Evidence-Based Strategy for Improving Access to Colorectal Cancer Screening for Diverse Populations

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A novel strategy of combining a drive-by flu vaccination clinic with an opportunity for participants to use a take-home fecal immunochemical test (FIT) increased access to colorectal screening among Black Americans during the COVID-19 pandemic. Results related to access to colorectal cancer screening were presented at the 2021 AACR Virtual Meeting: COVID-19 and Cancer.1 The authors will follow 13 patients with a positive fecal immunochemical test (which indicates occult blood in the stool) referred for colonoscopy as a result of participating in the program, known as FluFIT, over the next 3 months.

The FluFIT clinic model can be widely replicated, offering an evidence-based strategy for improving access to colorectal cancer screening during the pandemic and afterward for diverse populations.

Armenta L. Washington, MS

Armenta L. Washington, MS

“During the height of the COVID-19 pandemic, screening colonoscopy rates decreased by 90% and have not fully recovered,” stated Armenta L. Washington, MS, Research Coordinator Senior at the Abramson Cancer Center of the University of Pennsylvania. “Novel programs such as FluFIT can help mitigate the significant decline in colorectal cancer screening that has occurred as a result of the COVID-19 pandemic and, thus, can help reduce the burden of colorectal cancer in diverse communities,” she added.

As Ms. Washington observed, fecal immunochemical test–based colorectal cancer screening overcomes many of the challenges of traditional colonoscopy—which still remains the gold standard. The test is inexpensive, widely available, portable, and can be used in the privacy of one’s home.

Nuts and Bolts of FluFIT

Senior author of the study, Carmen Guerra, MD, Associate Professor at the Perelman School of Medicine at the University of Pennsylvania, explained the genesis of FluFIT. “Inspired by the death of actor Chadwick Boseman from metastatic colorectal cancer, Reverend Leroy Miles, of the Enon Tabernacle Baptist Church, called upon us to help improve access to colorectal cancer screening in his community. He proposed using the same drive-by model the church had already been using to distribute food and school supplies throughout the pandemic.”

Carmen Guerra, MD

Carmen Guerra, MD

The FluFIT initiative was a partnership among Penn Medicine, the Enon Tabernacle Baptist Church, the largest Baptist church in the Philadelphia region, and the Einstein Healthcare Network. Community members were invited to register online for one of three scheduled drive-by vaccination clinics, during which they would remain in their cars. The drive-by clinic was modeled on the National Cancer Institute’s Screen to Save colorectal cancer screening campaign, utilizing a socially distanced drive-by FluFIT test designed to increase colorectal cancer screenings in diverse communities. Participants who opted for a fecal immunochemical test could return their completed kits at a church drop box. Health-care workers and members of the Chi Eta Phi Sorority, were recruited to administer the flu vaccines, which were donated by the Philadelphia Public Health Department. Fecal immunochemical tests were donated by Polymedco.

Participants registered online for the drive-by FluFIT through the church’s website. They took a survey to determine colorectal cancer screening eligibility and were offered a link to a 7-minute educational video about colorectal cancer. Participants completed a questionnaire before and after the video to assess their pre- and postvideo knowledge about colorectal cancer and their likelihood of undergoing screening.

Individuals eligible for participation were between the ages of 45 and 75 and at average risk for colorectal cancer. People who were symptomatic, had a personal or family history of polyps or colorectal cancer, had a history of inflammatory bowel disease, or had recently had a colonoscopy or fecal immunochemical test were excluded. Eligibility, registration, and demographic questionnaires were completed electronically through REDCap, a browser-based, metadata-driven software.

At the drive-by event, participants were able to ask doctors and nurses (who were wearing personal protective equipment) questions while remaining in their cars, allowing for a socially distanced encounter with health-care providers.

Participant Characteristics

Of the 335 individuals who registered for the clinic, 192 (57.3%) were eligible for colorectal cancer screening and attended the event, receiving a fecal immunochemical test. Of the 335 individuals, 63 were ineligible, and 80 did not show up. The average age of participants was 59 years, 54.4% were female, and 93.8% identified themselves as Black. A total of 83% reported some college or graduate education, 54% were previously screened for colorectal cancer, and 15.5% were uninsured.

Among the participants who received the fecal immunochemical test (n = 192), 80.3% (n = 154) returned their tests, and 19.7% did not (n = 38). Participants received their fecal immunochemical test results by phone, and those who tested positive were advised to go for colonoscopy. The majority of participants who returned their fecal immunochemical test were found to test negative for the disease (n = 141), whereas 13 individuals tested positive and were referred for colonoscopy. A follow-up letter referring them for colonoscopy was also sent to the participants who tested positive, so that they might share that with their health-care providers.

Knowledge Pre- and Postvideo

The knowledge questionnaire showed a high baseline level of understanding of colorectal cancer screening, except for four items related to risk factors for colorectal cancer, frequency of fecal immunochemical testing, Lynch syndrome, and the relationship between physical activity and risk for colorectal cancer. Following the viewing of the 7-minute video on YouTube, all knowledge scores increased from baseline, with the exception of one item related to early detection of colorectal cancer and its relationship to survival.

Baseline knowledge of colorectal cancer risk factors was 52.6%, whereas baseline knowledge of Lynch syndrome was 67.9%; these scores increased to 72.3% and 92.4%, respectively, after viewing the video. Knowledge regarding the relationship between physical activity and colorectal cancer increased from 67.7% at baseline to 83.2% following the educational video. Knowledge pertaining to the early detection of colorectal cancer remained at 98.4% before and after watching the video.

Moreover, after viewing the video, participants expressed increases in the likelihood of discussing colorectal cancer and adopting healthier lifestyle habits ranging from 2.6% to 7.8%.

“The socially distanced, drive-by FluFIT program is feasible and effective in engaging the community in colorectal cancer education and screening during COVID-19 pandemic. Novel programs based on this model can be developed and extrapolated to different communities to circumvent the challenges presented by COVID-19,” Ms. Washington told listeners.

For example, this approach can potentially overcome workforce disruptions and other patient concerns because it does not require an in-office visit. Moreover, the FluFIT model includes risk stratification to prioritize patients for colonoscopy, and the test is less expensive than a colonoscopy, she said. 

DISCLOSURE: Ms. Washington reported no conflicts of interest. Dr. Guerra has served in a leadership role for Freenome, Genentech, and Guardant Health; holds stock or other ownership interests in BEAM Therapeutics, Crispr Therapeutics, Editas Medicine, and Intellia Therapeutics; has an immediate family member who has received honoraria from Lundbeck; has an immediate family member who has served as a consultant or advisor to EB Squibb; has participated in a speakers bureau for Janssen and Pfizer; has received research funding from Bristol Myers Squibb; has an immediate family member who has been reimbursed for travel, accommodations, or other expenses by Janssen and Lundbeck; and has held uncompensated relationships with Tapestry Networks.


1. Washington AL, Miles L, Melendez C, et al: Drive by Flu-FIT: A novel way to mitigate the decrease in colorectal cancer screening during the COVID-19 pandemic. 2021 AACR Virtual Meeting: COVID-19 and Cancer. Abstract S02-04. Presented February 3, 2021.

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