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. 

2022 Messaging Guidebook for Black & African American People: Messages to Motivate for Colorectal Cancer Screening 

Black and African American people experience disproportionately high incidence and mortality rates from colorectal cancer (CRC), with CRC death rates almost 40% higher than those of white people. While screening is only one element of the work that needs to be done to address these CRC disparities, it is important to promote screening in the best way possible.

The 2022 Messaging Guidebook for Black & African American People: Messages to Motivate for Colorectal Cancer Screening is intended to provide you with information and tools to help you work towards closing disparity gaps by using effective, tailored cancer screening messaging to help motivate people to get screened.

 

Learn More

The guidebook is a supplement to the 2019 Colorectal Cancer Screening Messaging Guidebook: Recommended Messages to Reach the Unscreened. Based on the 2019 market research findings, the NCCRT and the American Cancer Society set out to gain a deeper understanding of the barriers to screening that Black and African American people face through our market research. The overall goal of the research was to: 

  • Gain a deeper understanding of the barriers to being screened 
  • Understanding healthcare behaviors and perceptions 
  • Understand how systemic racism and social injustice impact the Black community’s experiences within the healthcare system 
  • Uncover different motivators to encourage screening
  • Identify preferred and trusted information sources 
  • Gather reactions to potential messaging and messaging aspects to identify what elements of messaging will be most effective

This guidebook shares the findings and recommendations gathered from that research and is further designed to help educate, empower, and mobilize those not getting screened for colorectal cancer. Our vision is that our partners and advocates in the field use this guidebook to strengthen their communication campaigns and create resources that resonate with Black and African American communities.

View the June 21, 2022 webinar introducing the messaging guidebook.

Additional NCCRT market research and messaging guidance:

The NCCRT would like to thank the Public Awareness & Social Media Strategic Priority Team members and Advisory Committee, who generously offered their time and expertise to develop this guidebook’s research and content. We want to extend a special thank you to Quest Diagnostics, the Association of Black Gastroenterologists and Hepatologists, and Elevance Health Foundation for their support and guidance in conducting the market research and developing this guidebook.

Spread the Word

Black and African American adults experience disproportionally higher incidence and mortality rates from colorectal cancer. The National Colorectal Cancer Roundtable’s newly released messaging guidebook provides market-research findings and research-tested messages to encourage unscreened Black and African American adults to seek colorectal cancer screening. https://www.nccrt.org/Black-Messaging-Guidebook  

Only 65% of Black adults aged 50 and older are up to date with potentially life-saving colorectal cancer screening. Download the newly released National Colorectal Cancer Roundtable messaging guidebook to uncover motivators and potential messaging mechanisms to encourage regular colorectal cancer screening among Black and African American adults. https://www.nccrt.org/Black-Messaging-Guidebook

Black & African American adults experience disproportionally higher incidence & mortality from #colorectalcancer. This new @NCCRTnews messaging guidebook can help strengthen your communications to promote #CRC screening. https://www.nccrt.org/Black-Messaging-Guidebook #80inEveryCommunity #getscreened

1 in 3 Black adults aged 50+ are not up to date with potentially life-saving #colorectalcancer screening. Download the new @NCCRTnews messaging guidebook for research-tested messages to encourage #CRC screening: https://www.nccrt.org/Black-Messaging-Guidebook #80inEveryCommunity #getscreened

Brief version:

The National Colorectal Cancer Roundtable’s newly released 2022 Messaging Guidebook for Black & African American People: Messages to Motivate for Colorectal Cancer Screening  highlights new market research focused on identifying barriers to colorectal cancer screening, understanding preferred and trusted sources for receiving healthcare information, and research-tested messages to help encourage unscreened Black and African American people to seek colorectal cancer screening.

Long version:

The National Colorectal Cancer Roundtable’s newly released 2022 Messaging Guidebook for Black & African American People: Messages to Motivate for Colorectal Cancer Screening  highlights new market research focused on identifying barriers to colorectal cancer screening, understanding preferred and trusted sources for receiving healthcare information, and research-tested messages to help encourage unscreened Black and African American people to seek colorectal cancer screening.

