Tailoring Colorectal Cancer Screening Messaging: A Practical Coalition Guide

This resource is targeted at coalition members and leaders who are looking to make highly effective campaigns to increase colorectal cancer (CRC) screening rates in their communities, especially for those hardest to reach. Research shows that tailoring health messaging to a specific community produces greater changes in health behavior, such as CRC screenings. By using this step-by-step guide, coalitions can find practical tips and strategies as well as successful case studies illustrating the process.  

This resource was developed by the ACS NCCRT through funding from the Centers for Disease Control and Prevention’s National Comprehensive Cancer Control Program.

ACS NCCRT Blue Star Conversation – September 11, 2023

This Blue Star Conversation features a brief presentation by Daniel Reuland, MD, MPH, Professor of Medicine, University of North Carolina School of Medicine; and  Program Director, Carolina Cancer Screening Initiative, UNC Lineberger Comprehensive Cancer Center, on a recent study: Uptake of colorectal cancer screening after mailed fecal immunochemical test (FIT) outreach in a newly eligible 45-49-year-old community health center population. Speakers will also provide updates on trends in colorectal cancer screening in community health centers and recently released resources to support health center work to increase CRC screening, including the Steps For Increasing Colorectal Cancer Screening Rates: A Manual For Primary Care Practices. This program was hosted by the ACS NCCRT Community Health Center Strategic Priority Team. Afterwards, participants discussed greatest barriers and solutions to increasing CRC screening in the newly eligible population. 

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

Key Links:

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. 

Blue Star Conversations – May 17, 2023

On May 17th, 2023, the NCCRT’s NCCRT Professional Education & Practice Implementation (PEPI) Strategic Priority Team hosted the latest Blue Star Conversation, an interactive program for NCCRT members and CDC grantees. The latest session highlighted a short presentation by Elizabeth Ciemins, PhD, MPH, MA, Vice President of Research and Analytics at AMGA (American Medical Group Association), on rates of follow-up colonoscopy after a positive stool-based screening test from the recent Jama New Open publication, Rates of Follow-up Colonoscopy After a Positive Stool-Based Screening Test Result for Colorectal Cancer Among Health Care Organizations in the US, 2017-2020. Afterwards, participants discussed potential opportunities and challenges to overcome barriers affecting follow-up colonoscopy. 

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

Key links:

Reigniting Colorectal Cancer Screening as Communities Face and Respond to the COVID-19 Pandemic: A Playbook

This resource provides an action-oriented playbook to be adopted throughout the COVID-19 pandemic and aims to align NCCRT members, 80% pledged partners, and colorectal cancer screening advocates across the nation to work together to reignite our screening efforts appropriately, safely, and equally for all communities.

The COVID-19 pandemic has challenged efforts to address inadequate screening and inequities in colorectal cancer outcomes, hindering the progress toward our 80% in Every Community goals. In the early stages of the COVID-19 pandemic, leading agencies, such as the Centers for Medicare & Medicaid Services (CMS) and the American Cancer Society, made recommendations to delay all non-urgent procedures. Colonoscopies to detect colorectal cancer have been delayed or cancelled and patient fears about contracting COVID-19 have led to further reductions in screening. This drop has raised concern that COVID-19 related screening delays will lead to missed and advanced stage colorectal cancer diagnoses and to excess deaths from colorectal cancer. Moreover, this burden will likely not be evenly distributed as screening disparities may be exacerbated in communities and populations that are disadvantaged by both old and new challenges in the COVID-19 era.

The colorectal cancer fighting community stands prepared and well-positioned to respond to and overcome the difficult task ahead, and this document offers the latest (as of June 2020) data, research, and clinical guidelines available related to colorectal cancer screening and COVID-19. 

Aligning Statements include: 

  1. Despite the challenges we face during the pandemic, colorectal cancer remains a public health priority, and we must provide the public with safe opportunities to prevent and detect colorectal polyps and cancer.
  2. Colonoscopy remains safe, is a good option for screening, and is quickly reopening around the country, but identifying patients who should receive higher priority for colonoscopic screening is a critical step.
  3. During a time when availability of elective screening colonoscopy may be limited by the COVID-19 pandemic, colorectal cancer screening can be safely offered through at-home stool-based tests.
  4. Gaining momentum and reigniting screening activities and public messaging will be highly dependent upon local regulatory requirements, public health priorities, and policy change.

Throughout the pandemic, individuals have options to screen for colorectal cancer. There are many safe, effective, and evidence-based screening tests available, including colonoscopy and non-colonoscopy options (e.g., stool-based tests, stool-DNA tests, and CT colonography). In addition to the information included in the Playbook specific to stool-based testing and colonoscopy, CT colonography also serves as an important option for patients. Learn more in an editorial published in Abdominal Radiology (July 2020), “CT Colonography’s role in the COVID-19 pandemic: a safe(r), socially distanced total colon examination.” 

