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

Disclaimer: This resource does not reflect the new 2018 ACS guideline for colorectal cancer.