Mailed FIT Implementation Guide

The Mailed FIT Implementation Guide provides a roadmap for how health systems and other entities can design and carry out mailed fecal immunochemical test (FIT) outreach programs, including information on key partnerships and what to have in place before launching a program. The guide was produced in partnership with the National Association of Chronic Disease Directors, the Kaiser Permanente Center for Health Research, and supported by the Centers for Disease Control and Prevention. 

The goal of this guide is to provide clinic and health system administrators and staff with the information needed to make informed decisions and successfully implement an outreach program. The guide details the process for planning and implementing an outreach program by addressing: Prerequisites (Technical Resources & Capacity); Getting Ready; Selecting a FIT; Executing a Mailed FIT Outreach Program; and Sustaining the Program. It also includes a section of mailed FIT references and resources.

Evaluation: The evidence provided in the Mailed FIT Implementation Guide is based on two recent primary sources. The first source is the five-year STOP CRC pragmatic trial of mailed FIT outreach in federally qualified health centers (2013-2018), which investigated whether the use of mailed FIT outreach, together with follow-up colonoscopy for abnormal FIT results, could increase CRC screening rates above those obtained with the usual care approach of opportunistic screening within 26 federally qualified community health center clinics in Oregon and California. The findings showed a significant improvement in CRC screening rates and an overall FIT return rate of 21%. The second source of evidence is from the 2019 CDC-sponsored and NACDD hosted Mailed FIT Summit, which included subject matter experts and stakeholders from across the nation. An accompanying journal article published in CA: A Cancer Journal for Clinicians described the Summit goals, process, and findings in detail.

Permissions: Made publicly available online by the National Association of Chronic Disease Directors.

Publication date: Published October 2021, last revised June 14, 2022

Post date: August 22, 2022

Contact: Please send comments or questions to Lorrie Graaf ( or Dawn Wiatrek (