Target Audience: Ages 65+

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Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Primary Care Practices

Colorectal cancer screening saves lives, yet more than 1 in 3 adults ages 45 and older is not getting screened as recommended.

Through a step-by-step format, this newly updated manual provides evidence-based, expert-endorsed strategies to improve colorectal cancer screening rates in primary care practices. The 2022 edition includes:

  • An expanded scope to include all primary care settings
  • Current screening guidelines and new screening modalities
  • Expert-endorsed strategies
  • Samples, templates, and tools
  • Updated literature references
  • NEW! Added exemplary case studies

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Background and Goals

The first edition, published in 2014, was one of the NCCRT’s most popular resources and has been instrumental in helping primary care practices throughout the United States achieve improvements in their colorectal cancer screening rates.  

The goal of this manual is to offer evidence-based, expert-endorsed recommendations for planning and implementing strategies in primary care practices to improve colorectal cancer screening rates. This manual provides a succinct step-by-step guide for primary care teams to improve colorectal cancer screening and outcomes in practice. These simple steps will assist teams to effectively:

  • Agree on and implement an office screening strategy
  • Provide education on appropriate and high-quality screening
  • Help patients to complete timely, recommended screening
  • Track follow-up of screening and results
  • Build networks among primary care, specialty care, and health systems
  • Provide examples of workflows from successful programs

View the NCCRT’s July 25, 2022 Steps Guide update webinar recording and slide set for an introduction to the new edition and testimonials from two primary care clinician champions on how the manual can be used to transform colorectal cancer screening delivery.  

Acknowledgement

The NCCRT would like to thank the numerous people who generously offered their time and expertise to the development of this updated second edition.

NCCRT is especially grateful to the advisory committee, who generously offered their time and expertise to develop this guidebook’s research and content, to HealthEfficient for serving as the lead author on this second edition, and to the Centers for Disease Control and Prevention for their support.

See the Acknowledgements section on page two of the Steps Guide for a comprehensive list of the many contributors.

This publication was supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $825,000 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.


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Sample Facebook & LinkedIn Posts

Colorectal cancer screening is one of the best ways to reduce the risk of colorectal cancer. Utilize the strategies in our Steps Guide to help increase screening rates in patients, and reference the newly added Case Studies to see their impact. https://nccrt.org/StepsGuide #80inEveryCommunity

Primary care clinicians’ use of our Steps Guide can help increase colorectal cancer screening rates in patients. We’re excited to include newly added case studies give insight into the effectiveness of strategies, all to meet the goal of #80inEveryCommunity. Read more: https://nccrt.org/StepsGuide  

Timely colorectal cancer screening is more important than ever now that major guidelines recommend screening start at age 45. The National Colorectal Cancer Roundtable’s newly updated Steps Guide provides a succinct step-by-step guide for primary care teams to improve colorectal cancer screening and outcomes in practice. https://nccrt.org/StepsGuide

Colorectal cancer screening saves lives. Learn how you can increase screening rates in primary care with the National Colorectal Cancer Roundtable’s newly updated Steps Guide: https://nccrt.org/StepsGuide

The lifetime risk of developing colorectal cancer is about 1 in 24 for men and 1 in 25 for women, yet nearly 1 in 3 adults ages 50 and older is not getting screened as recommended. The National Colorectal Cancer Roundtable’s newly updated Steps Guide is your one-stop-shop for strategies to increase colorectal cancer screening in your practice. Get started now at https://nccrt.org/StepsGuide

Only 72% of adults aged 50 and older are up to date with potentially life-saving colorectal cancer screening. Download the National Colorectal Cancer Roundtable’s newly updated Steps Guide to find evidence-based, expert-endorsed strategies to improve colorectal cancer screening rates. https://nccrt.org/StepsGuide

Sample Tweets

Colorectal cancer screening is one of the best ways to reduce the risk of colorectal cancer. Utilize the strategies in our Steps Guide to help increase screening rates in patients, and reference the newly added Case Studies to see their impact. https://nccrt.org/StepsGuide #80inEveryCommunity

Primary care clinicians’ use of our Steps Guide can help increase colorectal cancer screening rates in patients. We’re excited to include newly added case studies give insight into the effectiveness of strategies, all to meet the goal of #80inEveryCommunity. Read more: https://nccrt.org/StepsGuide  

The lifetime risk of developing colorectal cancer is about 1 in 24 for men and 1 in 25 for women. The new @NCCRTnews Steps Guide is your one-stop-shop for strategies to increase #CRC screening. https://nccrt.org/StepsGuide #80inEveryCommunity #GetScreened

Colorectal cancer screening saves lives. Learn how you can increase screening rates in your practice with the new @NCCRTnews Steps Guide: https://nccrt.org/StepsGuide #80inEveryCommunity #GetScreened

