Promoting early detection tests for colorectal carcinoma and adenomatous polyps

A framework for action: The strategic plan of the National Colorectal Cancer Roundtable


  • Bernard Levin M.D.,

    Corresponding author
    1. Division of Cancer Prevention, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
    • Division of Cancer Prevention—203, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030
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    • Fax: (713) 792-0629

  • Robert A. Smith Ph.D.,

    1. American Cancer Society, Atlanta, Georgia
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  • Gabriel E. Feldman M.D., M.P.H., MBA,

    1. New York City Department of Health and Hygiene, New York, New York
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  • Graham A. Colditz M.D.,

    1. Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
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  • Robert H. Fletcher M.D., M.Sc.,

    1. Department of Ambulatory Care and Prevention, Harvard Medical School, Cambridge, Massachusetts
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  • Marion Nadel Ph.D.,

    1. Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • David A. Rothenberger M.D.,

    1. Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, Minnesota
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  • Paul S. Schroy III M.D.,

    1. Department of Gastroenterology, Boston University, Boston, Massachusetts
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  • Sally W. Vernon Ph.D.,

    1. Center for Health Promotion and Prevention Research, University of Texas-Houston School of Public Health, Houston, Texas
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  • Richard Wender M.D.,

    1. Department of Family Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
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  • National Colorectal Cancer Roundtable

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    • The following are National Colorectal Cancer Roundtable Member Organizations: Association of State and Territorial Health Promotion and Public Health Educators, Agency for Healthcare Research and Quality, Alliance of Community Health Plans, American Academy of Family Physicians, American Association of Health Plans, American Cancer Society, American College of Gastroenterology, American College of Obstetrics and Gynecology, American College of Physicians-American Society of Internal Medicine, American College of Preventive Medicine, American College of Radiology, American Gastroenterological Association, American Medical Association, American Medical Women's Association, American Society for Gastrointestinal Endoscopy, American Society of Colon and Rectal Surgeons, Association of State and -Territorial Chronic Disease Program Directors, Boston Medical Center, Cancer Research Foundation of America, Centers for Disease Control and Prevention, Center for Medicare and Medicaid Services Collaborative Group of the Americas on Inherited CRC, Colon Cancer Alliance, Colorectal Cancer Network, Crohn's and Colitis Foundation of America, Inc., Digestive Disease National Coalition Foundation for Digestive Health and Nutrition, Hadassah, Harvard Center for Cancer Prevention, Harvard Medical School, Health and Medicine Council of Washington, Intercultural Cancer Council, Memorial Sloan-Kettering Cancer Center, Minnesota Colorectal Cancer Initiative, National Cancer Institute (National Institutes of Health, Department of Health and Human Services), National Caucus and Center on Black Aged, Inc., National Colorectal Cancer Research Alliance, National Committee for Quality Assurance, Presbyterian Medical Center, STOP Colorectal Cancer Foundation, Society of Gastroenterology Nurses and Associates, Inc., Stony Brook University, United Ostomy Association, University of Minnesota Cancer Center, University of Texas at Houston School of Public Health, and The Wellness Community – National. The following organizations are corporate affiliates: The Eric Davis Foundation, Exact Laboratories, Inc., Hoffman LaRoche, Inc., Olympus America, Sanofi-Synthelabo, and Pharmacia Corporation.



The purpose of the current study was to provide health professionals, professional organizations, policy makers, and the general public with a practical blueprint for increasing the practice of screening for colorectal carcinoma (CRC) and adenomatous polyps over the next decade. The National Colorectal Cancer Roundtable (NCCRT) was founded in 1997 by the American Cancer Society and the Centers for Disease Control and Prevention to provide strategic leadership, advocacy, long-range planning, and coordination of interventions targeted at reducing the disease burden of CRC through education, early detection, and prevention. The NCCRT and its three workgroups include CRC survivors; recognized experts in primary care, gastroenterology, radiology, colorectal surgery, nursing, public policy, epidemiology, and behavioral science; patient advocates; and representatives of health plans and insurers, government, and other organizations.


The NCCRT performed a literature review of published and unpublished data related to CRC screening guidelines, compliance, and barriers to adherence, as well as test effectiveness and cost-effectiveness. Members of the three NCCRT workgroups developed summary reports regarding professional education, public education and awareness, and health policy. A drafting committee developed the final strategic plan from workgroup reports, which was reviewed by the entire NCCRT membership, amended, and subsequently approved in final form.


Although the rationale for population-wide CRC screening is well established, the majority of adults in the U.S. are not currently being screened for CRC. Thus, the nation foregoes an opportunity to reduce CRC-related mortality by an estimated ≥ 50%. To increase CRC screening rates, the issues of patient and physician barriers to screening, lack of universal coverage, lack of incentives to motivate adherence, and expanded infrastructure must be addressed. Cancer 2002;95:1618–28. © 2002 American Cancer Society.

DOI 10.1002/cncr.10890