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Implementation of Programmatic Mailed Fecal Immunochemical Testing for Colorectal Cancer Screening in the Veterans
Jason A Dominitz1,2, Douglas J Robertson1,3, Anita Patil1,4
1National Gastroenterology and Hepatology Program, Veterans Health Administration, Washington, D.C., USA.
Introduction:
The COVID-19 pandemic prompted the Veterans Health Administration (VA) to implement programmatic mailed fecal immunochemical test (FIT) screening for colorectal cancer. This paper describes VA's programmatic mailed FIT development, implementation and initial outcomes.
Methods:
VA adapted mailed FIT processes from a Centers for Disease Control and Prevention-sponsored Mailed FIT Implementation Guide, performed regional pilots, created a national Mailed FIT Implementation Team (MFIT), and issued formal policy. The MFIT then provided training and disseminated tools to support VA mailed FIT programs.
Results:
Programmatic mailed FIT has been implemented in 89.5% of eligible facilities. Between December 1, 2022 and September 30, 2025, 643,933 FIT were ordered and 40.2% were returned. Of those, 89.1% were testable and 10.9% were cancelled, primarily due to missing sample collection date (63.2%) or receipt >15 days after collection (31.5%). Of the 230,427 FIT results, 7.4% were abnormal and colonoscopy was completed in 54.4%. Among 5846 VA colonoscopies, adenomas were detected in 68.0%, and adenocarcinoma was found in 2.3%. Linear regression analysis demonstrated a direct correlation between increasing mailed FIT adoption and the proportion of Veterans who are up to date with screening (r=0.65, p=0.003).
Conclusions:
VA has successfully developed and disseminated strong practices for population-level CRC screening outreach with programmatic mailed FIT. This practice is associated with moderate levels of adherence and significant improvements in the overall proportion of Veterans who are up to date with screening. Further dissemination of mailed FIT programs, process improvement, and sharing of best practices is ongoing.
