Randomized trial of centralized colorectal cancer screening outreach in federally qualified health centers

Despite compelling evidence that colorectal cancer (CRC) screening reduces CRC mortality, screening is severely underused in federally qualified health centers (FQHCs), which serve more than 30 million low-income individuals in the US. Accumulating evidence supports intervention strategies including organized mailed fecal immunochemical test (FIT) outreach directly to improve screening. A randomized clinical trial at independent FQHCs comprising 12 clinical delivery sites in North Carolina randomized 4002 individuals aged 50 to 75 years at average risk for CRC and not current with screening to usual care (n=2001) or usual care plus mailed FIT kit packet and patient navigation in case of positive FIT result (n=2001). Thirty percent of those who received the intervention completed screening within 6 months, compared with 9.7% who received usual care. The intervention resulted in increased detection of advanced colorectal neoplasia. The authors conclude that centralized mailed FIT outreach can substantially improve CRC screening in diverse populations served by FQHCs (visual abstract).