Program Components and Results From an Organized Colorectal Cancer Screening Program Using Annual Fecal...

Area of Science:

• Public Health
• Gastroenterology
• Health Services Research

Background:

• Programmatic colorectal cancer (CRC) screening models enhance uptake but their design and resource utilization are not well understood.
• This study characterizes the components and participation across a large-scale CRC screening program employing mailed fecal immunochemical testing (FIT) alongside opportunistic colonoscopy.

Purpose of the Study:

• To analyze the design and participation at each stage of a comprehensive CRC screening program.
• To identify the key components contributing to high screening uptake in a real-world setting.

Main Methods:

• A mixed-methods approach combining site visits and retrospective cohort analysis.
• Inclusion of 51-75-year-old adults within the Kaiser Permanente Northern California integrated health system during 2017.
• Analysis of screening participation across various outreach strategies.

Main Results:

• Out of 1,023,415 eligible individuals, 82% were up-to-date with screening by year-end.
• Mailed FIT kits achieved initial uptake (20%), with subsequent increases from automated reminders (10%) and personal contact (12%).
• 83.7% of patients with positive FIT results completed diagnostic colonoscopy.

Conclusions:

• A multi-faceted screening approach combining mailed FIT, automated reminders, and personal outreach is effective.
• High screening participation (>82%) was achieved through a combination of existing endoscopic screening and FIT-based strategies.
• The program demonstrated successful integration of different screening modalities to maximize CRC screening rates.