Colorectal cancer screening outreach: mailed stool kits, follow-up colonoscopy and patient letters

Colorectal cancer screening outreach is the work of finding patients who are due and getting a test done: a letter, a text or a portal message, a stool kit in the mail, a reminder when the kit is not returned, and a call when a result needs a colonoscopy. Primary care practices, community health centers and health systems run these programs, and gastroenterology practices receive the follow-up. Who should get the invitation? How do you compare a home stool test with a colonoscopy without a brand name or a slogan? What does the letter owe the patient about a positive result? Is a screening letter to your own patients marketing under HIPAA? This guide covers what the U.S. Preventive Services Task Force (USPSTF), Medicare, the National Cancer Institute and the federal advertising and privacy rules say, and how to turn that into an outreach program.

Three related topics have their own guides and are not repeated here. Screening pages for a GI practice and the full Medicare.gov wording on what a “free colonoscopy” can and cannot mean are covered in our guide to gastroenterology practice marketing. Invitations to the Medicare yearly wellness visit, where screening can come up, are covered in our guide to annual wellness visit outreach. The FCC rules for reminder texts are covered in our guide to text message appointment reminders. This guide covers what is specific to a colorectal screening outreach program. Prostate screening invitations work differently, because the Task Force recommends an individual decision for men aged 55 to 69; see prostate cancer screening outreach.

What the USPSTF, Medicare and the patient pages say

An outreach letter rests on three kinds of source: the clinical recommendation, the coverage rule and the patient summary. They say:

• The USPSTF Colorectal Cancer: Screening recommendation (published May 18, 2021) recommends screening “in all adults aged 50 to 75 years” (grade A) and “in adults aged 45 to 49 years” (grade B), and that clinicians “selectively offer screening” to adults aged 76 to 85 (grade C), considering overall health, prior screening and the patient’s preferences.
• It applies to adults 45 and older without signs or symptoms who are at average risk, meaning no prior colorectal cancer, adenomatous polyps or inflammatory bowel disease and no known genetic disorder or family history that puts them at high lifetime risk.
• It lists stool-based tests and direct visualization tests as recommended strategies, each with its own interval, and says that when a stool-based test is abnormal, follow-up with colonoscopy is needed.
• The CMS National Coverage Determination 210.3 (version effective June 8, 2026) covers one screening fecal occult blood test each 12 months for people 45 and older with a written order, and covers certain blood-based biomarker tests once each three years for people aged 45 to 85 who have no symptoms and are at average risk.
• Under 42 CFR 410.37, effective January 1, 2025, Medicare screening includes a follow-on screening colonoscopy after a covered stool-based or blood-based screening test returns a positive result.
• The Medicare.gov page Colonoscopies (screening) says the patient pays nothing for that follow-up colonoscopy when the provider accepts assignment, and that coinsurance applies if a polyp or other tissue is removed.
• The National Cancer Institute (NCI) Colorectal Cancer Screening summary (updated May 2, 2025) says studies show that certain screening tests help find cancer at an early stage and may decrease the number of deaths from the disease, and it lists the risks of each test.
• The MedlinePlus Colorectal Cancer topic page (last updated March 5, 2024) lists symptoms such as a change in bowel habits that lasts more than a few days and blood in the stool, and says colorectal cancer may not cause symptoms at first.

Two points shape the outreach. First, screening is for people at average risk without symptoms, so the invitation has to say who it is for and route everyone else to a visit. Second, a stool test is the first step of a screening, not all of it: a positive result means a colonoscopy, and the program is not finished until that colonoscopy is done.

Who gets the invitation

Build the list from the records the clinician would use, and keep the rules in the recommendation’s words. Patients aged 45 to 75 who are at average risk and not up to date are the core list. Patients aged 76 to 85 are a clinician decision under the USPSTF grade C, so they get a visit or a call, not a blanket mailing. The USPSTF says that for adults 86 and older, evidence on benefits and harms is lacking, so they stay off the list.

Patients with a personal history of polyps, colorectal cancer or inflammatory bowel disease, or a known high-risk family history, are outside the average-risk recommendation; their schedule is set by their clinician, and a mailed kit is the wrong invitation for them. The same goes for patients with symptoms. Check the list against the chart before the first mailing, and give staff a short script for the patient who calls to say “I had polyps last time”.

