Increasing Colorectal Cancer Screening in Health Care Systems Using Evidence-Based Interventions

Amy DeGroff, PhD; Krishna Sharma, PhD; Anamika Satsangi, MPH; Kristy Kenney, MPH; Djenaba Joseph, MD; Katherine Ross, MPH; Steven Leadbetter, MS; William Helsel, MS; William Kammerer, BS; Rick Firth, BS; Tanner Rockwell, BA; William Short, BS; Florence Tangka, PhD; Faye Wong, MPH; Lisa Richardson, MD


Prev Chronic Dis. 2018;15(8):e100 

In This Article

Abstract and Introduction


Cancer is the second leading cause of death in the United States,[1] and colorectal cancer (CRC) is the second leading cause of cancer death among cancers that affect both men and women.[2] There is strong evidence that screening for CRC reduces incidence and mortality rates from the disease either by detecting cancer early, when treatments are more effective, or by preventing CRC through removal of precancerous polyps.[3] The US Preventive Services Task Force recommends CRC screening for people at average risk (aged 50–75 y), using either stool-based tests (ie, fecal immunochemical test [FIT], fecal occult blood test [FOBT], multi-targeted stool DNA test [FIT-DNA]) or tests that directly visualize the colon (ie, colonoscopy, sigmoidoscopy, or computed tomographic colonography [CTC]).[3] Despite availability of these tests, a significant proportion of Americans remain unscreened; in 2016, only 67.3% of age-appropriate men and women were up to date with screening.[4]

Although mortality rates from CRC have declined over time,[5] disparities in incidence and mortality rates continue. In 2014, the most recent year for which data were available, the incidence of CRC among African Americans was 44.1 cases per 100,000, the highest rate among racial/ethnic groups.[2] Similarly, the mortality rate of CRC among African Americans was 18.5 cases per 100,000, compared with 13.8 per 100,000 for whites.[2] Disparities in incidence and mortality rates by socioeconomic factors, insurance status, and geographic areas are also well documented.[6–8] With regard to CRC screening, disparities in screening persist with lower rates among people with low annual household income, with low educational attainment, and who are Hispanic/Latino.[9] The National Colorectal Cancer Roundtable set an ambitious national target of 80% for CRC screening in the United States by 2018 (

The Colorectal Cancer Control Program (CRCCP), funded by the Centers for Disease Control and Prevention (CDC), aims to increase CRC screening rates among medically underserved populations ( The CRCCP funds 23 states, 6 universities, and 1 tribal organization (Figure 1) to partner with health care systems and implement evidence-based interventions (EBIs) recommended by the Community Preventive Services Task Force in the Guide to Community Preventive Services (Community Guide).[10] CDC is leading a comprehensive, multiple methods evaluation to address a range of process, outcome, and cost-related questions. In this article, we present evaluation results for the CRCCP's first program year (PY1), July 2015 through June 2016. Data were collected from October 2015 through April 2017.

Figure 1.

Map Showing Grantees of CDC's Colorectal Cancer Control Program, Program Year 1, July 2015 through June 2016. Abbreviation: CDC, Centers for Disease Control and Prevention.