Multilevel Intervention Improves CRC Screening, With Aasma Shaukat, MD, MPH

A multilevel outreach intervention combining mailed fecal immunochemical test (FIT) kits, education, and patient navigation increased colorectal cancer (CRC) screening completion among underserved adults at 5 federally qualified health centers (FQHCs) in Brooklyn, New York. Within 6 months, 35.9% of patients in the intervention group completed screening, compared with 23.6% of those receiving usual care.¹

Aasma Shaukat, MD, MPH, NYU Grossman School of Medicine, presented the randomized trial results at the American College of Gastroenterology (ACG) 2026 Annual Scientific Meeting in Nashville, Tennessee.¹

Mailed FIT Outreach and CRC Screening at Federally Qualified Health Centers

FQHCs care for uninsured and underinsured patients with a high burden of social determinants of health, and CRC screening rates in these settings remain low.¹ Mailed FIT outreach had not been tested in this New York City population, particularly among adults aged 45 to 49 years. This age group became eligible for average-risk screening when the US Preventive Services Task Force lowered the starting age in 2021.1,2

The trial randomly assigned 2007 adults aged 45 to 75 years to usual care (n = 1116) or the intervention (n = 891).1,3 Participants had a mean age of 57 years; 69% were Black, 25% were Hispanic, and 66% were women. The primary outcome was completion of screening by FIT or colonoscopy within 6 months.¹

Results showed screening completion was significantly greater with the intervention (35.9% vs 23.6%; odds ratio [OR], 1.75; 95% CI, 1.44-2.13; P <.001).¹

Screening Completion in Adults Aged 45 to 49 Years and Predictors of Uptake

The benefit extended to both age groups. Among adults aged 45 to 49 years, 31.9% of the intervention group completed screening vs 20.1% with usual care (P = .02). Among those aged 50 to 75 years, completion rates were 36.9% and 24.3%, respectively (P <.01).¹

In multivariable analysis, older age (OR, 1.014; 95% CI, 1.002-1.027) and Spanish-speaking status (OR, 1.43; 95% CI, 1.07-1.91) were associated with higher completion. Unemployment was associated with lower completion (OR, 0.79; 95% CI, 0.64-0.94).¹ Ten patients had abnormal stool tests, and all completed follow-up colonoscopy; patients and clinicians found the interventions acceptable.¹

In an interview with HCPLive, Shaukat said the 11- to 12-percentage-point gain among younger adults was encouraging, since screening data in this newly eligible group remain limited. She noted unemployment was linked to lower completion regardless of insurance status or neighborhood income. Shaukat suggested unemployment may carry an added burden of social determinants, such as competing priorities or lower self-efficacy, and said her team plans to examine the finding further.

Components of the Multilevel CRC Screening Intervention

Shaukat explained the intervention layered several evidence-based steps. Patients first received a personalized letter noting they were overdue for screening and alerting them to upcoming materials. Two weeks later, they received educational materials and a prepaid, preaddressed FIT kit to complete at home and return by mail.

Patients who did not return the kit received a series of 3 reminder phone calls or text messages. A final letter then informed nonresponders their screening would be referred back to their primary care clinician. According to Shaukat, the steps work together to remove friction from completing a test.

She described the model as designed to scale across health systems and said her team is willing to share its materials. Shaukat emphasized tailoring outreach to each population with language-congruent materials, and building sustainability through dedicated resources such as trained navigators. She also noted absolute screening rates remained low despite the 13-percentage-point gain, reflecting persistent disparities.

“We just need to be looking at our health systems and the unscreened or the under-screened patients and doing everything we can to bring them into the screening fold,” Shaukat said.

Editors’ note: Shaukat reports relevant disclosures with Freenome, Geneoscopy, and UniversalDx.

References

1. Shaukat A, et al. A randomized clinical trial of multi-level intervention to improve colorectal cancer screening rates at multiple federally qualified health care centers in New York City. Presented at: American College of Gastroenterology 2026 Annual Scientific Meeting; October 9-14, 2026; Nashville, TN.

2. US Preventive Services Task Force; Davidson KW, Barry MJ, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965-1977. doi:10.1001/jama.2021.6238

3. ClinicalTrials.gov identifier: NCT06269744. Accessed October 12, 2026. https://clinicaltrials.gov/study/NCT06269744