Mailed FIT Kits Boost CRC Screening at Ages 45–49: Daily Dose

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On August 5, 2025, we reported on a study published in JAMA that was designed to determine the most effective population health outreach strategy to promote colorectal cancer (CRC) screening in adults aged 45 to 49 years.

The study

The trial was conducted at UCLA Health between May and November 2022 and included 20 509 average-risk adults from primary care settings who were randomly assigned to one of 4 outreach strategies:

1. fecal immunochemical test (FIT)–only active choice

2. colonoscopy-only active choice

3. dual-modality (FIT or colonoscopy) active choice

4. usual care default mailed FIT outreach

The primary outcome was participation in screening (FIT or colonoscopy) at 6 months, and the secondary outcome was screening modality completed, according to the study.

The findings

Investigators reported that overall screening participation was 18.6%. They also observed that screening participation was highest (26.2%) in the group that received unsolicited mailed FIT kits. In contrast, they found significantly lower rates in the 3 “active choice” arms: 16.4% for FIT-only, 14.5% for colonoscopy-only, and 17.4% for those offered a choice between FIT or colonoscopy. All comparisons with the mailed FIT group were statistically significant (all P <.001).

Compared with usual care, the absolute differences in screening rates were −9.8% for FIT-only, −11.7% for colonoscopy-only, and −8.9% for dual-modality (all P <.001).

Authors' comments

"This study offers robust evidence for how to engage this age group in CRC screening. Future research should explore further optimization and tailoring of mailed FIT outreach to enhance screening participation across diverse populations and in other health care settings."

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