Colorectal Cancer Screening Beyond Primary Care: A Community-Based FIT Distribution Model Serving a Safety-Net...

Colorectal cancer (CRC) remains the second leading cause of cancer-related death in the United States, with screening disparities disproportionately affecting socioeconomically disadvantaged and underrepresented populations. Although outreach-based CRC screening programs using fecal immunochemical testing (FIT) have been previously described, many have focused on patients already engaged with primary care. The ACCESS (Advancing Colorectal Cancer Equity through Systematic Screening) initiative evaluates a community-based FIT distribution strategy designed to reach individuals outside traditional primary care pathways.

To describe the implementation, feasibility, screening outcomes, follow-up colonoscopy completion, and exploratory financial considerations of the ACCESS initiative at Temple University Hospital (TUH).

ACCESS distributed FIT in non-traditional, high-traffic community settings to average-risk individuals aged 45-75 years, consistent with United States Preventive Services Task Force (USPSTF) guidelines. The program was designed to reach individuals facing barriers to routine preventive screening.

Among 799 FIT distributed, 293 results were reported, yielding a response rate of 36.7%. Forty-eight FIT were positive, corresponding to a positivity rate of 16.4%. Individuals without a primary care visit in the preceding year had a higher FIT positivity rate than those with a recent primary care visit, although this difference did not reach statistical significance (26.5% vs. 15.1%; p = 0.064). Among men, positivity was 41.4% in those without a recent primary care visit compared with 16.0% in those with a recent visit (p = 0.056). Follow-up colonoscopy was completed at TUH in 29.2% of positive FIT cases, while follow-up outside Temple Health may not have been fully captured. Exploratory financial analysis showed higher average reimbursement per FIT-prompted colonoscopy CPT code compared with non-FIT-prompted colonoscopy codes ($1171.62 vs. $1084.60).

ACCESS demonstrates the feasibility of community-based FIT outreach outside traditional primary care pathways and provides insight into screening outcomes, follow-up challenges, and financial considerations within an urban safety-net health system.