Major guidelines recommend people at average risk start colorectal cancer screening at age 45. Download the new @NCCRTnews Steps Guide for a succinct step-by-step guide to increase #CRC screening in primary care. https://nccrt.org/StepsGuide #80inEveryCommunity #GetScreened

Only 72% of adults aged 50+ are up to date with potentially life-saving colorectal cancer screening. Download the @NCCRTnews Steps Guide for evidence-based, expert-endorsed recommendations to improve #CRC screening rates. https://nccrt.org/StepsGuide #80inEveryCommunity #GetScreened

Template Newsletter Blurbs

Brief version:

The National Colorectal Cancer Roundtable’s newly released Steps Guide (www.nccrt.org/StepsGuide) provides evidence-based, expert-endorsed strategies to increase colorectal cancer screening rates in primary care. This 2023 edition offers a much-anticipated update to the signature NCCRT resource that has been instrumental in helping primary care practices throughout the United States achieve improvements in delivering potentially life-saving colorectal cancer screening in the communities they serve.

Extended version:

A primary care clinician recommendation is the most powerful influence on a patient’s decision to get screened for cancer. Download the National Colorectal Cancer Roundtable’s 2023 edition of the Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Primary Care Practices (www.nccrt.org/StepsGuide) to find evidence-based, expert-endorsed strategies to improve colorectal cancer screening rates in primary care. 

This 2023 version provides a much-anticipated update to the signature NCCRT resource that has been instrumental in helping primary care practices throughout the United States achieve improvements in delivering potentially life-saving colorectal cancer screening in the communities they serve as well as ten exemplary case studies. Timely colorectal cancer screening is more important than ever now that major guidelines recommend screening for people at average risk start at age 45. 

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80% in Every Community Employer Challenge Guide

Employers have the ability to help save lives from colorectal cancer by encouraging their employees to get screened for colorectal cancer and reduce their risk of getting the disease.

This comprehensive guide provides the tools, resources and messaging for them to effectively increase timely, quality colorectal cancer screening in their workforce and be a part of the 80% in Every Community campaign.

Whether you work at a corporation, cancer center, health plan, non-profit, etc., you can find resources to help you ensure colorectal cancer screening is a priority in your workplace. It’s never too earlier to start planning your activities for March, National Colorectal Cancer Awareness Month!

Just getting started? View the short brief, How Can Employers Save More Lives from Colorectal Cancer?, for an introduction to increasing screening in the workplace. 

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Webinar – 2022 NCCRT Steps Guide Update – July 25, 2022

This webinar provided an introduction to the 2022 Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Primary Care Practices, an updated second edition to the first edition that was originally published in 2014. The 2022 edition includes the following updates:

  • An expanded scope to include all primary care settings
  • Current screening guidelines and new screening modalities
  • 10 case studies of exemplary practice sites
  • Updated literature references

The first edition was one of the NCCRT’s most popular resources and has been instrumental in helping primary care practices throughout the United States achieve improvements in their colorectal cancer screening rates.  The 2022 edition will be released in August 2022. 

Speakers:

  • Laura Makaroff, DO, Senior Vice President, Prevention and Early Detection, American Cancer Society
  • Keith Winfrey, MD, MPH, FACP, Chief Medical Officer, New Orleans East Louisiana Community Health Center
  • Michelle Tropper, MPH, Director of Clinical Programs, HealthEfficient
  • Frank Colangelo, MD, MS-HQS, FACP, Chief Quality Officer, Premier Medical Associates
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2022 Messaging Guidebook for Black & African American People: Messages to Motivate for Colorectal Cancer Screening 

Black and African American people experience disproportionately high incidence and mortality rates from colorectal cancer (CRC), with CRC death rates almost 40% higher than those of white people. While screening is only one element of the work that needs to be done to address these CRC disparities, it is important to promote screening in the best way possible.

The 2022 Messaging Guidebook for Black & African American People: Messages to Motivate for Colorectal Cancer Screening is intended to provide you with information and tools to help you work towards closing disparity gaps by using effective, tailored cancer screening messaging to help motivate people to get screened.

 

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Background and Goals

The guidebook is a supplement to the 2019 Colorectal Cancer Screening Messaging Guidebook: Recommended Messages to Reach the Unscreened. Based on the 2019 market research findings, the NCCRT and the American Cancer Society set out to gain a deeper understanding of the barriers to screening that Black and African American people face through our market research. The overall goal of the research was to: 

  • Gain a deeper understanding of the barriers to being screened 
  • Understanding healthcare behaviors and perceptions 
  • Understand how systemic racism and social injustice impact the Black community’s experiences within the healthcare system 
  • Uncover different motivators to encourage screening
  • Identify preferred and trusted information sources 
  • Gather reactions to potential messaging and messaging aspects to identify what elements of messaging will be most effective

This guidebook shares the findings and recommendations gathered from that research and is further designed to help educate, empower, and mobilize those not getting screened for colorectal cancer. Our vision is that our partners and advocates in the field use this guidebook to strengthen their communication campaigns and create resources that resonate with Black and African American communities.

