A Systems-Level Intervention to Increase Colorectal Cancer Screening in Community Health Centers



Colorectal cancer (CRC) is the second-leading cause of cancer death in the United States. Despite compelling evidence that screening and early detection reduce CRC incidence (new diagnosis) and mortality (death), less than 50 percent of adults are up-to-date with CRC screening recommendations. CRC screening rates are also low in the local region. PECaD Colorectal Cancer Community Partnership members have identified low screening rates as a priority to reducing significant CRC cancer disparities in screening, stage of diagnosis and survival.


This project works with safety-net health centers in St. Louis city and St. Louis County in Missouri; in East St. Louis and St. Clair County in Illinois; and in the Bootheel region of Missouri. It tests the effectiveness of community health center-selected, systems-level, evidence-based interventions for increasing rates of CRC screening. The control condition will be usual care, but the study uses a cluster-randomized delated start so, in concordance with community partner wishes, clinics in the control group will have access to the intervention after the intervention clinics.

The primary outcome of this study will be CRC screening adherence as measured by self-report surveys of a random sample of health center patients. The evaluation is informed by a chart audit to assess screening referral and completion, and interviews with physicians, staff and administrators at the health centers. This study was developed and is being conducted adhering to the principles of community-based participatory research (CBPR) working with the PECaD Colorectal Cancer Community Partnership.


The project team has enrolled the first set of local health clinics and has prepared several intervention proposals for them based on staff interviews. The centers have been presented with their intervention proposals, and the project team is waiting for their final selections before proceeding. Additional health centers across Missouri have expressed interest in participating in the project, and plans are in place to enroll some of these clinics in summer 2012. As implementation of the intervention begins on a rolling basis, follow-up data will be collected, and the project team will begin preliminary data and manuscript preparation.


National Cancer Institute at the National Institutes of Health (U54 CA153460)

Project staff

Aimee James, PhD, MPH, MA (Primary Investigator, Washington University)
Graham Colditz, MD, DrPH (Co-Investigator, Washington University)
Jean Wang, MD, PhD (Co-Investigator, Washington University)
Yan Yan, MD, PhD (Co-Investigator, Washington University)

Colorectal Cancer Community Partnership (Collaborators)
Matthew Brown, MPH (Research Study Coordinator, Washington University)

Contact information

Aimee James, PhD, MPH, MA (link to SCC profile)
Phone: 314-454-8300
Email: jamesai@WUSTL.EDU