Six Ways States Can Promote Colorectal Cancer Screening and Prevention

March 28, 2018 | Marcus Plescia, Richard Wender

Colorectal cancer is the second leading cause of cancer-related death among Americans, but it is largely preventable through screening and attention to risk factors. State health agencies have a long history of using evidence-based public health approaches to increase colorectal cancer screening rates and partnering with health systems and other national organizations, like the American Cancer Society, to reduce major risk factors. In recognition of National Colorectal Cancer Awareness Month, ASTHO Chief Medical Officer Marcus Plescia and Richard Wender, the American Cancer Society’s chief cancer control officer, identified six ways states can address colorectal cancer.

Colorectal cancer screening is currently recommended for adults over 50 (and earlier for those who may be at increased risk because of family history or certain medical conditions). There are several effective screening tests, but only 67 percent of eligible U.S. adults were up-to-date with colorectal cancer screening as of 2016.

For these reasons, colorectal cancer is one of eight priority areas for the American Cancer Society (ACS), with an emphasis on increasing screening and research efforts and other resources. Two decades ago, ACS joined with CDC to organize national leaders and advocates and launch the National Colorectal Cancer Roundtable (NCCRT), a national coalition that created the 80% by 2018 initiative with the goal of ensuring that 80 percent of adults aged 50 and older are regularly screened for colorectal cancer by the end of this year. Nearly 1,700 organizations—including health plans, medical professional societies, hospital systems, survivor groups, government agencies, businesses, and cancer coalitions—have pledged to make this goal a priority. If we achieve this milestone, an estimated 277,000 colorectal cancer cases and 203,000 colorectal cancer-related deaths will be averted by 2030.  

State health departments have made significant progress toward reducing the burden of cancer across the United States, and many federal, state, and local partners have joined these efforts to increase colorectal cancer screening. For example, CDC’s Colorectal Cancer Control Program currently funds 23 states, six universities, and one American Indian tribe to increase colorectal cancer screening rates among men and women aged 50 to 75 years. Grantees work with health systems, including clinics, hospitals, and other healthcare organizations, to use and strengthen evidence-based strategies that will increase high-quality screening. These programs have already demonstrated significant improvements in screening rates across various systems.

Throughout the nation, ASTHO and its members, along with ACS national and regional staff, and the ACS Cancer Action Network have a legacy of working closely together to address cancer and its associated risk factors. These partnerships have resulted in major successes across other public health areas, including measures to strengthen and enhance tobacco control, breast and cervical cancer screening, school- and workplace-based obesity interventions, and human papilloma virus (HPV) vaccination rates.

With this in mind, here are six ways that states can address colorectal cancer by leveraging the various partnerships and networks described above:

1. Develop strong, statewide coalitions. NCCRT has been highly effective in promoting colorectal screening at the national level. Recently, many states have convened their own roundtables to better organize collaboration across public health, primary care, oncology, researchers, and advocacy groups.  In fact, some type of colorectal cancer collaborative effort is occurring in all 50 states.
2. Coordinate breast and colorectal cancer screening efforts. State health departments receive and distribute resources to promote and provide breast cancer screening services across their states. Many of these women are also eligible for colorectal cancer screening. They should be encouraged to get screened, and these services should be offered and made available to them when they receive their mammograms.
3. Work with state Medicaid programs to track and increase colorectal cancer screening among Medicaid recipients. The expansion of many state Medicaid programs under the ACA to include childless adults means that more adults within recommended screening ages now have access to insurance coverage through state Medicaid programs and, subsequently, greater access to colorectal cancer screening.
4. Work with healthcare systems, health insurance, and Medicare quality improvement organizations.   Seventy-five percent of individuals who have not been screened have health insurance. Develop systems to track and notify those who need to be tested and provide intensive outreach in communities with low screening rates.
5. Increase awareness and advocate for all the different ways to get screened. While colonoscopies and various take-home stool screening tests each have benefits and disadvantages, they are all highly effective. The “best test” is the one that a person is willing to get!
6. Emphasize the link between cancer and behavioral risk factors to encourage policy, systems, and environmental changes that support healthy diets, exercise, and not smoking. Obesity, tobacco use, and heavy alcohol use are risk factors for colorectal cancer and are core priorities for state public health departments.

Few interventions in public health are as effective at reducing mortality as colorectal cancer screening, both through prevention of cancer by removing pre-cancerous polyps and the early detection of highly curable cancers. In fact, colorectal cancer mortality rates have already fallen by over 30 percent. Through the unified efforts of all state health departments and their many partners, like the American Cancer Society, fewer people will ever hear the words that they have colorectal cancer.