The Red Section

Am J Gastroenterol 2017; 112:1360–1362; doi:10.1038/ajg.2017.217; published online 8 August 2017

The American College of Gastroenterology and the 80% by 2018 Colorectal Cancer Initiative: A Multifaceted Approach to Maximize Screening Rates

Jordan J Karlitz MD1, Anne-Louise B Oliphant MPP2, David A Greenwald MD3 and Mark B Pochapin MD4

  1. 1Division of Gastroenterology, Tulane University School of Medicine, New Orleans, Louisiana, USA
  2. 2Communications, American College of Gastroenterology, Bethesda, Maryland, USA
  3. 3Division of Gastroenterology, Mount Sinai Hospital, Mount Sinai School of Medicine, New York, New York, USA
  4. 4Division of Gastroenterology, New York University School of Medicine, New York, New York, USA

Correspondence: Jordan J. Karlitz, MD, Division of Gastroenterology, Tulane University School of Medicine, 1430 Tulane Ave, SL-35, New Orleans, Louisiana 70112-2699, USA. E-mail: jkarlitz@tulane.edu

The National Colorectal Cancer Roundtable (NCCRT) was co-founded by the American Cancer Society (ACS) and Centers for Disease Control (CDC) and Prevention in 1997, and is co-funded by these organizations (1, 2). The goal of the NCCRT is to provide strategic leadership, advocacy, and coordination of efforts among coalition members in order to maximize colorectal cancer (CRC) screening. Members include federal health agencies, GI societies, survivor groups, and other national and state health organizations. In 2014, the NCCRT announced a major public health goal of screening 80% of eligible U.S. adults by 2018. This accelerated the U.S. Department of Health and Human Services’ “Healthy People 2020” goal of screening 70% by 2020. The 80% target was chosen specifically for a variety of reasons: the CDC had already set an 80% goal for its Colorectal Cancer Control Program, some states were already approaching 80% (i.e., Massachusetts) and overall an 80% screening target was felt to be ambitious yet attainable and would be a motivating force across the country. Through the leadership and vision of American College of Gastroenterology (ACG) past President Dr Ronald J. Vender and his connection to Dr. Howard K. Koh, who served as United States Assistant Secretary for Health, the ACG was instrumental in the original launch of the 80% by 2018 initiative, working alongside more than 1,000 organizations (3). The purpose of this article is to highlight ACG’s role in these ongoing national efforts.

Currently, wide disparities exist in CRC screening rates, with as many as 75.6% of patients in Massachusetts screened compared to as few as 57.1% in Wyoming (4). Through efforts, some less publicized than others, of ACG committees, ACG Governors, and members, concrete action has been taken to further contribute to overall declining rates of CRC (5). We will review and showcase work the ACG has conducted in a variety of domains, from social media to public policy, to achieve the 80% by 2018 goal.

The Public Relations (PR) Committee oversees the College’s observance of March CRC Awareness Month and has been at the forefront of traditional and social media domains to spread the word on the importance of screening. Twitter, in particular, is very effective to reach both the medical community and the general public. The ACG’s recently developed hashtag ontology list assures that information is disseminated efficiently (6) (Table 1). Through the National Radio Media Tour conducted each March, the ACG reaches millions nationwide (25 million in 2017), relaying key messages on CRC screening. Areas with low screening rates and high CRC incidence and mortality have been targeted. Utilization of national radio syndicates, including Spanish language stations, allows for diverse audiences to be reached.


In 2015, the PR Committee introduced the SCOPY Award (Service Award for Colorectal Cancer Outreach, Prevention and Year-Round Excellence), the first national CRC service award developed in the United States (7). The quality and number of award submissions surpassed expectations. A wide range of initiatives addressing barriers to care were discovered, including multifaceted interventions at large academic institutions and individual providers working on the frontlines in their communities to donate free colonoscopies to the uninsured, organize CRC awareness walks/runs, and offer expertise to local TV and radio stations. Providing ACG members with a formal award recognizing hard work and creative thinking inspires not only awardees, but also others who can intervene in their own communities.

Research conducted by the ACS and CDC revealed that in addition to more obvious barriers to CRC screening, including those related to income and insurance, many patients demonstrate “rationalized avoidance” (8) (Figures 1 and 2). Psychosocial assessment revealed these patients are knowledgeable and possess financial means to access screening, but tend to minimize its importance. ACG PR committee experience demonstrates that utilizing social media, including “calls-to-action” banners, as well as more traditional media outlets, can effectively target this group and others who may have negative connotations of colonoscopy, the bowel preparation, or who feel that screening is unnecessary due to lack of symptoms or family history of cancer.