Comparing a home stool test and a colonoscopy without a brand

The USPSTF says the tests differ in the interval at which they are repeated, where they are done, whether they need bowel preparation or sedation, and what follow-up an abnormal result needs. Describe the tests by type, in those terms, and leave the choice to the patient and the clinician. A plain comparison for a letter or a page:

• Stool test for blood, done at home: no bowel preparation and no sedation. The USPSTF interval for the high-sensitivity tests is once a year. A positive result means a colonoscopy is needed.
• Stool DNA test combined with a blood test of the stool, done at home: no bowel preparation. The USPSTF interval is once each 1 to 3 years. A positive result means a colonoscopy is needed.
• Colonoscopy, done at a center: bowel preparation and sedation. Polyps can be removed during the same procedure. The USPSTF interval is once each 10 years for screening at average risk.
• CT colonography and flexible sigmoidoscopy are also on the USPSTF list, with their own intervals, and an abnormal result on either leads to colonoscopy.

State the risks with the same care. The NCI says serious problems from colonoscopy can include tears in the lining of the colon and bleeding, that these occur more with polyp removal or biopsy, and that sedation can cause heart and lung problems. It says false-negative and false-positive results can occur with screening tests, and that a false negative can lead a person to delay care even with symptoms. A letter does not need the whole list, but the linked page does, and the letter should never say a test has no risk or cannot miss anything.

The mailed kit program, step by step

Each step is a message, and each message can be written to match the sources:

• The invitation says who it is for, that the practice’s clinician recommends screening for patients like them, which tests are offered, and whom to call with questions or symptoms.
• The kit insert says how to collect the sample in plain words, how to return it, and that a positive result means a colonoscopy, before the patient decides to use the kit.
• The reminder for an unreturned kit is short and neutral, sent on the schedule the clinician set, and stops when the patient says no or asks for another channel.
• The negative result message says what the result means, when the next screening is due under the clinician’s plan, and that symptoms still need a visit.
• The positive result call is made by a person, explains that a colonoscopy is the next step, and helps book it. For Medicare patients, it can say that a follow-on colonoscopy after a positive covered stool test is part of screening under 42 CFR 410.37, with the coinsurance note from Medicare.gov.

The positive result step is where outreach programs lose patients. Name who owns it, whether a nurse, a navigator or a front desk team member, and track every positive result until a colonoscopy is done or the patient declines in writing. If a GI practice receives the referral, agree in advance how the report comes back. A program that mails kits without that loop invites patients into the first half of a screening.

Phrases that need rewriting:

• “Skip the colonoscopy, use this simple kit”. A positive kit result means a colonoscopy. Say so in the invitation.
• “Just as good as a colonoscopy”. The USPSTF lists both as recommended strategies with different intervals and follow-up. Describe the difference.
• “Free colonoscopy after your kit”. Quote Medicare.gov in full, with the coinsurance if tissue is removed, and say private plans set their own terms. Our GI guide has the wording.
• “Everyone over 45, get your kit”. The recommendation covers adults at average risk without symptoms, and the clinician decides for adults over 75.

Saves lives, painless and other claims

Under 15 U.S.C. 45, deceptive acts or practices in commerce are unlawful, and 15 U.S.C. 52 prohibits false advertisements likely to induce the purchase of drugs, devices, services or cosmetics. The FTC staff Health Products Compliance Guidance says claims about the health benefits or safety of health-related products require competent and reliable scientific evidence, and that an advertiser is responsible for the claims a reasonable reader takes away, including implied ones.

The NCI wording is careful: certain screening tests help find cancer at an early stage and may decrease the number of deaths from the disease. That is a statement about tests and groups of people. It does not say a kit will save the reader’s life.

Phrases that need rewriting:

• “This test will save your life”. Quote the NCI wording about finding cancer early and the number of deaths, with the source.
• “A negative kit means you are cancer-free”. The NCI says false-negative results can occur. Say what a negative result means and when the next screening is due.
• “Painless, no risk”. The NCI lists the risks of each test, including bleeding and tears with colonoscopy and sedation risks. Describe what the patient will feel and link the risks.
• “Our patients never get colon cancer”. No program can say this, and it implies a result no source supports.

Symptoms come first

Outreach messages are also read by people who have symptoms now. Add a short line: if you have blood in your stool, a change in bowel habits that lasts more than a few days or belly pain that does not go away, do not wait for a kit; call us to book a visit. If you have heavy bleeding, severe belly pain or feel faint, call 911. This keeps a screening invitation from being used as a reason to delay care, which the NCI names as a harm of a false-negative result.

Is a screening letter to your own patients marketing?

45 CFR 164.501 defines marketing as a communication about a product or service that encourages recipients to purchase or use it, and then lists exceptions. One exception is a communication for treatment of an individual by a health care provider, including case management or care coordination, unless the covered entity receives financial remuneration for making it. A practice inviting its own patients to a screening its clinicians recommend, paid for by no one else, fits the facts that exception describes. A letter funded by a test maker, a lab or a third party is a different case, and it can need a signed authorization under 45 CFR 164.508. Ask your privacy officer and counsel which one your program is before the first mailing, and see our guide to HIPAA marketing rules.

