A feasibility study about increasing colon cancer screening: How to say “yes” even to the uninsured and under-insured

Background: Annual Fecal Immunochemical Test (FIT) is among the colorectal cancer (CRC) screening tests recommended by US Preventive Services Task Force and leading cancer organizations. A public health, health care and research consortium formed to assess the feasibility of implementing a low-cost CRC screening program for under- and uninsured average risk individuals age 50 or over. Methods: Eligible individuals (n=300) seen at three free or low-cost healthcare sites received a 3-sample FIT. A subgroup (n=200) was enrolled in a randomized control trial (RCT) comparing test completion rates for two versions of FIT: repackaged (intervention) FIT informed by local focus group findings; and conventional FIT (control). Telephone surveys with 16 RCT participants assessed barriers and facilitators to using each FIT. SAS V9.1 was used to generate descriptive statistics and p values. Results: FIT completion rates varied by distribution site (39%, 68%, 78%), with an overall rate of 64%. No significant difference was found between intervention and control completion rates, 69% and 65%, respectively. Two positive FIT results required diagnostic follow up. Conclusions: Return rates in this study population are higher than indicated in the research literature. FIT completion rates of 68% and 78% at two clinics for patients at or below 225% and 100% of the federal poverty level, respectively, indicate an important role for “free clinics” in closing the screening gap between insured and uninsured. Use of a 3-sample FIT with high specificity, compared with a guaiac stool test, may reduce the number of false-positives requiring follow-up colonoscopy.