Fecal Immunochemical Test Outreach for Colorectal Cancer Screening in Community Health Centers
11 affiliations
- 1UC San Diego Moores Cancer Center, University of California San Diego, La Jolla
- 2Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
- 3Department of Psychology, San Diego State University, San Diego, California
- 4Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla
- 5UC San Diego Altman Clinical and Translational Research Institute, Dissemination and Implementation Science Center, University of California San Diego, La Jolla
- 6Health Quality Partners of Southern California, San Diego
- 7Integrated Health Partners of Southern California, San Diego
- 8Neighborhood Healthcare, Escondido, California
- 9Vista Community Clinic, Vista, California
- 10University of Texas at San Antonio School of Public Health
- 11Division of Gastroenterology and Hepatology, Department of Medicine, UC San Diego, La Jolla, California
Abstract
Importance: Colorectal cancer (CRC) screening is suboptimal among people in traditionally underserved populations, many of whom receive primary care at federally qualified health centers (FQHCs). Mailed fecal immunochemical test (FIT) outreach improves screening, especially in underserved populations, but questions remain about impact over time.
Objective: To evaluate the effectiveness of centralized annual mailed FIT outreach delivered over 3 years to increase CRC screening in FQHCs.
Design, Setting, and Participants: This cluster randomized clinical trial was conducted between June 1, 2021, and May 31, 2024. Sixteen clinics from 2 FQHCs in Southern California were randomly assigned to mailed FIT outreach or usual care for patients aged 50 to 75 years and not up to date with screening.
Intervention: Intervention components followed best practices for mailed FIT outreach and included educational primers, FIT kits, and telephone reminders.
Main Outcomes and Measures: The primary outcome was the proportion of individuals up to date with any CRC screening after 3 years of intervention (point prevalence); screening at 2 years was a secondary outcome. Due to a resource constraint–related protocol modification, mailed FIT outreach began earlier in year 3, such that some individuals who completed screening in year 2 were not yet due for repeat FIT.
Results: Among 16 clinics serving 20 250 patients, 6 clinics serving 8334 individuals at baseline (4435 aged 55-64 years [53.2%]; 4896 female [58.7%]; 341 Asian [4.1%], 238 Black [2.9%], 2390 Hispanic [28.7%], and 4371 non-Hispanic White [52.4%]) were randomized to intervention and 10 clinics serving 11 916 individuals at baseline (6443 aged 55-64 years [54.1%]; 7250 female [60.8%]; 699 Asian [5.9%], 355 Black [3.0%], 4635 Hispanic [38.9%], and 4436 non-Hispanic White [37.2%]) were randomized to usual care. At year 3, screening was 39.4% (95% CI, 36.3% to 42.6%) in intervention clinics vs 36.5% (95% CI, 31.2% to 42.2%) in usual care clinics, which was not a statistically significant difference (2.9 percentage points; 95% CI, −3.2 to 9.0 percentage points). At year 2, screening was 37.8% (95% CI, 35.2% to 40.4%) in intervention clinics vs 27.0% (95% CI, 21.8% to 32.9%) in usual care clinics (difference, 10.8 percentage points; 95% CI, 4.9 to 16.7 percentage points).
Conclusions and Relevance: This study’s findings suggest that centralized mailed FIT outreach could increase CRC screening in FQHCs serving populations with persistent disparities, although maintaining intervention fidelity and providing ongoing implementation support over time are needed for consistent impact.
Trial Registration: ClinicalTrials.gov Identifier: NCT04941300
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BibTeX
@article{martinez2026fecal,
title = {{Fecal Immunochemical Test Outreach for Colorectal Cancer Screening in Community Health Centers}},
author = {Maria Elena Martinez and Scott Roesch and Valesca Largaespada and Jesse N. Nodora and Borsika A. Rabin and Sheila F. Castañeda and Jennifer Covin and Kristine Ortwine and Yesenia Preciado-Hidalgo and Nicole Howard and James Schultz and Nannette Stamm and Michael T. Halpern and Samir Gupta},
journal = {JAMA Network Open},
year = {2026},
month = oct,
doi = {10.1001/jamanetworkopen.2026.39013},
url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855574},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Fecal Immunochemical Test Outreach for Colorectal Cancer Screening in Community Health Centers
AU - Maria Elena Martinez
AU - Scott Roesch
AU - Valesca Largaespada
AU - Jesse N. Nodora
AU - Borsika A. Rabin
AU - Sheila F. Castañeda
AU - Jennifer Covin
AU - Kristine Ortwine
AU - Yesenia Preciado-Hidalgo
AU - Nicole Howard
AU - James Schultz
AU - Nannette Stamm
AU - Michael T. Halpern
AU - Samir Gupta
PY - 2026
DA - 2026/10/21
JO - JAMA Network Open
DO - 10.1001/jamanetworkopen.2026.39013
UR - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855574
AB - Importance: Colorectal cancer (CRC) screening is suboptimal among people in traditionally underserved populations, many of whom receive primary care at federally qualified health centers (FQHCs). Mailed fecal immunochemical test (FIT) outreach improves screening, especially in underserved populations, but questions remain about impact over time. Objective: To evaluate the effectiveness of centralized annual mailed FIT outreach delivered over 3 years to increase CRC screening in FQHCs. Design, Setting, and Participants: This cluster randomized clinical trial was conducted between June 1, 2021, and May 31, 2024. Sixteen clinics from 2 FQHCs in Southern California were randomly assigned to mailed FIT outreach or usual care for patients aged 50 to 75 years and not up to date with screening. Intervention: Intervention components followed best practices for mailed FIT outreach and included educational primers, FIT kits, and telephone reminders. Main Outcomes and Measures: The primary outcome was the proportion of individuals up to date with any CRC screening after 3 years of intervention (point prevalence); screening at 2 years was a secondary outcome. Due to a resource constraint–related protocol modification, mailed FIT outreach began earlier in year 3, such that some individuals who completed screening in year 2 were not yet due for repeat FIT. Results: Among 16 clinics serving 20 250 patients, 6 clinics serving 8334 individuals at baseline (4435 aged 55-64 years [53.2%]; 4896 female [58.7%]; 341 Asian [4.1%], 238 Black [2.9%], 2390 Hispanic [28.7%], and 4371 non-Hispanic White [52.4%]) were randomized to intervention and 10 clinics serving 11 916 individuals at baseline (6443 aged 55-64 years [54.1%]; 7250 female [60.8%]; 699 Asian [5.9%], 355 Black [3.0%], 4635 Hispanic [38.9%], and 4436 non-Hispanic White [37.2%]) were randomized to usual care. At year 3, screening was 39.4% (95% CI, 36.3% to 42.6%) in intervention clinics vs 36.5% (95% CI, 31.2% to 42.2%) in usual care clinics, which was not a statistically significant difference (2.9 percentage points; 95% CI, −3.2 to 9.0 percentage points). At year 2, screening was 37.8% (95% CI, 35.2% to 40.4%) in intervention clinics vs 27.0% (95% CI, 21.8% to 32.9%) in usual care clinics (difference, 10.8 percentage points; 95% CI, 4.9 to 16.7 percentage points). Conclusions and Relevance: This study’s findings suggest that centralized mailed FIT outreach could increase CRC screening in FQHCs serving populations with persistent disparities, although maintaining intervention fidelity and providing ongoing implementation support over time are needed for consistent impact. Trial Registration: ClinicalTrials.gov Identifier: NCT04941300
SN - 2574-3805
ER -