View the June 21, 2022 webinar introducing the messaging guidebook.

Additional NCCRT market research and messaging guidance:

Acknowledgement

The NCCRT would like to thank the Public Awareness & Social Media Strategic Priority Team members and Advisory Committee, who generously offered their time and expertise to develop this guidebook’s research and content. We want to extend a special thank you to Quest Diagnostics, the Association of Black Gastroenterologists and Hepatologists, and Elevance Health Foundation for their support and guidance in conducting the market research and developing this guidebook.

Spread the Word

Sample Facebook/LinkedIn Posts

Black and African American adults experience disproportionally higher incidence and mortality rates from colorectal cancer. The National Colorectal Cancer Roundtable’s newly released messaging guidebook provides market-research findings and research-tested messages to encourage unscreened Black and African American adults to seek colorectal cancer screening. https://www.nccrt.org/Black-Messaging-Guidebook  

Only 65% of Black adults aged 50 and older are up to date with potentially life-saving colorectal cancer screening. Download the newly released National Colorectal Cancer Roundtable messaging guidebook to uncover motivators and potential messaging mechanisms to encourage regular colorectal cancer screening among Black and African American adults. https://www.nccrt.org/Black-Messaging-Guidebook

Sample Tweets

Black & African American adults experience disproportionally higher incidence & mortality from #colorectalcancer. This new @NCCRTnews messaging guidebook can help strengthen your communications to promote #CRC screening. https://www.nccrt.org/Black-Messaging-Guidebook #80inEveryCommunity #getscreened

1 in 3 Black adults aged 50+ are not up to date with potentially life-saving #colorectalcancer screening. Download the new @NCCRTnews messaging guidebook for research-tested messages to encourage #CRC screening: https://www.nccrt.org/Black-Messaging-Guidebook #80inEveryCommunity #getscreened

Template Newsletter Blurbs

Brief version:

The National Colorectal Cancer Roundtable’s newly released 2022 Messaging Guidebook for Black & African American People: Messages to Motivate for Colorectal Cancer Screening  highlights new market research focused on identifying barriers to colorectal cancer screening, understanding preferred and trusted sources for receiving healthcare information, and research-tested messages to help encourage unscreened Black and African American people to seek colorectal cancer screening.

Long version:

The National Colorectal Cancer Roundtable’s newly released 2022 Messaging Guidebook for Black & African American People: Messages to Motivate for Colorectal Cancer Screening  highlights new market research focused on identifying barriers to colorectal cancer screening, understanding preferred and trusted sources for receiving healthcare information, and research-tested messages to help encourage unscreened Black and African American people to seek colorectal cancer screening.

Black and African American people experience disproportionately high incidence and mortality rates from colorectal cancer, with colorectal cancer death rates almost 40% higher than those of white people. While screening is only one element of the work to address these colorectal cancer disparities, it is essential to promote screening in the best way possible. This new guidebook is intended to provide recommendations to enhance marketing and communication efforts while providing tools to strengthen communication campaigns that resonate with Black and African American communities. 

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Webinar – What Do the Data Tell Us: What Can We Learn from the Latest Colorectal Cancer Screening Rate Trends Over Time? – November 3, 2021

This webinar provided a look at the latest data that informs how we are doing as a nation with our efforts to reach an 80% colorectal cancer screening rate. The webinar included a review of the key colorectal cancer screening data sets: BRFSS, NHIS, HEDIS, and UDS. Participants heard from experts as they gave an update on where we are progressing and where we still need to focus, to help inform your work ahead. 

Speakers:

  • Lisa Richardson, MD, MPH, Director, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, NCCRT Steering Committee
  • Sepheen Byron, Assistant Vice President, Performance Measurement, National Committee for Quality Assurance
  • Neeraj Deshpande MBBS, MPH, MHA, Public Health Analyst, Quality Recognition and Health Promotion Team, Bureau of Primary Health Care/Office of Quality Improvement, DHHS/Health Resources and Services Administration
  • Stacey Fedewa, Senior Principal Scientist, Surveillance Research, American Cancer Society, Inc.

Note: Slides for three of the four presentations have been approved to share and can be downloaded through the button on this page. We will post the final deck and the replay to this page as soon as we receive approval to share all presentations.

Note: Data and data set measurement specifications were current as of November 3, 2021, but may become obsolete when changes are made in the future.

