A pragmatic randomized trial of mailed fecal immunochemical testing to increase colorectal cancer screening among low‐income and minoritized populations in San Diego County

Colorectal cancer (CRC) screening can reduce morbidity and mortality but is underused, particularly among low-income and some minoritized populations. Mailed fecal immunochemical testing (FIT) is an evidence-based strategy to increase colorectal cancer (CRC) screening. We tested a multi-level mailed FIT intervention in 3 community health center (CHC) systems in San Diego County using a cluster-randomized trial design. Multi-level implementation strategies were utilized to increase CRC screening uptake. Among 26,736 participants who met eligibility criteria, approximately 58% were female, 55% were Hispanic individuals, and 44% were Spanish speaking. The proportion completing screening was 11.5 percentage points (ppts) (95% CI, 6.1–16.9 ppts) higher in intervention versus usual care clinics. Variation in differences between intervention and usual care clinics was observed by racial and ethnic group (13.8 ppts [7.0–20.6 ppts] for Hispanics; 13.0 ppts [3.6–22.4 ppts] for Asians; 11.3 ppts [5.8–16.8 ppts] for non‐Hispanic Whites; 6.1 ppts [0.8–10.4 ppts] for Blacks). These results show that a regional mailed FIT intervention was effective for increasing CRC screening rates across CHC systems serving diverse, low‐income populations.