We gratefully acknowledge the contributions of the following individuals and organizations. Thank you to our authors Durado Brooks, Rachel Issaka, Steven Itzkowitz, Michael Sapienza, Ma Somsouk, Richard Wender, Caleb Levell, and Emily Bell. We also extend a special note of gratitude to our committed partners, NCCRT Steering Committee members, and subject matter experts that have contributed to both reviewing and advising on this document, but also for their participation in ongoing discussions aimed at uniting and guiding the colorectal cancer community throughout the COVID-19 pandemic. And finally, we recognize the efforts of the Colorectal Cancer Alliance to provide support, in-kind staff, and continued commitment in coordinating a national response to improving colorectal cancer screening rates during the COVID-19 era. 

Clinician’s Reference: Stool-Based Tests for Colorectal Cancer Screening

This newly revised resource is designed to introduce (or reintroduce) clinicians to the value of stool-based testing for colorectal cancer. It explains the different types of stool-based tests available—Fecal Immunochemical Tests (FIT), High-Sensitivity Fecal Occult Blood Tests (HS-gFOBT) and FIT-DNA testing—and provides guidance on implementing high quality stool-based screening programs. The resource now includes information on sensitivity and specificity for many of the most commonly used tests.

We would like to thank the following individuals, many from the NCCRT Professional Education and Practice Implementation Task Group, for reviewing past and current versions of this resource and contributing to this work: James Allison, Kim Andrews, Barry Berger, Durado Brooks, Gloria Coronado, Debbie Kirkland, Theodore Levin, Dorothy Lane, Laura Makaroff, Marion Nadel, Kerstin Ohlander, Mike Potter, Robert Smith, and Richard Wender. We’d also like to thank the Comprehensive Cancer Control Program National Partners for providing funding support.

Colorectal Cancer Screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer

The US Multi-Society Task Force on Colorectal Cancer Screening, comprised of representatives from the American Society for Gastrointestinal Endoscopy, American College of Gastroenterology and American Gastroenterological Association, develops recommendations for the prevention and early detection of colorectal cancer. Recommendations are based on scientific evidence, practical considerations, and cost.
The latest set of recommendations, summarized in this press release, recommends screening begin at age 50 for average risk individuals, with screening starting at age 45 for African-Americans. The recommendations rank screening tests into three “tiers” according to the strength of the recommendation. The recommendations also provide guidance for screening individuals with a family history of the disease.

The press release links to joint publications of these recommendations in GastroenterologyThe American Journal of Gastroenterology and GIE: Gastrointestinal Endoscopy.

Evaluation: The US Multi-Society Task Force is made up of representatives from the American Society for Gastrointestinal Endoscopy, the American College of Gastroenterology, and the American Gastroenterological Association. Recommendations for screening are re-evaluated periodically as new evidence emerges and as shifts occur in health care delivery and access.

Permissions: Made publicly available online by the American Society for Gastrointestinal Endoscopy.

Publication date: June 2017

Post date: September 15, 2017

Contact: Follow instructions in the press release to reach out to media contacts at each of the three societies.

What Can Primary Care Physicians Do To Advance 80% By 2018?

Learn how primary care physicians can be part of the national effort to make sure 80% of adults ages 50 and older are regularly screened for colorectal cancer by 2018.

Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement

The US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for people at average risk and with no signs or symptoms of the specific disease or condition under evaluation. Recommendations are assigned a letter grade (A, B, C, or D grade or I statement) based on the strength of the evidence and the balance of benefits and harms of a preventive service. Costs of services are not considered in the evaluation.

In 2016, the USPSTF released a new “A” grade Final Recommendation Statement for colorectal cancer screening, which recommends screening for colorectal cancer starting at age 50 and continuing until age 75 years with one of several screening strategies. One of the primary differences from the 2008 recommendation is the addition of computed tomography (CT) colonography and multitargeted stool DNA (FIT-DNA) to the list of screening strategies.

Evaluation: The USPSTF is comprised of volunteer members who are nationally recognized experts in prevention, evidence-based medicine, and primary care. The USPSTF bases its recommendations on the strength of the evidence and the balance of benefits and harms of a preventive service. This recommendation statement was also published in the peer-reviewed journal JAMA.

Permissions: Made publicly available online by the US Preventive Services Task Force.

Publication date: June 2016

Post date: September 15, 2017

Contact: Submit comments, questions, and suggestions via web form.

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.