Advancing access and equity in colorectal cancer screening: Key insights from Cycles of Impact Philadelphia Initiative

Background: Colorectal cancer (CRC) is the second leading cause of cancer death in the U.S., disproportionately affecting Black Americans due to systematic barriers and medical mistrust. The Cycles of Impact (COI) Philadelphia Initiative was a collaboration between the Colorectal Cancer Alliance, Independence Blue Cross, and University of Pennsylvania Medicine designed to reduce disparities through an integrated multi-level strategy of centralized outreach, behavioral health engagement, and community activation. Methods: Between 2022-2025, COI distributed over 2,400 fecal immunochemical test (FIT) kits and executed three key interventions: (1) centralized outreach to 1,888 unscreened Black patients through proactive phone, text messaging, and navigation support; (2) integration of CRC screening within a 28-day residential substance use treatment facility utilizing on-site education and an incentive program; and (3) broad community engagement through faith-based events, digital media campaigns, and healthcare partnerships. Results: Out of 1,888 patients reached through centralized outreach, 97 completed FIT, with 7 positive), and 82 underwent colonoscopy, detecting adenomas in (35) 43% and adenocarcinoma in 1%. In the behavioral health facility, 125 of 155 eligible residents (81%) completed FITs, with 13.5% positive results and successful linkage to colonoscopy. Across all COI activities, 2,736 participants were engaged, 430 screenings completed, and 126 adenomas, 8 advanced neoplasms, and 1 instance of stage IV cancer detected. Follow-up completion after positive FIT averaged 27.8%. Conclusion: Equity-driven, multi-level interventions including centralized navigation, behavioral health integration, and community partnerships led to colorectal cancer screening and detection among Black Philadelphians who may otherwise have not been screened. Deploying navigators in trusted community settings and establishing payer-academic collaborations created a scalable, sustainable model to address racial disparities in colorectal cancer outcomes.