Black and African American people experience disproportionately high incidence and mortality rates from colorectal cancer, with colorectal cancer death rates almost 40% higher than those of white people. While screening is only one element of the work to address these colorectal cancer disparities, it is essential to promote screening in the best way possible. This new guidebook is intended to provide recommendations to enhance marketing and communication efforts while providing tools to strengthen communication campaigns that resonate with Black and African American communities. 

Webinar – 2022 Messaging Guidebook for Black & African American People: Messages to Motivate for Colorectal Cancer Screening – June 21, 2022

This webinar provided an introduction to the 2022 NCCRT Messaging Guidebook for Black & African American People: Messages to Motivate for Colorectal Cancer Screening

Speakers:

  • Kaitlin Sylvester, MPA, Director, NCCRT – Programs & Partnerships
  • Folasade (Fola) P. May, MD, PhD, MPhil, Director of Gastroenterology Quality, UCLA Health
  • Michelle Aubertine, MBA, Project Consultant, KS&R
  • Adjoa Anyane-Yeboa, MD, MPH, Gastroenterologist, Massachusetts General Hospital, Harvard Medical School

Attendees received an overview of the NCCRT market research findings, learned about identifying barriers to CRC screening, understanding preferred and trusted sources for receiving healthcare information, and learned which research-tested messages could help encourage unscreened Black and African American people to seek CRC screening.

 

How Can Survivors & Families Save More Lives from Colorectal Cancer?

This newly updated brief shares how survivors and families can help advance the national effort to reach colorectal cancer screening rates of 80% and higher in adults ages 45 and older.

How Can Employers Save More Lives From Colorectal Cancer?

This newly updated brief shares how employers can help advance the national effort to reach colorectal cancer screening rates of 80% and higher in adults ages 45 and older.

Ready to take your work to increase colorectal cancer screening in the workplace to the next level? Download the NCCRT’s 80% In Every Community Employer Challenge Guide for a comprehensive, step-by-step guide including tools, resources and messaging to effectively increasing timely, quality colorectal cancer screening in the workplace.

How Can Women’s Health Providers Save More Lives from Colorectal Cancer?

This newly updated brief shares how women’s health providers can help advance the shared goal to reach colorectal cancer screening rates of 80% and higher in adults ages 45 and older.

NCCRT would like to thank the American College of Obstetricians and Gynecologists for supporting the development of this resource, and for their longtime commitment to advancing colorectal cancer screening as an NCCRT member. 

 

 

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.

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.

2019 Colorectal Cancer Screening Messaging Guidebook: Recommended Messages to Reach the Unscreened

In 2018, the NCCRT and the American Cancer Society researched screened and unscreened populations to better understand and address screening disparities. The goals of the market research were to:

  • Measure general awareness of colorectal cancer screening methods.
  • Understand the rationale, attitudes, and motivations for being screened or not.
  • Analyze priority populations such as adults aged 50-54, rural dwellers, and the marketplace insured.
  • Identify logical and emotional drivers that could encourage screening.
  • Use the drivers to create and test messages that would motivate unscreened individuals.

This guidebook shares the findings and recommendations gathered from that research and is further designed to help in the education, empowerment, and mobilization of those who are not getting screened for colorectal cancer. Our hope is that our partners can take this research and the recommended messaging provided to strengthen your own communications campaigns, creating resources that resonate with the target audiences even more by using your own creativity, innovation and spokespersons.

The NCCRT would like to thank the Public Awareness and Social Media Task Group members who participated in the conceptualization of this Guidebook’s research and content. Also, a very special thank you to the 80% in Every Community Market Research Advisory Group for their participation, expertise, and oversight. 

Other Guides and Resources: 

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. The 2017 Communications Guidebook is also still a useful resource for developing your messaging campaigns. 

2019 Messaging Guidebook – Table of Contents (Section Downloads Below)

Other tools were developed during the 80% by 2018 campaign and can still help you promote and evaluate your communications:

More communications tools and resources will be coming soon!