How the Colorectal Cancer Control Program Increases Screening

Of the cancers that affect both men and women, cancers of the colon and rectum (colorectal cancer) is the second leading cause of cancer death in the United States.

But it doesn’t have to be.

Screening tests can find precancerous polyps—abnormal growths in the colon or rectum—so they can be removed during the test, before they turn into cancer. Screening also helps find colorectal cancer early, when treatment works best.

But people are not getting screened for colorectal cancer as often as they should, if at all. About one-third of adults ages 50 to 75 are not up-to-date with colorectal cancer screening using any of the recommended tests—regardless of whether they have health insurance.

CDC’s Colorectal Cancer Control Program (CRCCP) works with health systems, including clinics, hospitals, and other health care organizations, to use and strengthen strategies that have been shown to work to improve quality screening. CRCCP focuses on increasing screening among people ages 50 to 75 within a health system, geographic area, or group most affected and in need. In some geographic areas, it supports screening directly.

CRCCP collects and uses data to determine whether the program increases screening, and if so, by how much, where, and for which groups. These data guide plans for prevention and early detection.

Screening Promotion Activities

CRCCP uses strategies recommended by the Guide to Community Preventive Servicesexternal icon focusing on four activities in partner health systems—

Provider Assessment and Feedback

Physicians are the most trusted and preferred source of colorectal cancer information. To make the best use of this resource, these strategies look at how doctors and other health care professionals offer screening to patients. Feedback is then given to these health care providers. Examples include—

  • Within a clinic, looking at health care providers’ history of recommending appropriate screening and telling them how they are doing in comparison to each other.
  • Among many clinics, looking at the percentage of patients who are screened according to recommendations and publishing results compared to a target rate.

Provider Reminders

Reminders inform health care providers when it’s time for a client’s screening test, or that the client is overdue for screening. Reminders can be delivered via e-mail or by—

  • Using the reminder function in an electronic health record (EHR). Reminders could include the recommendations for colorectal cancer screening.
  • Creating a system that places clearly visible reminders on paper charts before an office visit.

Patient Reminders

Patient reminders are written (letter, postcard, e-mail, text message) or telephone messages telling patients that they are due for screening. A provider might use the EHR to support this strategy and track responses.

Removing Structural Barriers for Clients

Structural barriers are problems other than money that make it hard for people to get screened. Strategies that reduce these barriers may include—

  • Extending clinic hours.
  • Offering services in alternative or nonclinical settings, such as making stool tests available at flu vaccination sites.
  • Simplifying paperwork or procedures.
  • Providing patient navigators to help patients through part or all of the screening process, including translation services, if needed.
  • Providing transportation to and from a clinic.
  • Providing an escort for the day of procedure.
  • Providing child care.
Preventing colorectal cancer saves money.
  • Patients: Reduces lost wages.
  • Employers: Lowers health care costs, absenteeism, and costs of hiring and training new workers.
  • Insurers: Helps avoid high costs associated with late-stage colorectal cancer treatment.

Screening Tests

CRCCP awardees use only screening tests recommended by the United States Preventive Services Task Force (USPSTF). Those options include—

At-Home Stool Tests

  • A guaiac fecal occult blood test (gFOBT) every year.
  • A fecal immunochemical test (FIT) every year.
  • FIT-DNA every 1 or 3 years.

Tests Performed in Clinics

  • Colonoscopy every 10 years.
  • Computed tomography (CT) colonography every 5 years.
  • Flexible sigmoidoscopy every 5 years.
  • Flexible sigmoidoscopy every 10 years plus FIT every year.

Providers should offer patients the screening test they’re most comfortable with.

Page last reviewed: February 11, 2020