BACKGROUND: It has been demonstrated that fecal immunochemical test (FIT) mailing programs are effective for increasing colorectal cancer (CRC) screening. The objectives of the current study were to assess the magnitude of uptake that could be achieved with a mailed FIT program in a federally qualified health center and whether such a program can be implemented at a reasonable cost to support sustainability. METHODS: The Washington State Department of Health’s partner HealthPoint implemented a direct-mail FIT program at 9 medical clinics, along with a follow-up reminder letter and automated telephone calls to those not up-to-date with recommended screening. Supplemental outreach events at selected medical clinics and a 50th birthday card screening reminder program also were implemented. The authors collected and analyzed process, effectiveness, and cost measures and conducted a systematic assessment of the short-term cost effectiveness of the interventions. RESULTS: Overall, 5178 FIT kits were mailed with 4009 follow-up reminder letters, and 8454 automated reminder telephone calls were made over 12 months. In total, 1607 FIT kits were returned within 3 months of the end of the implementation period: an overall return rate of 31% for the mailed FIT program. The average total intervention cost per FIT kit returned was $39.81, and the intervention implementation cost per kit returned was $18.76. CONCLUSIONS: The mailed FIT intervention improved CRC screening uptake among HealthPoint’s patient population. This intervention was implemented for less than $40 per individual successfully screened. The findings and lessons learned can assist other clinics that serve disadvantaged populations to increase their CRC screening adherence.

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has played a critical role in providing cancer screening services to American Indian and Alaska Native (AI/ANs) women and strengthening tribal screening capacity. Since 1991, the NBCCEDP has funded states, tribal nations, and tribal organizations to develop and implement organized screening programs. The ultimate goal is to deliver breast and cervical cancer screening to women who do not have health insurance and cannot afford to pay for these services. The delivery of clinical services is supported through complementary program efforts such as professional development, public education and outreach, and patient navigation. This article seeks to describe the growth of NBCCEDP's tribal commitment and the unique history and aspects of serving the AI/AN population. The article describes: 1) how this program has demonstrated success in improving screening of AI/AN women; 2) innovative partnerships with the Indian Health Service, state programs, and other organizations that have improved tribal public health infrastructure; and 3) the evolution of Centers for Disease Control and Prevention work with tribal communities. Cancer 2014;120(16 suppl):2557-65. V C 2014 American Cancer Society.KEYWORDS: American Indians, Alaska Natives, early detection of cancer, breast cancer, cervical cancer, partnerships. INTRODUCTIONProviding health services to American Indians and Alaska Natives (AI/ANs) poses unique challenges related to geographic isolation, cultural attitudes, poverty, and language. Nonetheless, the Indian Health Service (IHS), working with its tribal, state, and federal partners, offers unique opportunities to deliver health care for members of federally recognized tribes. IHS-initiated cervical cancer screening in the 1960s and 1970s contributed to declining incidence of cervical cancer and mortality rates in the 1980s and 1990s. However, screening mammography provided to women served by the IHS before the establishment of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of the Centers for Disease Control and Prevention (CDC) was very limited. 1,2 We describe the important contributions of NBCCEDP, in partnership with the IHS tribal programs and state programs. We review how these efforts improved access of breast and cervical cancer screening to AI/AN women and strengthened the tribal screening infrastructure. We begin with a brief history of the role of IHS and NBCCEDP in addressing the burden of breast and cervical cancer and include the impact of the program using multiple data sources. We discuss considerations important in working with tribal communities and provide examples of partnerships created between state and tribal grantees and between federal agencies.