Djenaba A. Joseph, MD, MPH Medical Director, Colorectal Cancer Control Program, Division of Cancer Prevention and Control, NCCDPHP

1. CDC’s Colorectal Cancer Control Program
Djenaba A. Joseph, MD, MPH
Medical Director, Colorectal Cancer Control Program
Center for Disease Control and Prevention
Division of Cancer Prevention and Control
Division of Cancer Prevention and Control
Centers for Disease Control and Prevention

2. CDC
Office of Non-Communicable Diseases, Injury, and
Environmental Health
National Center for Chronic Disease Prevention and Health
Promotion
Division of Cancer Prevention and Control

4. CRC Demonstration Screening Program
2005-2009
• CDC designed CRC demonstration screening program
– To determine feasibility of establishing organized screening
program for underserved population using federal funds
– To learn how best to implement CRC screening at
community level
– To explore NBCCEDP model
– To inform current and future organized CRC
screening efforts

5. Clallam County King County
Nebraska
St. Louis
Jefferson County
Suffolk County
Baltimore City
Colorectal Cancer Demonstration Screening Sites
2005-2009

6. COLORECTAL CANCER
CONTROL PROGRAM (CRCCP)
2009 - 2014

7. CRCCP State & Tribal Grantees
CRCCP State Grantees and Tribal Grantees Funded 2009–11
Fiscal
Year
2010
Awarded
$26.9 M
to 25
states
and 4
tribal
groups

8. Goals
Colorectal Cancer Control Program
• Increase high-quality CRC screening
among persons 50 years and older to
80% nationwide by 2014.
• Reduce disparities in CRC burden,
screening and access to care.

9. Colorectal Cancer Control Program
• Two broad functions that are parallel, but separate tracks
in terms of program development and evaluation
planning:
• Providing CRC screening to low-income, un- and under-
insured men and women
• Promoting CRC to all persons, insured and uninsured
who are aged 50 and older for whom CRC screening is
recommended
• Both contribute to achieving our program goal to
increase CRC screening rates to 80% at the population-
level by 2014

10. Providing CRC Screening
• Direct service delivery of CRC screening and
diagnostic services to target population:
– Men and women aged 50 – 64 years
– Underinsured or uninsured for screening services
– 250% Federal Poverty Level or lower

11. CRC Screening Test Options
 USPSTF
 Colonoscopy
 High-sensitivity gFOBT or FIT
 Flexible sigmoidoscopy with HS-gFOBT or FIT

12. Promoting CRC Screening
• Implementation of activities aimed to
increase population-level screening rates:
– Policy
– Health Systems
– Health Care Providers
– Public Awareness and Education
– Strategic Partnerships
– Communities

13. Community Guide Goals
• Systematic reviews of
interventions to promote
health and prevent disease
• Evidence-based
recommendations issued
by the Task Force
• Highlight important
research gaps

14. Grantee Required Activities
CRCCP Program Framework
1. *Client reminder systems (esp where large
populations reached)
2. *Small media (well designed, audience-appropriate
informational or motivational videos, brochures, newsletters,
checklists)
3. *Structural barriers (Patient navigator programs to
address identified barriers)
4. *Provider assessment and feedback
5. *Provider reminder systems

15. A Social Ecological Model
15

16. Program Logic Model (Simplified)
16

17. Implementation, Outcome, Impact Evaluation
 Implementation
 Outcomes – Secondary analysis of BRFSS and
USCS data on annual basis
 Impact – Quasi-experimental control-group design
with pre and post testing with six states

18. Evaluation
Implementation,
Outcome and Impact
Clinical Services
Program
Cost
Indirect/non-medical

19. CRC Screening Promotion Achievements and
Challenges by Partner Type, Year 1
Partner Type Achievements Challenges
Private and nonprofit health care  Recruit individuals for CRC screening  No significant challenges
systems
Federally Qualified Health Centers  Recruit individuals for CRC screening  No significant challenges
 Implement patient navigation
Private health insurers  Implement patient and provider  Scheduling a meeting with staff
reminder systems
 Agreeing on shared goals
 Influencing partner to view CRC
screening as a priority
State Medicaid office  Develop a small media campaign  Identifying the right person to contact
 Support insurance enrollment  Scheduling a meeting with staff
 Promote use of performance measures  Agreeing on shared goals
(HEDIS)
Employers and work sites  Recruit individuals for CRC screening  Agreeing on shared goals
 Education of employees regarding the  Influencing partner to view CRC
importance of CRC screening screening as a priority
 Identifying ways for partner to
contribute
Professional organizations  Drafted/supported the passage of CRC  Identifying the right person to contact
screening legislation
 Scheduling a meeting with staff
 Recruit individuals for CRC screening
 Influencing partner to view CRC
screening as a priority
 Identifying ways for partner to
contribute
Data Source: Grantee Interim Progress Reports, February 2010

20. CRC Screening Provision
 Clients screened
 14,600
• 7,400 gFOBT/FIT
• 7,157 colonoscopy
 2,050 adenomas
 36 cancers

21. Thank you!
dajoseph@cdc.gov
For more information please contact Centers for Disease Control and
Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
National Center for Chronic Disease Prevention and Health Promotion
Division of Cancer Prevention and Control