Increasing Screening in Rural Areas

Overview

People who live in rural areas may face problems with getting health care. Researchers in CDC's Colorectal Cancer Control Program (CRCCP) study these problems and share the results with CRCCP award recipients. In this way, the program finds the best ways to help rural residents get screened for colorectal cancer.

In the studies listed below, CDC scientists estimated the cost of screening for two Alaska Native tribal health organizations. The scientists also talked to nine award recipients across the country and staff in health clinics that work with them about the most useful ways to increase screening.

Estimating screening costs for Alaska Native people

Alaska Native people have the highest rate of getting colorectal cancer of any racial and ethnic group in the United States. In 2022, only 56% of Alaska Native adults who were 45 or older had been screened for colorectal cancer.

It may be hard for many Alaska Native people to get screened for colorectal cancer because:

• It often takes a long time and costs a lot of money to travel to a health center for a colonoscopy. Many people live in remote areas that aren't accessible by car, so they must take an airplane. Severe storms, fog, and extreme cold can cause roads to be closed and flights to be canceled.
• Air mail often must be used to receive a stool test kit and send it back for processing.
• People may be afraid of getting a colonoscopy, or of possibly learning that they have cancer.

This study looked at the cost of providing and getting colorectal cancer screening in two Alaska Native tribal health organizations in 2023. Maniilaq Association is based in Kotzebue and serves 12 federally recognized tribes in northwest Alaska. Bristol Bay Area Health Corporation, based in Dillingham, includes 21 village clinics and serves communities in southwest Alaska. Both organizations are partners of the Alaska Native Tribal Health Consortium, which receives funds from CRCCP.

The study found:

• The average cost for a patient and their caregiver to travel to get a colonoscopy—including the cost of a flight, lodging, meals, and missed work—was $2,569 to Maniilaq Association and $2,748 to Bristol Bay Area Health Corporation.
• Each stool test (fecal immunochemical test) cost Maniilaq Association $53 and Bristol Bay Area Health Corporation $76.
• Each screening colonoscopy cost Maniilaq Association $4,066 and Bristol Bay Area Health Corporation $2,600.
• Each follow-up colonoscopy cost Maniilaq Association $1,114 and Bristol Bay Area Health Corporation $898.

This is the first study to estimate patient and travel costs for colorectal cancer screening in Alaska. It found that the costs were much higher than the national average.

Citation

Tangka FKL, Hoover S, Krudy M, et al. Cost of colorectal cancer screening in two tribal health organizations in Alaska. Cancer Causes Control 2025;36(11):1377–1383.

Learning how to help patients in rural areas

People who live in rural areas are less likely to be screened for colorectal cancer than people who live in metropolitan areas. There are often fewer doctors in rural areas, so it may take longer to get an appointment. Rural residents often need to travel further to see a doctor and are more likely to have problems with transportation and the cost of medical care.

CDC scientists wanted to learn about the problems that people in rural areas face in getting screened for colorectal cancer, how health clinics were trying to address these problems, and how well the solutions worked. Between January and August 2023, CDC set up five monthly meetings with nine CRCCP award recipients across the United States that serve rural communities. After the meetings were finished, CDC held two focus groups with staff from health clinics that work with the award recipients.

The study found:

• For patients, all nine award recipients used appointment reminders (calls, text messages, emails, and/or postal mail) and small media (such as educational brochures or videos shown in the waiting room) in patients' native language. All nine award recipients agreed that these were useful ways to increase colorectal cancer screening.
• All of the award recipients agreed on several ways to help doctors increase screening. These included writing standard procedures for colorectal cancer screening, encouraging them to offer stool test kits, and providing reminders of which patients are due for screening.
• At the health system level, all of the award recipients used standing orders for stool tests and agreed they were useful.

Citation

Hoover S, Pilar MR, Tangka FKL, Subramanian S. Approaches to address common barriers to colorectal cancer screening in rural communities of the CDC's Colorectal Cancer Control Program. Prev Oncol Epidemiol 2025;3(1):10.1080/28322134.2025.2504900.