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State-by-State Colorectal Cancer Screening Landscape

This resource, developed by Exact Sciences, provides a snapshot of the colorectal cancer screening landscape in each state while also putting into context how the different states compare with each other in a range of areas. While the majority of the information included is publicly available, it is difficult to find all this information in one place. This resource is intended to help people better understand what the CRC screening landscape – from coverage to screening rates to legislation – looks like in each state.

Evaluation: The last slide includes reference links for the included information. This involved considerable time and research across multiple websites and through research from Exact Sciences’ legal team.

Permissions: Made publicly available online by Exact Sciences.

Publication date: November 2019; updated August 2020

Post date: November 3, 2020

Contact: Submit comments, questions, and suggestions to Bryan Goettel: bgoettel@exactsciences.com.

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“Thank you! This is exactly the type of information health plans need to pass to one another to improve partnership/collaboration, as the consumer will benefit at the end.”

“I really enjoyed that each of the health plans featured in the toolkit highlights a different intervention or opportunity. That gives our partners many approaches to choose from.”

Colorectal Cancer Screening Best Practices Handbook for Health Plans

Health plans have an essential role to play in the effort to screen more Americans for colorectal cancer, particularly given that seven out of 10 people who are unscreened are covered by insurance.

Colorectal Cancer Screening Best Practices Handbook for Health Plans, provides a first-of-its-kind compilation of best practices, case studies, templates and tools, that will kick start or infuse health plans’ efforts to save more lives and prevent more cancers.

To develop the handbook, the NCCRT convened an advisory group of health plan experts and interviewed high-performing health plans to understand what works and what doesn’t when it comes to increasing screening among members. Thank you to the many individuals and organizations who contributed their time and expertise to developing this much requested resource.

In the future, we hope to update this handbook with more case studies from high-performing health plans. If you have a story to share about how your health plan has worked to raise colorectal cancer screening rates, please email nccrt@cancer.org.

NCCRT’s issue brief, The Importance of Waiving Cost-sharing for Follow-up Colonoscopies, provides additional information on the colonoscopy copay issue.

View the March 28, 2017 webinar introducing the Handbook for a guided tour of the best practices, case studies, and templates and tools found within the handbook, and hear from one of the profiled health plans.

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Colorectal Cancer Screening Best Practices Handbook For Health Plans

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Colorectal Cancer Screening Best Practices Handbook for Health Plans – March 28, 2017

This webinar introduced the new NCCRT Colorectal Cancer Screening Best Practices Handbook for Health Plans. The purpose of this handbook is to provide health plans with advice on the design and delivery of effective colorectal cancer screening programs. The webinar provided participants with a guided tour of the best practices, case studies, and templates and tools found within the handbook, including a deeper dive into the exemplary practices for one of the profiled health plans.

Speakers:

  • Tamara O’Shaughnessy, QNA Group
  • Anshul Dixit, MD, MPH, MBA, Wellmark Blue Cross and Blue Shield

“This was one of the best colorectal cancer presentations, and it also provided information we can readily utilize with our current health plans in support of the 80% by 2018 initiative.”

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The Importance of Waiving Cost-sharing for Follow-up Colonoscopies: Action Steps for Health Plans

The Affordable Care Act (ACA) eliminates cost-sharing for United States Preventive Services Task Force (USPSTF) – recommended preventative services for individuals who are privately insured, including screening for colorectal cancer by high sensitivity stool test or colonoscopy for adults ages 50 and 75.* Some health plans, however, apply cost-sharing to colonoscopies that follow a positive stool test. This creates a financial incentive for patients to select the more costly and invasive colonoscopy as their initial test. Additionally, this cost-sharing creates a financial disincentive that may lead patients to forego the follow-up test that they need.

This Issue Brief gives an overview of this issue and makes a request to health plans to waive cost-sharing for members when colonoscopy is ordered as follow-up to a positive stool test or other colorectal cancer screening test, just as cost-sharing is waived for colonoscopy when it is selected as the first-line screening exam.

Learn more in Colorectal Cancer Screening Best Practices Handbook for Health Plans, a compilation of best practices, case studies, templates and tools.

*The ACA preventive services requirements do not apply to “grandfathered” health plans that were in existence prior to March 23, 2010, as long as such plans continue to meet certain standards for grandfathered plans.

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Preventive Medicine
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Colorectal Cancer Screening Barriers and Facilitators in Older Persons

The review article, Colorectal Cancer Screening Barriers and Facilitators in Older Persons, commissioned by the NCCRT, was published in the Jan./Feb 2010 issue of Preventive Medicine. This systematic review identifies factors that are most consistently mentioned as either barriers to or facilitators of colorectal cancer screening in older persons.