Although large health systems have implemented programs and initiatives to improve the quality of CRC screening and treatment in their populations, coordinated, population-level public health efforts that reach most, or all, of the US population to address the burden of CRC have been limited (6). The high public health burden of CRC indicates a need for population-level interventions to improve its prevention and control (2). Screening rates are lower among people who have a low annual household income, have no health insurance, have no regular health care provider, identify as a racial or ethnic minority, or have low levels of educational attainment (5). In 2016, 67% of adults aged 50 to 75 reported that they were up-to-date with CRC screening, whereas 26%, or approximately 22 million adults, reported that they had never been screened (4). Despite strong evidence for its effectiveness, too few eligible adults are screened for CRC. The US Preventive Services Task Force (USPSTF) recommends CRC screening for average-risk people aged 50 to 75 by fecal occult blood test (FOBT), fecal immunochemical test (FIT), a combination stool DNA and FIT test (FIT–DNA), computed tomographic colonography (CTC, or virtual colonoscopy), flexible sigmoidoscopy, or colonoscopy (3). If CRC is detected early, the 5-year survival rate (90%) is much higher than when it is detected late (14%) (1). Strong evidence indicates that screening can decrease CRC incidence and mortality by identifying and removing precancerous polyps and by detecting CRC early when treatment is more effective (3). In 2015, an estimated 766,000 person-years of life lost and $9.4 billion in lost earnings were attributed to CRC deaths, second only to lung cancer (2). The public health impact of CRC due to years of potential life lost, the economic burden of lost productivity, and the costs associated with illness and treatment are substantial. In 2016, the most recent year for which data are available, more than 141,000 new cases of CRC were reported, and more than 52,000 people died of the disease (1).
Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States among cancers that affect both men and women (1).
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