Mailed fecal immunochemical test outreach for colorectal cancer screening: Summary of a Centers for Disease Control and Prevention–sponsored Summit

Abstract

Uptake of colorectal cancer screening remains suboptimal. Mailed fecal immunochemical testing (FIT) offers promise for increasing screening rates, but optimal strategies for implementation have not been well synthesized. In June 2019, the Centers for Disease Control and Prevention convened a meeting of subject matter experts and stakeholders to answer key questions regarding mailed FIT implementation in the United States. Points of agreement included: 1) primers, such as texts, telephone calls, and printed mailings before mailed FIT, appear to contribute to effectiveness; 2) invitation letters should be brief and easy to read, and the signatory should be tailored based on setting; 3) instructions for FIT completion should be simple and address challenges that may lead to failed laboratory processing, such as notation of collection date; 4) reminders delivered to initial noncompleters should be used to increase the FIT return rate; 5) data infrastructure should identify eligible patients and track each step in the outreach process, from primer delivery through abnormal FIT follow‐up; 6) protocols and procedures such as navigation should be in place to promote colonoscopy after abnormal FIT; 7) a high‐quality, 1‐sample FIT should be used; 8) sustainability requires a program champion and organizational support for the work, including sufficient funding and external policies (such as quality reporting requirements) to drive commitment to program investment; and 9) the cost effectiveness of mailed FIT has been established. Participants concluded that mailed FIT is an effective and efficient strategy with great potential for increasing colorectal cancer screening in diverse health care settings if more widely implemented.

The Impact of the Coronavirus Disease-19 Pandemic on Access to Endoscopy Procedures in the VA Healthcare System

“…Thus, it is imperative that the VA optimize its supply of endoscopic resources while continuing to work to shape the demand, as discussed. As a part of that effort to shape the demand, some VA facilities are building infrastructure to support programmatic noninvasive colorectal cancer screening, such as through mailed FIT, 18 , 19 , 20 which has been shown to be associated with significant benefits in the Kaiser Permanent system. 21 …”

Spatial Insights for Understanding Colorectal Cancer Screening in Disproportionately Affected Populations, Central Texas, 2019

“…Overall screening rates in the system were generally low, a finding similar for other FQHC systems ( 14 – 16 ). Interventions that seek to increase screening in ways that do not require in-person visits or extended travel, such as mailed stool testing programs, may be effective in overcoming barriers ( 4 , 5 , 17 ).…”

“…We prioritize interventions that identify unscreened patients apart from opportunistic visit-based care, inform patients about their eligibility for screening, and invite them into care. Mailed fecal immunochemical test programs are particularly effective and efficient ( 4 , 5 , 17 ) and are the principal intervention in our system to increase CRC screening, coupled with patient navigation to help identify and reduce transportation barriers. We plan to adopt a new electronic health record that includes preventive care prompting and to conduct additional formative work to understand barriers for patients who do not respond to the interventions.…”

Screening and Surveillance Colonoscopy and COVID-19: Avoiding More Casualties

“… 13 , 14 Mailed FIT outreach usually packages several evidence-based strategies for addressing patient-level barriers to screening by delivering education on importance of screening, providing completion reminders, and eliminating the structural barrier of having to attend a clinic visit to complete screening. 15 Some mailed programs have included the option of deferring FIT in lieu of immediately scheduling a screening colonoscopy, based on patient preference. Mailed programs require a clinician champion, and gastroenterologists are well-positioned to bring this and other interventions for optimizing screening participation to attention of clinic and health system leaders.…”