Michael Halpern, MD, PhD, co-authors paper showing that mailed screening kits drive early gains in colorectal cancer prevention

A new study published in the Journal of the American Medical Association (JAMA Network Open) examines the effectiveness of centralized mailed fecal immunochemical test (FIT) outreach to boost colorectal cancer (CRC) screening rates in federally qualified health centers (FQHCs). The study was co-authored by Michael Halpern MD, PhD, MPH, Chair of the Department of Health Policy and Health Services Administration at the Kate Marmion School of Public Health. 

Colorectal cancer stands as the second leading cause of cancer deaths in the United States, with marked disparities existing across racial, ethnic, and socioeconomic lines. Health centers serving historically marginalized and underserved populations often encounter low screening participation. The pragmatic cluster randomized clinical trial evaluated an annual, centralized mailed FIT outreach intervention across 16 Southern California FQHC clinics over a three-year period. 

The study’s findings highlight both early successes and ongoing implementation challenges. At the end of the second year, clinics participating in the mailed FIT outreach achieved a statistically significant 10.8 percentage point higher screening rate compared to those delivering usual care (37.8% vs. 27.0%). Additionally, the outreach intervention proved effective at preventing the sharp declines in screening participation observed in usual care clinics during the height of the COVID-19 pandemic. 

By Year 3, however, the screening rates between the intervention and control groups narrowed (39.4% vs. 36.5%), resulting in a non-statistically significant difference. This convergence was influenced in part by dynamic clinical populations, pandemic disruptions, and a timing adjustment in Year 3 outreach scheduling due to resource constraints. 

As Halpern and his colleagues emphasize, while centralized mailed FIT outreach offers a promising pathway to expand CRC screening in safety-net settings, long-term intervention fidelity and continuous implementation support are critical to sustaining these gains over time. 

Read the paper in the Journal of the American Medical Association Network Open:

Fecal Immunochemical Test Outreach for Colorectal Cancer Screening in Community Health Centers