May 8, 2025

Colon and intestines. (Shutterstock)

Colorectal cancer is the second-leading cause of cancer deaths in the United States. Like most cancers, it’s more easily treated when caught early. Colorectal cancer screening rates are typically low in rural areas, especially among people on Medicaid. But public health scientists at the Oregon Clinical and Translational Research Institute (OCTRI) may have found a way to change that. They showed that mailing stool-based tests with an offer for more personal follow-up could increase colorectal cancer screening in rural areas.

Researchers led by OCTRI’s Melinda Davis, Ph.D., and Gloria Coronado, Ph.D., at the University of Arizona Cancer Center looked for a way to boost colorectal cancer screening rates in rural counties. They conducted a trial at 28 rural clinics in Oregon that work with three Medicaid health plans. In the study, 5,614 Medicaid enrollees ages 50 to 75 were divided into two groups. One group received the mailed test and an offer of support from a patient navigator. This support included information about a colonoscopy after an abnormal test result. The other group received usual care without help from a patient navigator.

The researchers found that the direct mailing plus the extra support mattered. Of the group that received patient navigator help, 11.8% completed cancer screening within six months. Only 4.5% were screened during the same period in the usual care group. People with abnormal test results in the patient navigation group were almost three times more likely to have a follow-up colonoscopy than those in the usual care group (43.3% compared with just 15.4%).

“Adherence to colorectal cancer screening guidelines can be a challenge for some populations,” said Michael Kurilla, M.D., Ph.D., director of NCATS’ Division of Clinical Innovation, which oversees the Clinical and Translational Science Awards (CTSA) Program, including OCTRI. “These promising results underscore the value of the CTSA Program’s commitment to improving rural health across the country.”

The results appeared in JAMA Network Open.