(180) No Colon Left Behind: Increasing Colorectal Cancer Screening Rates Among SUD Patients

Background & Introduction: Colorectal cancer (CRC) is currently the second leading cause of cancer-related mortality in the United States, with an estimated 52,900 deaths projected in 2025. Routine CRC screenings between the ages of 45 - 75 reduce cancer incidence and mortality. Available modalities include stool-based tests, endoscopic visualization, and blood-based screening.
Individuals with substance use disorder (SUD) are a particularly susceptible population with a higher rate of colon cancer mortality, especially men. Screening rates are lower amongst this population; patients with SUD were 19% less likely to get a colonoscopy compared to patients without SUD. Logistical barriers may be mitigated by improving access to transportation, structured care environments, or stable housing.
Existing interventions to increase general CRC screening rates include mail-in fecal immunochemical testing (FIT) kits, patient navigation, reminders, and patient education, with patient navigation paired with mailed FIT kits showing the greatest efficacy. However, limited interventions have been tailored specifically to SUD patients. One study improved screening rates within an SUD population through patient navigation but only screened with colonoscopies.
By partnering with local residential programs and utilizing a noninvasive, at-home screening test, this project aims to reduce structural barriers and improve CRC screening in this underserved population.

Methods: This quality improvement project was conducted in partnership with a local alcohol and drug treatment program from October 1st, 2025, to January 15th, 2026.
The target population was SUD patients in treatment at a recovery program empaneled with a primary care clinic. The target metric was increasing the completion rate of CRC screenings within the patient cohort. Inclusion criteria were patients from ages 45-75 with no history of colorectal cancer who had completed at least one initial intake visit at the clinic within 6 months of the start of the intervention.
For the intervention, clinic staff and patient advocates collaborated with residential program case managers to locate eligible patients within the inpatient and community arms of the recovery program. Advocates called patients for health screenings, consent, and health education using a standardized script and protocol. Non-invasive screening kits were ordered and sent to the clinic. Clinic staff arranged for on-site pick up and instruction on kit use. advocates then called patients to provide reminders, answer questions, and assess barriers.

Screening completion data was extracted from the EHR at the end of the intervention period. Data cleaning and descriptive analyses were performed in R Studio version 4.5.2.

Results: A total of 152 patients met cohort criteria. The cohort was majority male (61.8%), Hispanic/Latino (50.0%) and primarily English-speaking (63.8%) with a mean age of 56.6 (SD = 6.6). At baseline, the CRC screening completion rate was 44.1% (N = 67) with 85 patients due for screening. Of those, 28 patients were initially identified by the EHR and contacted by patient advocates. The remaining patients (N = 57 were not initially flagged as eligible in the EHR and were not contacted. By the end of the intervention, 17.9% (N = 5) of patients engaged by advocates completed treatment compared to 14.0% (N = 8) of non-contacted patients. Furthermore, an additional 57.1% (N = 16) of the patient advocate group were in progress. The overall CRC screening completion rate within the cohort increased to 52.6% over the 3-month period.

Conclusion & Discussion:
This quality improvement project identified several strategies that increased CRC screening rates within a SUD residential program-based population. Patients who had contact with patient advocates or staff were more likely to complete screening, suggesting that even brief interactions can improve participation. Ongoing outreach supported patients throughout the process by providing health education, troubleshooting kit issues, giving reminders, and updating contact information. Collaboration with residential program case managers was also critical in identifying eligible patients, tracking them, and facilitating access to patients in the inpatient setting throughout the process.
Despite these successes, several barriers remained. Many patients were not initially identified through electronic health record (EHR) analytics because SUD program enrollment was entered manually. This limitation makes it difficult to consistently flag eligible patients for screenings and integrate primary care into recovery treatment. When a system is unable to reliably flag patients for screening, those patients are missed.
Patient tracking also became challenging after patients left the inpatient residential setting, particularly when contact information changed. The absence of a structured tracking system led to several patients being lost to follow up. These challenges highlight the importance of early screening and reliable tracking to improve preventive care for patients in recovery programs.

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2. Screening for colorectal cancer. Centers for Disease Control and Prevention. Updated February 26, 2025. https://www.cdc.gov/colorectal-cancer/screening/index.html.
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