J, Engstrand L, Fritzell K, et al. (2022) Once-only colonoscopy or two rounds of faecal immunochemical testing 2 years apart for colorectal cancer screening (SCREESCO): Preliminary report of a randomised controlled trial. Lancet Gastroenterology Hepatology 7(6):513–521.Crossref, Google Scholar
• Gao SY, He Y, Zhang R, Zheng Z, Wei SLS (2025) Optimizing initial screening for colorectal cancer detection with adherence behavior. Management Sci. 71(9):7516–7536.Link, Google Scholar
• Gelman A, Imbens G (2019) Why high-order polynomials should not be used in regression discontinuity designs. J. Bus. Econom. Statist. 37(3):447–456.Crossref, Google Scholar
• Gould MK, Huang BZ, Tammemagi MC, Kinar Y, Shiff R (2021) Machine learning for early lung cancer identification using routine clinical and laboratory data. Amer. J. Respiratory Critical Care Medicine 204(4):445–453.Crossref, Google Scholar
• Gupta S, Halm EA, Rockey DC, Hammons M, Koch M, Carter E, Valdez L, et al. (2013) Comparative effectiveness of fecal immunochemical test outreach, colonoscopy outreach, and usual care for boosting colorectal cancer screening among the underserved: A randomized clinical trial. JAMA Internal Medicine 173(18):1725–1732.Google Scholar
• Hahn J, Todd P, Van der Klaauw W (2001) Identification and estimation of treatment effects with a regression-discontinuity design. Econometrica 69(1):201–209.Crossref, Google Scholar
• Honeycutt S, Green R, Ballard D, Hermstad A, Brueder A, Haardörfer R, Yam J, Arriola KJ (2013) Evaluation of a patient navigation program to promote colorectal cancer screening in rural Georgia, USA. Cancer 119(16):3059–3066.Crossref, Google Scholar
• Hornbrook MC, Goshen R, Choman E, O’Keeffe-Rosetti M, Kinar Y, Liles EG, Rust KC (2017) Early colorectal cancer detected by machine learning model using gender, age, and complete blood count data. Digestive Diseases Sci. 62(10):2719–2727.Crossref, Google Scholar
• Hu Y, Chan CW, Dong J (2025) Prediction-driven surge planning with application in the emergency department. Management Sci. 71(3):2079–2126.Link, Google Scholar
• Imbens G, Kalyanaraman K (2012) Optimal bandwidth choice for the regression discontinuity estimator. Rev. Econom. Stud. 79(3):933–959.Crossref, Google Scholar
• Jandorf L, Gutierrez Y, Lopez J, Christie J, Itzkowitz SH (2005) Use of a patient navigator to increase colorectal cancer screening in an urban neighborhood health clinic. J. Urban Health 82(2):216–224.Crossref, Google Scholar
• Jordan MI, Mitchell TM (2015) Machine learning: Trends, perspectives, and prospects. Science 349(6245):255–260.Crossref, Google Scholar
• Kahi CJ, Imperiale TF, Juliar BE, Rex DK (2009) Effect of screening colonoscopy on colorectal cancer incidence and mortality. Clinical Gastroenterology Hepatology 7(7):770–775.Crossref, Google Scholar
• Kinar Y, Akiva P, Choman E, Kariv R, Shalev V, Levin B, Narod SA, Goshen R (2017) Performance analysis of a machine learning flagging system used to identify a group of individuals at a high risk for colorectal cancer. PLoS One 12(2):e0171759.Crossref, Google Scholar
• Kinar Y, Kalkstein N, Akiva P, Levin B, Half EE, Goldshtein I, Chodick G, Shalev V (2016) Development and validation of a predictive model for detection of colorectal cancer in primary care by analysis of complete blood counts: A binational retrospective study. J. Amer. Medical Informatics Assoc. 23(5):879–890.Crossref, Google Scholar
• Kraus M, Feuerriegel S, Saar-Tsechansky M (2024) Data-driven allocation of preventive care with application to diabetes mellitus type II. Manufacturing Service Oper. Management 26(1):137–153.Link, Google Scholar
• Lee DS, Lemieux T (2010) Regression discontinuity designs in economics. J. Econom. Literature 48(2):281–355.Crossref, Google Scholar
• Lee YH, Kung PT, Wang YH, Kuo WY, Kao SL, Tsai WC (2019) Effect of length of time from diagnosis to treatment on colorectal cancer survival: A population-based study. PLoS One 14(1):e0210465.Crossref, Google Scholar
• Leone LA, Reuland DS, Lewis CL, Ingle M, Erman B, Summers TJ, DuBard CA, Pignone MP (2013) Reach, usage, and effectiveness of a Medicaid patient navigator intervention to increase colorectal cancer screening, Cape Fear, North Carolina, 2011. Preventing Chronic Disease 10:E82.Crossref, Google Scholar
• Leshno M, Halpern Z, Arber N (2003) Cost-effectiveness of colorectal cancer screening in the average risk population. Health Care Management Sci. 6(3):165–174.Crossref, Google Scholar
• Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G (2000) Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. New England J. Medicine 343(3):162–168.Crossref, Google Scholar
• Lin W, Kim S-H, Tong J (2025) Revisiting the cause of algorithm aversion: Algorithm feedback asymmetry in the field and lab. Preprint, submitted March 15, http://dx.doi.org/10.2139/ssrn.3891832.Google Scholar
• McCrary J (2008) Manipulation of the running variable in the regression discontinuity design: A density test. J. Econom. 142(2):698–714.Crossref, Google Scholar
• National Cancer Institute (2024) Cancer stat facts: Colorectal cancer. Accessed March 26, 2024, https://seer.cancer.gov/statfacts/html/colorect.html.Google Scholar
• Percac-Lima S, Grant RW, Green AR, Ashburner JM, Gamba G, Oo S, Richter JM, Atlas SJ (2009) A culturally tailored navigator program for colorectal cancer screening in a community health center: A randomized, controlled trial. J. General Internal Medicine 24(2):211–217.Crossref, Google Scholar
• Phillips L, Hendren S, Humiston S, Winters P, Fiscella K (2015) Improving breast and colon cancer screening rates: A comparison of letters, automated phone calls, or both. J. Amer. Board Family Medicine 28(1):46–54.Crossref, Google Scholar
• Quintero E, Castells A, Bujanda L, Cubiella J, Salas D, Lanas Á, Andreu M, et al. (2012) Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. New England J. Medicine 366(8):697–706.Crossref, Google Scholar
• Rice K, Gressard L, DeGroff A, Gersten J, Robie J, Leadbetter S, Glover-Kudon R, Butterly L (2017) Increasing colonoscopy screening in disparate populations: Results from an evaluation of patient navigation in the New Hampshire Colorectal Cancer Screening Program. Cancer 123(17):3356–3366.Crossref, Google Scholar
• Roy HK, Backman V, Goldberg MJ (2006) Colon cancer screening: The good, the bad, and the ugly. Arch. Internal Medicine 166(20):2177–2179.Crossref, Google Scholar
• Schneider JL, Layefsky E, Udaltsova N, Levin TR, Corley DA (2020) Validation of an algorithm to identify patients at risk for colorectal cancer based on laboratory test and demographic data in diverse, community-based population. Clinical Gastroenterology Hepatology 18(12):2734–2741.Crossref, Google Scholar
• Sekhon JS, Titiunik R (2017) On interpreting the regression discontinuity design as a local experiment. Cattaneo MD, Escanciano JC, eds. Regression Discontinuity Designs: Theory and Applications, Advances in Econometrics, vol. 38 (Emerald Publishing Limited, Bingley, UK), 1–28.Crossref, Google Scholar
• Shaukat A, Levin TR (2022) Current and future colorectal cancer screening strategies. Nature Rev. Gastroenterology Hepatology 19(8):521–531.Crossref, Google Scholar
• Singal AG, Gupta S, Skinner CS, Ahn C, Santini NO, Agrawal D, Mayorga CA, et al. (2017) Effect of colonoscopy outreach vs fecal immunochemical test outreach on colorectal cancer screening completion: A randomized clinical trial. JAMA 318(9):806–815.Crossref, Google Scholar
• Stark GF, Hart GR, Nartowt BJ, Deng J (2019) Predicting breast cancer risk using personal health data and machine learning models. PLoS One 14(12):e0226765.Crossref, Google Scholar
• Thistlethwaite DL, Campbell DT (1960) Regression-discontinuity analysis: An alternative to the ex post facto experiment. J. Ed. Psych. 51(6):309–317.Crossref, Google Scholar
• Tørring ML, Frydenberg M, Hansen RP, Olesen F, Vedsted P (2013) Evidence of increasing mortality with longer diagnostic intervals for five common cancers: A cohort study in primary care. Eur. J. Cancer 49(9):2187–2198.Crossref, Google Scholar
• Underberger D, Boell K, Orr J, Siegrist C, Hunt S (2022) Collaboration to improve colorectal cancer screening using machine learning. NEJM Catalyst Innovations Care Delivery 3(4), 10.1056/CAT.21.0170.Google Scholar
• U.S. Preventive Services Task Force (2016) Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA 315(23):2564–2575.Crossref, Google Scholar
• U.S. Preventive Services Task Force (2021) Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA 325(19):1965–1977.Crossref, Google Scholar
• Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, et al. (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. New England J. Medicine 329(27):1977–1981.Crossref, Google Scholar
• Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, Shi W, et al. (2012) Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. New England J. Medicine 366(8):687–696.Crossref, Google Scholar