Advanced Colorectal Polyp Brief

The National Colorectal Cancer Roundtable created the Advanced Colorectal Polyp GI Brief to help endoscopists and primary care clinicians identify patients with advanced colorectal polyps, understand the epidemiology and associated risk factors, and most importantly know the risks of colorectal neoplasia for patients with advanced colorectal polyps and their first-degree relatives (parents, siblings, children).

This brief aims to:

  1. Remind endoscopists that patients with an advanced colorectal polyp and their close relatives are at increased risk for advanced colorectal polyps and colorectal cancer;
  2. Keep endoscopists up to date with current guidelines; and,
  3. Provide template letters to communicate colonoscopy and pathology results, risk status, and follow-up recommendations for patients and close relatives.

Supplemental template letters: 

Learn more on how gastroenterologists and endoscopists can play a role in the national efforts to improve colorectal cancer screening rates:

Penn State Health Electronic Employee Survey

Physician researchers at Penn State Health developed this colorectal cancer screening uptake and risk assessment tool for use by large entities such as employers and medical practices. The survey tool assesses whether an employee is up to date with screening based on 2016 USPSTF guidelines and also includes a risk assessment checklist to determine if the individual is at increased risk for colorectal cancer.

Penn State Health administered the survey to 6,188 employees, with a response rate of 45%. For respondents ≥50 years, 81% reported up-to-date colorectal cancer screening; thirty-three percent of all participants self-identified as high-risk.

Large employers are encouraged to adapt the survey tool and introduction letter for use with their employees.

Evaluation: The survey was administered electronically to all Penn State Health employees ≥40 years via an online platform. The survey anonymously collected demographic data. Associations between demographic/ risk factors and up-to-date screening status were examined using Fisher’s exact test for categorical variables and Wilcoxon Rank-Sum test for quantitative variables.

Permissions: These tools can be used by any large employer to measure their colorectal cancer screening rates.

Publication date: July 2018

Post date: December 18, 2018

Contact: Send comments, questions, and suggestions to Thomas McGarrity, MD at

Risk Assessment And Screening Toolkit To Detect Familial, Hereditary And Early Onset Colorectal Cancer

Limited or inaccurate family history collection and risk assessment is a major barrier to successful cancer screening. Individuals who have a first-degree relative with colorectal cancer (CRC) are at least two times more likely to develop CRC, with the risk increasing with earlier ages of diagnosis and the number of relatives diagnosed with CRC. Therefore, screening and prevention efforts must focus on those with familial or hereditary risk, which requires collecting the necessary family history information for risk assessment. Primary care clinicians play a pivotal role in identifying people at increased CRC risk and facilitating recommended screening.

This new NCCRT toolkit aims to improve the ability of primary care clinicians to systematically collect, document, and act on a family history of CRC and adenomas polyps, while also educating clinicians on the need for more timely diagnostic testing for young adults who present with alarm signs or symptoms of CRC and ensuring that those patients receive a proper diagnostic work up. This toolkit serves as a comprehensive, step-by-step guide to improve operations within practices and suggests many useful resources and tools to aid these changes. 

Companion Quick Start Guide

Accompanying the full toolkit is a short, quick start guide with recommendations on how to ease into the transition process, while still making the critical improvements necessary for successful system-wide implementation. 

Thank you to the outstanding work and guidance provided from the NCCRT Family History and Early Age Onset Colorectal Cancer Task Group and the smaller project advisory group. Also, thank you to the excellent work from our project developers at The Jackson Laboratory. 


Sample Risk Assessment Screening Algorithm

These screening algorithms include recommended screening options for the average-risk and high-risk patient and provide a sample starter policy for your practice. A policy that incorporates the considerations of risk level, insurance coverage, local medical resources, and patient preference will lead to the best screening choice for each patient. These sample algorithms also provide a review of screening options, helpful definitions to improve understanding, and coding assistance for Medicare patients. Two samples are provided for practices considering either the USPSTF screening recommendations or the 2018 American Cancer Society Colorectal Cancer Screening Guideline. 

Innovative Ways To Increase Colorectal Cancer Screening Among The Underserved – February 20, 2018

This webinar was a repeat of one of our most highly rated workshops from the NCCRT meeting last month. The purpose of the webinar was to move beyond describing the challenges of reaching the underserved to showcasing innovative solutions, including using systems change to increase colorectal cancer screening in a multi-ethnic community; providing an example of how local health departments can team up with academics on community engagement; and partnering with emergency departments to reach rural residents who don’t have a primary care provider.