Channel choice matters too. 45 CFR 164.522 says a covered provider must accommodate reasonable requests to receive communications by alternative means or at alternative locations. Check each patient’s stated preference before a kit or a letter goes out, keep the condition off the outside of the envelope and the kit box where the request calls for it, and follow the FCC rules in our text reminders guide for texts. Portal message rules are in our guide to patient portal messages.

Ads, pixels and the outreach list

The outreach list is protected health information where the practice is a covered entity: it says who is due for colorectal screening. So is the fact that a patient clicked a kit link or booked a colonoscopy. Keep the list, the link clicks and the bookings out of tracking pixels and ad platform tools unless a written agreement covers them. The Google Ads personalized advertising policy restricts targeting based on health conditions, including health status. Public ads can target by place, by age range where the platform allows it and by search terms, and they should never be built from the practice’s patient list.

Patient stories

A patient who returned a kit, had a positive result and had a polyp removed makes a strong story, and it is one person’s result. Under 16 CFR 255.2, an ad that shows one person’s result on a key attribute is likely to be read as what others will generally achieve, unless the practice has substantiation for that or clearly and conspicuously discloses what people can generally expect. Where the practice is a covered entity, a story used in marketing needs a signed authorization under 45 CFR 164.508. Our guide to testimonials covers the full rules.

Illustration: two outreach letters for the same program

Illustration: a letter reads “Everyone over 45: skip the colonoscopy! Our free, painless home kit will save your life. Mail it back and you are done.” It invites patients outside the recommendation, implies the kit replaces a colonoscopy, calls it free and painless without support, promises an individual result, and hides the follow-up a positive result needs.

Illustration: a second letter for the same program reads “Dear [Patient name], our records show you may be due for colorectal cancer screening. [Physician name] recommends screening for adults aged 45 to 75 at average risk. You can choose a home stool test or a colonoscopy; we have enclosed a guide to both. If a home test is positive, a colonoscopy is the next step, and we will help you book it. If you have had polyps, have bowel symptoms or bleeding, call us at [phone] instead of using the kit.” It quotes the group, offers the choice, names the follow-up and routes high-risk patients and symptoms to a call.

Checklist before an outreach program starts

• The list follows the USPSTF ages and average-risk definition, with adults 76 to 85 left to the clinician.
• Patients with polyps, colorectal cancer, inflammatory bowel disease, high-risk family history or symptoms are routed to a visit.
• Tests are compared by type, interval, preparation and follow-up, with no brands and no “just as good” claims.
• The invitation and the kit insert say a positive result means a colonoscopy.
• One named role tracks each positive result until a colonoscopy is done or declined.
• Cost wording quotes Medicare.gov and 42 CFR 410.37, with the coinsurance note, and leaves private plans to the plan.
• The privacy officer has reviewed the letter under 45 CFR 164.501, and channel requests under 164.522 are honored.
• The outreach list, kit clicks and bookings stay out of pixels and ad audiences.

How we help

We build websites, local search, Google Ads and AI front desk tools for independent practices and health businesses, including primary care and GI practices that run screening programs. For colorectal screening outreach, that means screening pages that compare the tests in the USPSTF’s terms with links and dates, invitation and reminder copy that names the follow-up colonoscopy, and booking and kit request forms that keep screening data away from tracking tools. We do not decide who is screened or how care is delivered; your clinicians, your counsel and your state boards do. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We are not a healthcare provider and we do not give legal or medical advice. We do not sell lead lists and we do not pay for referrals. For the wider rules, see our healthcare marketing rules hub.

Sources

• USPSTF: Colorectal Cancer: Screening (published May 18, 2021)
• CMS: NCD 210.3 Colorectal Cancer Screening Tests (version effective June 8, 2026)
• 42 CFR 410.37: Colorectal cancer screening tests: Conditions for and limitations on coverage
• Medicare.gov: Colonoscopies (screening) (checked October 30, 2026)
• National Cancer Institute: Colorectal Cancer Screening (PDQ), Patient Version (updated May 2, 2025)
• MedlinePlus: Colorectal Cancer (last updated March 5, 2024)
• 15 U.S.C. 45: Unfair methods of competition unlawful
• 15 U.S.C. 52: Dissemination of false advertisements
• FTC: Health Products Compliance Guidance (December 2022)
• 45 CFR 164.501: Definitions
• 45 CFR 164.508: Uses and disclosures for which an authorization is required
• 45 CFR 164.522: Rights to request privacy protection for protected health information
• 16 CFR 255.2: Consumer endorsements
• Google Ads: Personalized advertising policy

More in Physician specialty marketing