Multilevel Intervention Boosts Colorectal Cancer Screening in Adults Aged 45 to 49
- A multilevel intervention that pairs personalized reminder letters with mailed fecal immunochemical test kits significantly increases colorectal cancer screening rates among younger and older adults, according to findings...
- The study evaluated a multi-level strategy implemented across federally qualified health centers in New York City.
- Multivariable analysis identified older age as a predictor of higher completion, with an odds ratio of 1.014.
A multilevel intervention that pairs personalized reminder letters with mailed fecal immunochemical test kits significantly increases colorectal cancer screening rates among younger and older adults, according to findings presented at the American College of Gastroenterology 2026 Annual Scientific Meeting in Nashville, Tennessee, and reported by HCPLive. Among adults aged 45 to 49 years, 31.9% of the intervention group completed screening compared to 20.1% in the usual-care group. Among adults aged 50 to 75 years, completion rates reached 36.9% for the intervention group and 24.3% for usual care.
Multilevel Intervention Design and Outreach Steps
The study evaluated a multi-level strategy implemented across federally qualified health centers in New York City. Patients who were overdue for screening first received a personalized notification letter. Two weeks later, they received educational materials alongside a prepaid, preaddressed fecal immunochemical test kit to complete at home and return by mail. Nonresponders subsequently received a series of three reminder phone calls or text messages, followed by a final letter warning that uncompleted screenings would be referred back to their primary care clinician. Shaukat explained that the steps work in tandem to remove friction from completing a test. Shaukat reported relevant disclosures with Freenome, Geneoscopy, and UniversalDx.
Predictors of Screening Completion and Disparities
Multivariable analysis identified older age as a predictor of higher completion, with an odds ratio of 1.014. Spanish-speaking status was also associated with higher completion, yielding an odds ratio of 1.43. Conversely, unemployment was associated with lower completion, showing an odds ratio of 0.79. Shaukat noted that unemployment linked to lower completion regardless of insurance status or neighborhood income, suggesting that joblessness carries an added burden of social determinants such as competing priorities or lower self-efficacy. Ten patients in the evaluation had abnormal stool tests, and all of them completed a follow-up colonoscopy. Shaukat emphasized that absolute screening rates remained low overall despite the gains, reflecting persistent disparities that require health systems to actively engage unscreened or under-screened populations.