A multi-level outreach strategy deployed across New York City federally qualified health centers increased colorectal cancer screening completion to 31.9% among adults aged 45 to 49 compared to 20.1% for usual care, according to findings presented by Shaukat at the American College of Gastroenterology 2026 Annual Scientific Meeting in Nashville, Tennessee.
In Plain English: The Clinical Takeaway
- Removing Barriers: Patients overdue for screenings received a personalized letter, educational materials, and a prepaid, preaddressed FIT kit to complete at home and return by mail.
- Persistent Disparities: Despite a 13-percentage-point gain, absolute screening rates remained low, reflecting persistent disparities.
- Follow-Up Compliance: Ten patients had abnormal stool tests, and all completed follow-up colonoscopy.
Multilevel Intervention Framework at New York City Centers
The randomized clinical trial, registered under ClinicalTrials.gov identifier NCT06269744, evaluated a structured outreach model across multiple community health centers. Patients identified as overdue for screening first received a personalized notification letter. A fortnight later, participants were sent learning resources along with a postage-paid, return-addressed FIT kit designed for home completion and postal submission.
For individuals who did not return the kit, the protocol initiated a series of 3 reminder phone calls or text messages. A final letter notified nonresponders that their screening would be referred back to their primary care clinician. Shaukat explained in an interview with HCPLive that these steps work together to remove friction from completing a test.
The trial demonstrated improvements across both evaluated age cohorts. Among adults aged 45 to 49 years, completion reached 31.9% in the intervention arm versus 20.1% in the usual care group, yielding a statistically significant difference (P = .02). For older adults aged 50 to 75 years, completion rates were 36.9% and 24.3%, respectively (P < .01).
| Patient Age Cohort | Multilevel Intervention Rate | Usual Care Rate | Statistical Significance |
|---|---|---|---|
| Ages 45 to 49 Years | 31.9% | 20.1% | P = .02 |
| Ages 50 to 75 Years | 36.9% | 24.3% | P < .01 |
Multivariable Predictors and Socioeconomic Barriers
Multivariable analysis of trial data identified distinct predictors associated with test completion. Older age demonstrated a positive association with screening uptake (odds ratio [OR], 1.014; 95% confidence interval [CI], 1.002-1.027). Additionally, Spanish-speaking status correlated with higher completion rates (OR, 1.43; 95% CI, 1.07-1.91).
Conversely, unemployment was associated with lower screening completion (OR, 0.79; 95% CI, 0.64-0.94). Shaukat noted that unemployment linked to lower completion regardless of insurance status or neighborhood income. She suggested that unemployment carries an added burden of social determinants, such as competing priorities or lower self-efficacy, and indicated her team plans to examine the finding further.
On the diagnostic follow-up front, ten patients returned abnormal stool test results. All ten successfully completed a follow-up colonoscopy. Furthermore, patients and clinicians found the interventions acceptable.
Scalability and Clinical Disclosures
Shaukat described the intervention model as designed to scale across health systems and confirmed her team is willing to share its materials. Emphasizing the necessity of tailored outreach, she highlighted the importance of building sustainability through dedicated resources such as trained navigators.
“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 stated.
Editors’ note: Shaukat reports relevant disclosures with Freenome, Geneoscopy, and UniversalDx.
References
- Shaukat A, et al. Evaluation of a multi-strategy program designed to boost colorectal cancer screening percentages across various urban health clinics in New York City. Presented at: American College of Gastroenterology 2026 Annual Scientific Meeting; October 9-14, 2026; Nashville, TN.
- 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
- ClinicalTrials.gov identifier: NCT06269744. Accessed October 12, 2026.