  • Joseph Ravenell, MD, MS, Assistant Professor of Population Health and Medicine; Associate Dean for Diversity Affairs and Inclusion at NYU School of Medicine; NCCRT Steering Committee (Presenter/Moderator)
  • Karen E. Kim, MD, Professor of Medicine, Dean, Faculty Affairs, Associate Director, Cancer Disparities, the University of Chicago Medicine Comprehensive Cancer Center
  • Jenna Hatcher, RN, PhD, MPH, Director of Diversity and Inclusion, University of Kentucky, College of Nursing

Identifying High Risk Patients and Families in Your Practice

In What can Gastroenterologists & Endoscopists Do to Advance 80% by 2018?, we describe the key role that gastroenterologists and endoscopists play in the national effort to make sure 80% of age-appropriate adults are regularly screened for colorectal cancer by 2018.

Identifying high risk patients and families is another key step you can take to ensure your patients and their families receive timely and appropriate screening. This supplemental guide is meant to aid you in these efforts.

Familial Risk And Colorectal Cancer Screening

Familial Risk and Colorectal Cancer Screening – December 8, 2016

This webinar addressed what we know and don’t know about colorectal cancer screening for those with a familiar risk of colorectal cancer. Study authors Dr. Jan Lowery and Dr. Dennis Ahnen review the NCCRT-commissioned article that was published in June 2016 on colorectal cancer and family history in the journal CancerUnderstanding the contribution of family history to colorectal cancer risk and its clinical implications: A state-of-the-science review. The NCCRT’s Family History Task Group conducted this review to better understand the current state of knowledge regarding family history and colorectal cancer.


  • Dennis Ahnen, MD, University of Colorado Cancer Center
  • Jan Lowery, PhD, MPH, Catholic Health Initiatives

Improving Northern Plains American Indian Colorectal Cancer Screening (INPACS) Report

The American Indian Cancer Foundation’s Improving Northern Plains American Indian Colorectal Cancer Screening (INPACS) project recruited 54 Indian Health Services (IHS), tribal health, and urban health clinics within MN, WI, ND, SD, NE, MT, and WY to better understand successes and challenges for colorectal cancer screening and to collaboratively develop strategies to improve cancer screening rates.

About 96,000 American Indians between ages 50 and 74 reside in the Northern Plains, where the incidence of colorectal cancer is 53% higher for American Indians compared to non-Hispanic Whites. Although rates are improving, less than half of Northern Plain American Indians ages 50 years and older are up to date with colorectal cancer screening.

Data for this report was collected by INPACS staff during visits to each participating site. Multiple components of the project comprehensively assessed quality assurance measures at both the provider-level and the systems-level such as colorectal cancer policies and clinic systems for provider and patient reminders.

A clear, overarching finding of this project is that system-level strategies are needed to impact colorectal cancer screening rates in clinics across Indian Country. A provider who recommends screening is the most influential factor in patients completing colorectal cancer screening. The report also discusses clinic policies on screening, clinic reminder systems, communication systems, highlights from provider discussions, and lessons learned from the INPACS project.

Evaluation: The INPACS project used surveys and one-on-one discussions to assess clinic colorectal cancer screening practices. The project focused on evaluating the use of evidence-based practices, such as patient and provider reminders, described in in NCCRT’s “How to Increase Colorectal Cancer Screening Rates in Practice: A Primary Care Clinician’s Evidence-Based Toolbox & Guide.”

Permissions: Made publicly available online through the American Indian Cancer Foundation.

Publication date: May 2013

Post date: October 2, 2017

Contact: Send comments, questions, and suggestions to Anne Walaszek at or


Family PLZ! is an NCCRT colorectal cancer awareness campaign with a special focus on family history that targets the younger population.

Family PLZ! focuses on the importance of learning your family history of colorectal cancer or polyps, sharing this information with your doctor and loved ones, and getting the younger generation to start conversations about health and screening.

We have tools to help promote Family PLZ! that are free and available to use, including:

  • Downloadable posters and palm cards,
  • Facebook application,
  • Animated video, and
  • Web banner ads

The campaign was developed in conjunction with the Mayo Clinic, the Colon Cancer Alliance and the Art Center College of Design.

The campaign will allow us to talk to young people about colorectal cancer on their terms in their environments. We want them to use their energy to spur their family members to get screened and to talk with their families about family history.

Use the campaign materials in March–or through out the year to give a special reminder about colorectal cancer screening and the importance of knowing your family history.

The Mayo Clinic Center for Innovation provided financial and advisory support in the development of this campaign. This website was supported by CDC Cooperative Agreement Number U50/DP001863. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.

The Family Plz! concept and original design template was created by students at Art Center College of Design, under the leadership of Designmatters at Art Center, the College’s social impact design department.