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 ( or Dawn Wiatrek (

President’s Cancer Panel Cancer Screening Report

On February 2, 2022, President Joe Biden announced a relaunch of the “Cancer Moonshot” program with a goal of reducing the death rate from cancer by at least 50 percent over the next 25 years.

The same day, the President’s Cancer Panel released a timely report that spotlights innovative approaches to improve cancer screening uptake nationwide and calls for expanding evidence-based programs to better address equity in cancer screening access and outcomes. The report, Closing Gaps in Cancer Screening: Connecting People, Communities, and Systems to Improve Equity and Access, identifies four critical goals to improve cancer screening rates and close gaps in screening access:

  1. Improve and align cancer screening communication;
  2. Facilitate equitable access to cancer screening;
  3. Strengthen workforce collaborations to support cancer screening and risk assessment; and
  4. Create health information technology that promotes appropriate cancer risk assessment and screening.

The report recommends “Expand and strengthen National Cancer Roundtables that include a focus on cancer screening” and explicitly acknowledges the NCCRT as an exemplary model to promote evidence-based cancer screening strategies.

Following the release, Steven Itzkowitz, MD, shared: “As Chair of the NCCRT, I’d like to commend the Panel for their focus on the critical need to prioritize cancer screening and, in particular, for their recognition of the national roundtables. For 25 years, the NCCRT has been committed to increasing awareness and access to timely colorectal cancer screening in every community. It’s clear that our work is as important as ever and that our screening efforts are THE opportunity to end colorectal cancer as we know it.”

Permissions: Made publicly available online by the National Cancer Institute at the National Institutes of Health

Publication date: February 2022

Post date: June 13, 2022


NCCN Guidelines for Patients: Colorectal Cancer Screening – 2021

The National Comprehensive Cancer Network (NCCN®) announced the publication of Guidelines for Patients: Colorectal Cancer Screening in December 2021. This free guide for patients and caregivers breaks down the different ways screening can be done and explains the recommended timing according to the latest research. It is available in 18 languages.

The guide is supported in part by NCCRT member Fight Colorectal Cancer.

The NCCN issued a corresponding press release.

Evaluation: NCCN Guidelines for Patients are based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), which are determined by multidisciplinary teams of experts from across NCCN Member Institutions.

Permissions: Made publicly available online by the National Comprehensive Cancer Network.

Publication date: December 2021

Post date: June 13, 2022

Contact: Email




Continuing Education Courses for Healthcare Providers on Colorectal Cancer Screening

To provide up-to-date information on recommended best practices for colorectal cancer screening, the Centers for Disease Control and Prevention (CDC) partnered with Medscape Education to create two continuing education courses for healthcare providers.

In one of these courses, Screening for Colorectal Cancer: Recommended Best Practices (0.5 CME/CNE credits), David Lieberman, MD, of Oregon Health and Science University, leads a video lecture that explains why colorectal cancer screening is important, how to determine the timing and frequency of colorectal cancer screening, recommended stool-based and direct visualization screening strategies, and how to improve screening quality with a programmatic approach and quality metrics.

The second course, CRC Screening and Surveillance: Optimizing Quality (1.0 CME/CNE credits), is a three-part clinical anthology that includes more detail on these topics and explains the role of primary care providers in stool testing and colonoscopy programs.

These free courses are available for continuing education credit. You can create a free Medscape account and view the courses at:  and

Evaluation: The courses were developed by nationally recognized experts in colorectal cancer screening, including primary care clinicians, gastroenterologists, and epidemiologists.

Permissions: Made publicly available online through Medscape Education.

Publication date: March 15 and 24, 2021.

Post date: March 31, 2021.

Contact: Submit comments, questions, and suggestions via the links on the Medscape Education website. 

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:

My CT Colonography Center Locator Tool

The American College of Radiology (ACR) is now offering the My CT Colonography Center online locator, a patient-friendly online tool to find a computed tomography (CT) colonography screening center near you.

