Rethinking Colorectal Cancer Screening: Culturally Tailored Navigation for Mailed FIT Kits in 45- to 49-Year-Olds

In response to rising colorectal cancer (CRC) incidence in younger adults, the US Preventive Services Task Force now recommends CRC screening to begin at age 45. Despite this change, screening rates remain low among 45- to 49-year-olds. Mailed fecal immunochemical test (FIT) programs with navigation have shown promise in increasing uptake.

To evaluate the effectiveness of a mailed FIT program with culturally tailored navigation to improve CRC screening rates among adults aged 45-49 in a large, hospital-based safety-net primary care clinic.

A quality improvement initiative identified eligible patients aged 45-49 not up to date with CRC screening. FIT kits were mailed following an invitation letter in English and Spanish with messaging based on the health belief model. Navigation was multi-modal including tailored patient education, bilingual phone calls, and reminder letters. Screening completion and follow-up outcomes were tracked via Epic and REDCap.

Of the 589 patients who received mailed FITs, 143 (24%) returned a completed test. Overall, Hispanic patients returned FITs at higher rates than non-Hispanic patients (29% vs. 21%), including both those who received navigation and those who did not. Navigation improved return rates, with 16% of outstanding FITs returned after outreach. Eleven tests were positive (8%), and 8 (73%) had a follow-up colonoscopy which identified 3 advanced adenomas.

A culturally tailored mailed FIT intervention with navigation significantly improved screening rates among newly eligible adults, especially Hispanic patients. The findings highlight the importance of culturally tailored, multi-modal navigation to increase screening among younger, newly eligible adults and reduce screening disparities among underrepresented groups. Findings support broader implementation and suggest that navigation services can advance health equity in primary care. Future work should explore scalability and compare navigation to usual care.