Common Keyword: FIT/gFOBT

Fecal immunochemical test/guaiac-based fecal occult blood test

Return To Resources
Download the Full Steps Guide with Appendices
Download the Steps Guide without Appendices

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

Colorectal cancer screening saves lives, yet nearly 1 in 3 adults ages 50 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

As a companion to the new edition, we will release ten extensive case studies from diverse and exemplary clinical practices later this fall.

Learn More

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.


Spread The Word

Sample Facebook & LinkedIn Posts

A primary care clinician recommendation is the most powerful influence on a patient’s decision to get screened for cancer. The National Colorectal Cancer Roundtable’s newly updated Steps Guide is your one-stop-shop for strategies to increase colorectal cancer screening. Get started now at 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

A primary care clinician recommendation is the most powerful influence on a patient’s decision to get screened for cancer. The newly updated @NCCRTnews Steps Guide is your one-stop-shop for strategies to increase #CRC screening. https://nccrt.org/StepsGuide #80inEveryCommunity

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 2022 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 newly released 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 2022 edition 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. Timely colorectal cancer screening is more important than ever now that major guidelines recommend screening for people at average risk start at age 45. 

Return To Resources
Link to Resource

Mailed FIT Implementation Guide

The Mailed FIT Implementation Guide provides a roadmap for how health systems and other entities can design and carry out mailed fecal immunochemical test (FIT) outreach programs, including information on key partnerships and what to have in place before launching a program. The guide was produced in partnership with the National Association of Chronic Disease Directors, the Kaiser Permanente Center for Health Research, and supported by the Centers for Disease Control and Prevention. 

The goal of this guide is to provide clinic and health system administrators and staff with the information needed to make informed decisions and successfully implement an outreach program. The guide details the process for planning and implementing an outreach program by addressing: Prerequisites (Technical Resources & Capacity); Getting Ready; Selecting a FIT; Executing a Mailed FIT Outreach Program; and Sustaining the Program. It also includes a section of mailed FIT references and resources.

Evaluation: The evidence provided in the Mailed FIT Implementation Guide is based on two recent primary sources. The first source is the five-year STOP CRC pragmatic trial of mailed FIT outreach in federally qualified health centers (2013-2018), which investigated whether the use of mailed FIT outreach, together with follow-up colonoscopy for abnormal FIT results, could increase CRC screening rates above those obtained with the usual care approach of opportunistic screening within 26 federally qualified community health center clinics in Oregon and California. The findings showed a significant improvement in CRC screening rates and an overall FIT return rate of 21%. The second source of evidence is from the 2019 CDC-sponsored and NACDD hosted Mailed FIT Summit, which included subject matter experts and stakeholders from across the nation. An accompanying journal article published in CA: A Cancer Journal for Clinicians described the Summit goals, process, and findings in detail.

Permissions: Made publicly available online by the National Association of Chronic Disease Directors.

Publication date: Published October 2021, last revised June 14, 2022

Post date: August 22, 2022

Contact: Please send comments or questions to Lorrie Graaf (lgraaf_ic@chronicdisease.org) or Dawn Wiatrek (dwiatrek_ic@chronicdisease.org).

Return To Resources
Link to Resource

NCCRT Learning Center

The NCCRT Learning Center is a digital learning platform which features courses, tools, and other resources on colorectal cancer screening delivery and research. Current educational offerings include:

  • 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.
  • The Communications Education Portal—This course houses our suite of market research findings on the unscreened for colorectal cancer and messaging recommendations to more effectively develop communication campaigns and resources for unscreened populations. Learners can peruse the market research findings from start to finish or jump in to find just what you need to educate, empower, and mobilize those who are not getting screened for colorectal cancer.

We plan to populate the NCCRT Learning Center with additional tools and learning modules over time. Users can create an account to track your progress, learn when new content is released, and access more courses as they become available.

 

Return To Resources
Download Resource
Sample Letter (Primary Care)

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. 

Return To Resources
Download Resource

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.

Return To Resources
Download Slide Deck

How To Assure Follow Up Colonoscopy For Positive FIT From The Process Side – January 30, 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 review evidence and processes to help ensure that patients obtain a follow-up colonoscopy after a positive test result.

Speakers:

  • Kevin Selby, MD, Kaiser Permanente Division of Research
  • Amanda Petrik, Kaiser Permanente Center for Health Research
  • Frank Colangelo, MD, FACP, Premier Medical Associates
  • Jason A. Dominitz, MD, MHS, FASGE, AGAF Department of Veterans Affairs

Note:  This webinar will not address access issues. For advice on securing access to colonoscopy, check out our webinars on Links of Care from 2017 and 2015. For more general guidance on implementing FIT screening programs, view this webinar or check out our new resource on stool based testing.

Return To Resources
New ranking of colorectal cancer screening tests
Link to Resource

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 Gastroenterology, The 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.

Return To Resources
best practices handbook for health plans
Download Resource

“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.

Return To Resources
CRC Communications Guidebook
Download Resource

80% by 2018 Communications Guidebook: Recommended Messaging to Reach the Unscreened

This Guidebook is based on market research from the American Cancer Society with guidance from the NCCRT Public Awareness Task Group. The Guidebook is designed to help educate, empower and mobilize three key audiences who are not getting screened for colorectal cancer:

  • The newly insured
  • The insured, procrastinator/rationalizer
  • The financially challenged

The goal of the Guidebook is to share what we know about reaching these hard-to-persuade groups using tested messages.

The 2017 Guidebook includes additional templates, tools and customized resources. (Note: Some versions of Internet Explorer create errors in the document. If you experience problems please use an alternate browser, such as Firefox or Google Chrome.)

The Hispanics/Latinos and Colorectal Cancer Companion Guide and Asian Americans and Colorectal Cancer Companion Guide introduce market research about the unscreened from these populations and include tested messages in Spanish and several Asian languages.

Use the following tools to help you promote and evaluate 80% by 2018 communications:

The Guidebook reviews what we know from market research about the unscreened and introduces and explains new tested messages. It also provides tools with the messages incorporated to get you started:

Our hope is that partners can take this research and messages provided in the Guidebook and make the message resonate with the target audiences even more by using their own creativity, innovation and spokespersons.

View the following webinars to learn more about the market research that went into this work, and the tools that are available.

Return To Resources
flu FIT
Link to Resource

FluFIT Program

FluFIT programs increase colorectal cancer screening rates by providing a take home fecal immunochemical test (FIT) to eligible patients when they receive their annual flu shot. Thus, the annual flu shot campaign create an opportunity to reach people who are also due for colorectal screening.

The FluFIT website offers program planning and implementational materials, including staff training, work flows, log sheets, sample reminder letters, and sample telephone call scripts. The site also provides patient educational materials, such as clinic posters, and FIT instructions (both printed materials and videos) in several languages. These materials can help prepare a healthcare team to develop the simple systems needed to implement a FluFIT program and jump start program development.

FluFIT programs have been implemented successfully in a variety of clinical settings. Many FluFIT campaigns are run by nurses, pharmacists, or medical assistants. They can be implemented and sustained with limited resources, are well accepted by patients, and can lead to higher screening rates.

Evaluation: FluFIT is a research-tested program. Visit the Publications section of the website to find research articles and reviews of the FluFIT approach.

Evaluation Assets: The Program Materials section of the website includes a sample FluFIT log sheet and sample FluFIT results tracking sheet.

Permissions: Made publicly available online by the Department of Family and Community Medicine, University of California.

Publication date: 2009; updated in 2017

Post date: September 15, 2017

Contact: Send comments, questions, and suggestions to Michael Potter, MD at potterm@fcm.ucsf.edu.