Mail-Based Self-Sampling to Complete Colorectal Cancer Screening: Accelerating Colorectal Cancer Screening and Follow-up Through Implementation Science

IntroductionLeveraging cancer screening tests, such as the fecal immunochem-ical test (FIT), that allow for self-sampling and postal mail for screening invitations, test delivery, and return can increase parti- cipation in colorectal cancer (CRC) screening. The range of ap-proaches that use self-sampling and mail for promoting CRC screening, including use of recommended best practices, has not been widely investigated.MethodsWe characterized self-sampling and mail strategies used for imple-menting CRC screening across a consortium of 8 National Cancer Institute Cancer Moonshot Initiative Accelerating Colorectal Can-cer Screening and Follow-up through Implementation Science (ACCSIS) research projects. These projects serve diverse rural, urban, and tribal populations in the US.ResultsAll 8 ACCSIS projects leveraged self-sampling and mail to pro-mote screening. Strategies included organized mailed FIT out-reach with mailed invitations, including FIT kits, reminders, and mailed return (n = 7); organized FIT-DNA outreach with mailed kit return (n = 1); organized on-demand FIT outreach with mailed offers to request a kit for mailed return (n = 1); and opportunistic FIT-DNA with in-clinic offers to be mailed a test for mailed re-turn (n = 2). We found differences in patient identification strategies, outreach delivery approaches, and test return options. We also observed consistent use of Centers for Disease Control and Prevention Summit consensus best practice recommendations by the 7 projects that used mailed FIT outreach.ConclusionIn research projects reaching diverse populations in the US, we observed multiple strategies that leverage self-sampling and mail to promote CRC screening. Mail and self-sampling, including mailed FIT outreach, could be more broadly leveraged to optimize cancer screening.