Bracco Diagnostics, Inc. originally developed the tool, which includes 120 centers – only a portion of the more than 700 estimated centers that perform CT Colonography (CTC). The ACR will now work with stakeholders to explore ways to achieve the goal of having all facilities that perform CTC registered on a center locator. To date, there are 220 centers registered for the locator tool.

The webpage also includes patient brochures on CTC, a video of a patient receiving a CTC, and more.

Evaluation: This tool was developed as a collaborative effort with Bracco Diagnostic and ACR CTC registry participants discussing a need to increase awareness of CTC screening option for patients.

 Made publicly available online by the American College of Radiology.

Publication date: 
September 2019

Post date: 
April 20, 2020

Submit comments, questions, and suggestions

Nuestras Voces Network Colorectal Cancer Awareness Month Infographic

This bilingual infographic on colorectal cancer was developed by the National Alliance for Hispanic Health’s Nuestras Voces Network Program to raise awareness about the importance of screening, and to promote the information from Centers for Disease Control and Prevention’s (CDC’s) Screen for Life National Colorectal Cancer Action Campaign during National Colorectal Cancer Awareness Month.

This infographic can be shared, posted on social media, printed for community distribution, and customized to include a local organization logo. For more information on how to use this resource in your own community see contact information below.

Evaluation: The content of the infographic was based on evidence-based resources including NCCRT’s 2019 Colorectal Cancer Screening Messaging Guidebook and CDC’s Screen for Life National Colorectal Cancer Action Campaign.

Permissions: Made publicly available online by the National Alliance for Hispanic Health’s Nuestras Voces Network Program. See Contact section below for more information.

Publication date: 2020

Post date: March 30, 2020

Contact: For more information about this infographic and the Nuestras Voces Network Program please contact Marcela Gaitán at

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 Awareness Month Social Media Toolkit – March 2019

This toolkit, developed by the George Washington University (GW) Cancer Center, is designed to help public health professionals establish a Colorectal Cancer Awareness Month social media strategy, implement Facebook and Twitter best practices, disseminate Colorectal Cancer Awareness Month messaging, and manage and evaluate social media efforts.

This toolkit provides a short introduction to use of social media in a health system context, a list of Twitter and Facebook best practices for messages, a list of sample tweets and Facebook posts, other ideas for participating in colorectal cancer awareness month, tips on evaluating social media efforts, and a list of references and other resource links.

Public health professionals, cancer control professionals, coalitions, community-based organizations and stakeholders can all use this toolkit and adapt its messaging for their unique audiences and areas of expertise.

Evaluation: The recommendations and sample messages in the toolkit were designed using evidence-based social media and colorectal cancer messaging best practices.

Evaluation assets: The toolkit includes a section on Measuring Success, which explains how to use analytics to evaluate the impact of social media messages and campaigns.

Permissions: Made publicly available online by the GW Cancer Center.

Publication date: February 2019

Post date: September 2017, revised February 2019

Contact: Send comments, questions, and suggestions to

Penn State Health Electronic Employee Survey

Physician researchers at Penn State Health developed this colorectal cancer screening uptake and risk assessment tool for use by large entities such as employers and medical practices. The survey tool assesses whether an employee is up to date with screening based on 2016 USPSTF guidelines and also includes a risk assessment checklist to determine if the individual is at increased risk for colorectal cancer.

Penn State Health administered the survey to 6,188 employees, with a response rate of 45%. For respondents ≥50 years, 81% reported up-to-date colorectal cancer screening; thirty-three percent of all participants self-identified as high-risk.

Large employers are encouraged to adapt the survey tool and introduction letter for use with their employees.

Evaluation: The survey was administered electronically to all Penn State Health employees ≥40 years via an online platform. The survey anonymously collected demographic data. Associations between demographic/ risk factors and up-to-date screening status were examined using Fisher’s exact test for categorical variables and Wilcoxon Rank-Sum test for quantitative variables.

Permissions: These tools can be used by any large employer to measure their colorectal cancer screening rates.

Publication date: July 2018

Post date: December 18, 2018

Contact: Send comments, questions, and suggestions to Thomas McGarrity, MD at