How Do We Get to 80% Screening?

Douglas K. Rex, MD, MASGE reviewing Inadomi JM, et al. Clin Gastroenterol Hepatol 2019 Dec 27.

The National Colorectal Cancer Roundtable set a goal of achieving 80% adherence to colorectal cancer (CRC) screening in the U.S. by 2018. No individual state has achieved that level, and most states have adherence rates in the 60% to 70% range.

This review examined the evidence regarding what measures are effective in increasing adherence. The measure with the greatest impact is “outreach,” in which fecal occult blood test kits are mailed to eligible screenees. This has produced an absolute gain in adherence of 21% and was the measure behind the >80% overall CRC screening adherence rate recently reported by Kaiser Permanente in California. The second tool with a major impact is navigation.

Factors with some, but more limited, benefit include financial incentives to complete screening, advising primary care providers of the adherence rates in their patient panels with comparison to colleagues, patient education, and patient reminders. Outreach with mailed fecal blood kits and navigation are also important in achieving adherence to repeated rounds of fecal blood screening. Some evidence indicates that a multi-component approach is superior.

The authors summarized pathways moving forward and recommended that CRC screening be nationalized in the U.S., as it already is in several other countries, in order to provide national programmatic screening.


This review indicates that much of the problem with our persistent lower-than-optimal screening rates in the U.S. is a function of the health care system itself. There is sufficient evidence about how to improve screening rates, but the effort requires organization and sponsorship at the health care system, state, or national program level.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, MASGE

Bio and Disclosures


Inadomi JM, Issaka RB, Green BB. What multi-level interventions do we need to increase the colorectal cancer screening rate to 80%? Clin Gastroenterol Hepatol 2019 Dec 27. (Epub ahead of print) (