Background
colorectal cancer, CRC
MAY, COLORECTAL CANCER
In May 2021, the U.S. Preventive Services Task Force (USPSTF) extended colorectal cancer (CRC) screening recommendations to adults aged 45–49 who are at average risk for CRC [Mailing at-home CRC screening tests, including fecal immunochemical tests (FIT), directly to patients has potential to promote uptake of CRC screening in this newly eligible population of 45–49-year-olds. In addition to promoting FIT uptake, these programs may serve as general reminders about CRC screening and induce screening by other types of screening tests (e.g., colonoscopy). Mailed FIT outreach has been shown to be an effective evidence-based intervention that is associated with increased CRC screening compared to usual care among the 50–75-year-old population [Research has yet to focus specifically on the effectiveness of mailed FIT programs in the 45–49-year-old population, especially in more resource-limited settings such as Federally Qualified Health Centers (FQHCs) which receive federal funds to serve medically underserved areas and populations regardless of patients’ ability to pay for care. This will be particularly important to understand as FQHCs may soon be required to report CRC screening in this younger age category as a Uniform Data System (UDS) measure and, thus, need to prioritize achieving high screening rates in this population. In addition, little is known about how modifying the appearance of mailed outreach materials may affect uptake of these mailed FIT interventions. Gupta and colleagues (2020) reported that a common challenge with mailed FIT programs is getting patients to open the envelopes, with patients often not remembering that they received a letter or FIT packet [Therefore, in addition to assessing FIT uptake (effectiveness) associated with an organized mailed FIT outreach (hereafter “mailed FIT”) intervention among 45–49-year-old patients at a single FQHC clinic site, we also evaluated the effect of using an enhanced envelope (i.e., FIT mailed in a padded envelope with a tracking label and messaging sticker) versus a plain envelope on mailed FIT uptake in this population. Finally, in order to evaluate the ability of these mailed FITs to serve as broad screening reminders and to prepare for future reporting of CRC screening in this age category, we determined the change in clinic-level CRC screening, i.e., the proportion of 45–49-year-old patients at this FQHC who were up-to-date on CRC screening by any modality recommended by the USPSTF (e.g., FIT, colonoscopy), between baseline and 6 months after the mailed FIT intervention.