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 guide was developed by the ACS NCCRT with funding from the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) cooperative agreement #NU58DP006460. 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.

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:

Mailed FIT Implementation Guide

The Mailed FIT Implementation Guide and the Mailed FIT Online Course have been developed to help improve colorectal cancer screening rates in diverse healthcare settings.

The Mailed FIT Implementation Guide provides a roadmap for how health systems and other health entities can design and carry out mailed fecal immunochemical test (FIT) outreach programs. The Guide was created by the National Association of Chronic Disease Directors (NACDD) in partnership with the Kaiser Permanente Center for Health Research (KPCHR) and with the support of the Centers for Disease Prevention and Control (CDC).

The goal of the Mailed FIT Implementation Guide is to provide 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 a mailed FIT outreach program by addressing the following process steps: Prerequisites (Key Partnerships, Capacity, Technical Resources), Getting Ready, Selecting a FIT Kit, Executing a Mailed FIT Outreach Program, Following Up on Abnormal Test Results, and Sustaining the Program. Two chapters containing Resources and References are also included.

The Mailed FIT Online Course is the newest resource and was developed based on the components of the Mailed FIT Implementation Guide. The course is a free, self-paced online program for busy health professionals that provides easy-to-access information in video format. Ten videos narrated by subject matter experts from around the nation cover all components of a mailed FIT outreach program. Three testimonial videos from experienced clinics describe their tips and strategies for implementing a successful mailed FIT outreach program. Finally, a helpful companion notebook for the course gives step-by-step activities and checklists for gathering and organizing the information needed to establish an outreach program. The Mailed FIT Online Course was created by NACDD in partnership with KPCHR and with the support of the CDC.

Evaluation: The evidence provided in the Mailed FIT Implementation Guide and subsequently created Mailed FIT Online Course was based on two primary sources. The first source was the five-year STOP CRC trial of mailed FIT outreach programs in 26 federally qualified health centers in Oregon and California (2013-2018). The trial investigated whether the use of mailed FIT outreach programs with follow-up colonoscopy for abnormal FIT results could increase CRC screening rates above the rates obtained with usual care opportunistic screening. The findings showed a significant improvement in CRC screening rates and an overall FIT return rate of 21%. The second source of evidence was the 2019 Mailed FIT Summit, which was sponsored by the CDC and hosted by the NACDD. The Summit participants 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’s goals, process, and findings in detail.

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

Publication date: Guide published October 2021, last revised June 14, 2022; Online Course published March 2023. 

Post date: August 22, 2022, updated August 2023. 

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

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.

 

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.

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.

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.