Colorectal Cancer (CRC) is the third most common cancer in men and women and the second
leading cause of cancer related death. Screening for CRC reduces CRC incidence and
mortality, and is recommended for average risk men and women between the ages of 45 and 75
by the US Preventive Services Task Force guidelines; which were updated recently to include
45-49 year olds, an additional 20 million individuals in the US. In New York City screening rates
are 78% in Manhattan but only 26-55% in federally qualified Health Centers (FQHC) across the
city that provide free and subsidized health services to underrepresented minorities. Currently,
invitations to screen are offered only when a patient is seen by his or her provider.
Consequently, many eligible individuals, particularly 45-55 year olds who do not regularly
access healthcare, are under-screened. Hence, there is an unmet need for improving screening
practices. We hypothesize that patient care (rates of CRC screening) will improve in under-
served populations with the implementation of a proactive approach that incorporates a mailed
outreach invitation to screen, followed by active assistance to a colonoscopy completion
including overcoming financial and logistical barriers. To address this hypothesis, we seek to
improve CRC screening in a hybrid type I trial by assessing the effectiveness and
implementation of a proactive outreach colorectal cancer screening program in multiple federally
qualified health centers (FQHCs) in Brooklyn, serving primarily Black patients. This proposed
work will provide critical, foundational information for scaling up long-term, sustained
implementation of screening program across other FQHCs in NYC. We propose to perform a
randomized trial of proactive invitation at five FQHCs with aims to study the effect of a
proactive outreach program that identifies those due for screening, mail a fecal immunochemical
test and provide navigation and financial support for cost of preparation and transport to usual
care in improving CRCc screening rates, understand barriers and facilitators to proactive
outreach by surveying patients and providers, and perform a cost analysis of the program