Figure 1.
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Top barriers to CRC screening. Adopted from the National Colorectal Cancer Roundtable 2016 Communications Guidebook.

Full figure and legend (246K)

Figure 2.
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CRC screening prevalance by insurance. Adopted from the National Colorectal Cancer Roundtable 2016 Communications Guidebook. Other Includes: Military, and other government.

Full figure and legend (63K)

A number of other ACG committees and the ACG Board of Governors have been integral to furthering the 80% by 2018 initiative. The Women in GI committee established an “Education and Promotion of CRC Screening in Women Taskforce” to support the 80% by 2018 pledge. ACG’s Governors are leaders in their states and have worked with state legislatures to issue proclamations and garner support for the 80% by 2018 goal.

The Minority Affairs and Cultural Diversity Committee has led efforts to overcome screening disparities, a major barrier to reaching 80% by 2018, and recently published an updated perspective on the College’s recommendation that African Americans begin screening at age 45 (9) (Figure 3). The African-American population has earlier onset disease and is disproportionately affected by CRC, with incidence and mortality rates that are 25% and 50% higher than Caucasians, respectively. Many African-American patients cite that their healthcare providers have not recommended CRC screening, a key barrier to care (8). A similar finding has been demonstrated in the Hispanic population, where ~50% have not undergone screening. An analysis of ACG website traffic demonstrates that some of the most frequented sections are Spanish language resources, developed by the ACG Patient Care Committee, suggesting that opportunities exist for wide dissemination of impactful educational materials to overcome screening barriers. Efforts have also focused on better understanding CRC screening practices in Native Americans, Asian-American populations, and Pacific Islanders.

Figure 3.
Figure 3 - Unfortunately we are unable to provide accessible alternative text for this. If you require assistance to access this image, please contact help@nature.com or the author

CRC screening prevalance by race/ethnicity. Adopted from the National Colorectal Cancer Roundtable 2016 Communications Guidebook. AI/AN, American Indian/Alaskan Natives.

Full figure and legend (57K)

The ACG National Affairs Committee and the PR Committee have been engaged in federal policy issues centered on CRC screening. Recently, the ACG has participated in Capitol Hill lobby days sponsored by the non-profit CRC advocacy group, Fight Colorectal Cancer. During Fight CRC’s “Call on Congress” in March 2016 and 2017, ACG members traveled to Washington DC, partnering with hundreds of CRC survivors and caregivers. The objective was to advance CRC screening legislative policy issues with members of the U.S. Congress. An important focus with an uncertain future has been the Supporting Colorectal Examination and Education Now (SCREEN) Act (10). Currently, Medicare waives cost sharing for CRC screening modalities recommended by the United States Preventive Services Task Force. However if a positive screening test (i.e., stool test) leads to a subsequent colonoscopy or if a polyp is discovered during screening colonoscopy, “screening” becomes “diagnostic” and increased procedure costs are shifted to the patient. This has enormous implications for those suddenly faced with an unexpected bill, however it may also prevent others from undergoing CRC screening in the first place. The recent “Dent bill” (H.R. 1017) also focuses on assuring that costs associated with polypectomy during screening exams are not shifted to the patient (11).

Significant progress has been made to reach 80% by 2018, however work remains. A multifaceted “call to action” approach is needed to align grassroots efforts, community activity, physician leadership, and national initiatives so that our patients are knowledgeable, empowered, and motivated to get screened. The energy, creativity, and leadership of ACG members have helped to fuel this process. New frontiers will need to be targeted, including the early-onset CRC population, with recently demonstrated rising incidence rates, and geographic hotspots, including parts of the United States southeast that are disproportionately affected by CRC and may be particularly vulnerable due to a relative lack of resources (12, 13, 14). Supporting and participating in newly formed state CRC roundtables, which address unique barriers in local populations, will also be key to achieving the 80% by 2018 (15). With continued engagement, the 80% mark is achievable, and hopefully with homogenous screening uptake in all communities.

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Conflict of interest

Guarantor of article: Jordan J. Karlitz, MD.

Specific author contributions: Manuscript concept: Jordan J. Karlitz, MD. Drafting of manuscript: Jordan J. Karlitz, MD. Critical revision of manuscript: all authors.

Financial support: None.

Potential competing interests: None.

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