Screening for Success: Turning the Tables on Colon Cancer Before It Strikes

Background Colorectal cancer is the second leading cause of cancer-related death in the United States. Screening has been shown to reduce incidence and mortality, yet adherence remains suboptimal, particularly among underserved populations. Objective This study aimed to evaluate adherence to colorectal cancer screening guidelines among patients aged 45-75 years at Christ Health Center (CHC), a Federally Qualified Health Center in Birmingham, Alabama. Methods Patients aged 45-75 years without documented colorectal cancer screening in the preceding year were identified using the Azara Data Reporting and Visualization System. A total of 2,061 patients were initially identified; 191 were excluded due to death, relocation, unstable medical conditions, or receipt of psychiatric-only care, resulting in 1,870 patients eligible for review. Screening status was subsequently verified through the electronic medical record (EMR), and eligible patients were contacted up to three times to encourage completion of screening. Available screening modalities include colonoscopy, fecal immunochemical testing (FIT), and stool DNA testing (Cologuard). Outcomes were recorded in a secure, HIPAA-compliant database. Patients found to be up to date with colorectal cancer screening despite inaccurate EMR documentation were excluded, yielding a final analytic cohort of 1,680 patients.  Results The mean patient age was 67.3 years, and 1,179 (62.2%) were female. A total of 1,046 (55.9%) could not be reached despite multiple attempts. Among 585 (31.3%) contacted patients, 319 (54.5%) agreed to screening while 266 (45.5%) declined. In addition, 243 (13%) had prior screening that was not mapped appropriately within the EMR. The group most frequently lacking up-to-date screening was females aged 65-75 years, while the lowest percentage occurred among newly eligible patients aged 45-55 years.  Conclusion Direct patient outreach significantly improved screening uptake among eligible patients, demonstrating the effectiveness of proactive communication in a community health setting. However, barriers such as incomplete EMR documentation, patient engagement challenges, and insurance limitations persist. Enhanced outreach efforts, improved record integration, and targeted education strategies are needed to strengthen colorectal cancer screening adherence in underserved populations.