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

Learn More

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.  

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.


Spread The Word

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

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

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. 

NCCRT Blue Star Conversation- June 7, 2022

On June 7, 2022, the NCCRT’s Policy Action Strategic Priority Team hosted the latest Blue Star Conversation, a new interactive program for NCCRT members and CDC grantees. The latest session titled “Demystifying Colorectal Cancer Screening Quality Measures: A Conversation with NCQA’s Mary Barton,” featured an interview between co-chair of the Policy Action Team, Heather Dacus, DO, MPH and Mary Barton, MD, MPP, Vice President of Performance Measurement at the National Committee of Quality Assurance (NCQA)  where they discussed what it means to be a measure steward, reviewed recent changes to the HEDIS CRC screening measure and implementation timeline, and discussed the process for updating measures.

Visit NCCRT’s Events & Webinars page to find information about upcoming programs and events.

Key links:

 

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.

The Colonoscopy Needs Calculator

This tool estimates the number of colonoscopies your practice can realistically anticipate with a high-quality stool-based colorectal cancer screening program based on various screening rate goals and other data inputs. It also provides an estimation of what the total colonoscopy need would cost a system as well as a comparison between the costs of treating cancer and costs of providing colonoscopies.

Users have the option to create an account to track your progress and update data over time.

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.

Note: We are not able to share the webinar recording at this time since some of the presentations contain unpublished data, but we will post the recording to this webpage as soon as we have permission to do so. 

Webinar – What Do The Data Tell Us: What Can We Learn From The Latest Colorectal Cancer Screening Rate Trends Over Time? –  January 30, 2020

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. (Note: this webinar was a repeat of a panel that was hosted at the 2019 NCCRT Annual Meeting.)

Speakers:

  • Djenaba A. Joseph, MD, MPH, Medical Director, Colorectal Cancer Control Program, Centers for Disease Control and Prevention
  • Stacey Fedewa, Senior Principal Scientist, Surveillance Research, American Cancer Society, Inc.
  • Mary Barton, MD, MPP, Vice President, Performance Measurement, National Committee for Quality Assurance
  • Minh Nguyen, Pharm D, MPH, Public Health Analyst, Health Resources and Services Administration

Colorectal Cancer Screening and Risk Assessment Workflow and Documentation Guide for Health Center NextGen Users

This Guide provides focused documentation to assist users of NextGen software to improve the process of assessing, documenting, tracking, and following up on colorectal cancer screening. The Guide gives particular attention to assessment of personal and family risk and the tracking and follow-up of screening results that are not addressed in the standard NextGen guidance documents.

The Guide was initially developed by Harbor Health Services in collaboration with the Massachusetts League of Community Health Centers and NACHC, with support from the American Cancer Society. 

Colorectal Cancer Screening State Profiles

The Centers for Disease Control and Prevention’s (CDC’s) Colorectal Cancer Screening State Profiles provide state-specific colorectal cancer screening trends from 2012 through 2016, modeled county-level colorectal cancer screening estimates from 2014, and screening prevalence by race/ethnicity, sex, insurance status, and age group for all for all 50 states, DC, and Puerto Rico.

These profiles can help comprehensive cancer control programs, colorectal cancer control programs, and others with planning interventions and sharing current colorectal cancer screening estimates in their state.

Evaluation: Screening statistics come from CDC’s Behavioral Risk Factor Surveillance System, CDC’s National Center for Health Statistics, and other sources. View the footnotes of the state profiles to learn more.

Permissions: Made publicly available online by the Centers for Disease Control and Prevention, with content provided and maintained by the Division of Cancer Prevention and Control.

Publication date: November 14, 2018

Post date: December 6, 2018

Contact: Send comments, questions, and suggestions to ncccpcommunications@cdc.gov.

 

evaluation toolkit

“The 7-step process is helpful. It is a guide/outline that can be used to ensure that you have developed a great program and the ability to evaluate the effectiveness of your program.”

Evaluation Toolkit, Version 4:

How to Evaluate Activities to Increase CRC Screening and Awareness: Evaluation Toolkit – Now With Case Studies That Include Policy and Systems Change!

This latest version of the evaluation toolkit is intended to help organizations and communities evaluate a wide variety of interventions designed to increase awareness and use of colorectal cancer screening. The toolkit will help you learn the seven basic steps to evaluation, whether you are working to increase community demand for colorectal cancer screening, encouraging health care providers to recommend screenings, or trying to implement policy, systems, or environmental (PSE) changes.This toolkit will provide you with:

  • A basic understanding of evaluation strategies.
  • Tools that you can use and adapt to assess baseline screening rates, or the effectiveness or impact of the intervention.
  • Basic skills to collect outcome data to inform and improve decision-making.
  • Tips for incorporating evaluation results into grant proposals, reports, and other dissemination activities.
  • Practical yet comprehensive evaluation references and resources.

Download this comprehensive resource.

Evaluation Tip Sheets – designed to give you a quick overview of the evaluation process.

Click here to download four separate Evaluation 101 learning modules.  These four pre-recorded webinars are designed to walk you through the evaluation process in greater depth.

New! Guidance on Evaluation 80% by 2018 Messaging

Evaluation Toolkit Update

Evaluation Toolkit Update – June 27, 2017

This webinar introduced the new updates to NCCRT’s evaluation toolkit, How to Evaluate Activities to Increase Colorectal Cancer Screening and Awareness. The webinar walked participants through new features in the toolkit, including how to evaluate provider-focused interventions, as well as policy and systems change interventions. The webinar also reviewed the seven steps to program evaluation through the lens of various colorectal cancer screening interventions, while also highlighting new case studies, tools and templates.

Speakers:

  • Cheryl Holm-Hansen, PhD, Senior Research Manager, Wilder Research
  • Amanda Hane, MS, MA, Research Associate, Wilder Research
  • Heather Dacus, DO, MPH, Director, Bureau of Cancer Prevention and Control (BCPC), New York State Department of Health
  • Heather M. Brandt, PhD, CHES, Associate Professor, Health Promotion, Education, & Behavior, University of South Carolina, Arnold School of Public Health
  • Andrea (Andi) Dwyer, The Colorado School of Public Health, University of Colorado Cancer Center and NCCRT Steering Committee/NCCRT Evaluation & Measurement Task Group Co-Chair