1. In a randomized trial involving 20,509 adults aged 45 to 49 years, usual care with mailed fecal immunochemical test (FIT) outreach led to a significantly higher screening participation (26.2%) compared to three active choice strategies (14.5% to 17.4%).
2. Offering a dual-modality active choice between FIT or colonoscopy modestly improved screening completion compared to a single active choice intervention.
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