Community-based colorectal cancer screening in a rural setting using fecal immunochemical test (FIT) kits

Introduction: Colorectal cancer (CRC) disproportionately affects rural Americans, and the fecal immunochemical test (FIT) represents a novel approach to improving CRC screening rates in rural communities that lack healthcare access. The purpose of this study was to assess the feasibility of a mailed FIT program in a rural region with high CRC burden.

Methods: Guideline-eligible individuals (N=345) were recruited in 2014 through community outreach efforts in eight rural Appalachian Kentucky counties to receive a FIT kit; participants were encouraged to return the kits via U.S. mail in a postage paid envelope.  Four out of five participants (82%) returned their kit via mail; these individuals were compared to participants who did not return a kit relative to multiple characteristics. 

Results: In bivariate analyses, participants with low incomes (p<.001), not having a regular healthcare provider (p=.019), lacking a high school education (p=.036), and self-reporting as overweight or obese (p=.009) were more likely to return kits.  In adjusted regression models, subjects reporting an annual income <$15,000 were 2.85 times more likely to return their kits (95% CI: 1.56-5.24).  Also, those self-reporting as overweight/obese were 1.95 times more likely to return their kits (95% CI: 1.07-3.55). 

Discussion: These findings suggest that a community-based CRC screening outreach program may yield high FIT kit return rates via mail in a rural setting.  Innovative community-clinical linkages may enhance acceptability of CRC screening tests by targeted rural populations.