Colorectal cancer is a significant health challenge, and ranks as the second leading cause of cancer-related death and the third most common type of cancer in the United States, among men and women combined. Each year, over 52,000 people in the U.S. die from colorectal cancer, with more than 5,300 deaths occurring in California alone. While early detection of colorectal cancer through screening can significantly reduce both its incidence and mortality, ensuring that screening programs remain effective and sustainable is no small feat, particularly in the face of uncertain funding. This pressing issue is at the heart of recent research conducted by Dr. Ndukaku Omelu of the California Department of Public Health, and colleagues, who examined the sustainability of colorectal cancer screening strategies implemented through the California Colon Cancer Control Program (or C4P for short), with a particular focus on how these screening programs would fare in the absence of future C4P funding, a program funded by the Centers for Disease Control and Prevention (or CDC for short). More
Dr. Omelu and his team focused on a critical question: Can health systems continue to offer evidence-based interventions (or EBIs for short) for colorectal cancer screening without ongoing financial support from programs like C4P? Their study explored how seven health systems and their 38 satellite clinics, which served underserved communities across California, navigated the challenge of sustaining these vital programs once funding from the CDC ended.
Colorectal cancer often develops from precancerous polyps in the colon or rectum. Screening tests such as the Fecal Immunochemical Test (or FIT for short) can detect these polyps early, sometimes even before they turn into cancer. FIT is a simple, noninvasive test that checks for hidden blood in the stool, an early warning sign of colorectal cancer. Compared to colonoscopy, which requires a more intensive preparation and procedure, FIT is more accessible, affordable, and easier to encourage among large populations. Part of the attractiveness of FIT lies in its convenience, requiring participants to provide a simple stool sample, rather than undergo an invasive colonoscopy, which would deter many participants in a routine screening program.
At the time C4P intervention was implemented, the U.S. Preventive Services Task Force recommended regular colorectal cancer screening for adults aged 50-75 (it has since been changed to 45-75), yet screening rates remain stubbornly low in many communities. The C4P program, funded by the Centers for Disease Control and Prevention, aimed to boost colorectal cancer screening rates in California by supporting health systems in implementing proven strategies.
These strategies, known as evidence-based interventions (EBIs), included patient reminders. These involved personalized message via letters, emails, text messages, or phone calls that aimed to alert patients when they were due for a screening. The system also included electronic alerts within patient health records that prompted doctors and nurses to recommend screening during visits. The EBIs also included supporting activities such as small media campaigns involving informational materials, brochures, posters, and videos designed to educate and motivate patients about colorectal cancer screening. Another key aspect was patient navigation services, where trained health workers guided patients through the often confusing healthcare process, helping them schedule tests, overcome language barriers, and address transportation issues. Community health workers were another key EBI resource and provided supporting activity. These local health advocates, often from the same communities they serve, provided culturally relevant education and support for colorectal cancer screening.
Dr. Omelu’s research revealed both promising successes and significant challenges. The study found that 100% of clinics sustained provider reminder systems (that remind healthcare staff a patient is due for screenings) and professional development initiatives. This suggests that once integrated into routine clinical workflows, these strategies became part of the daily practice, requiring minimal additional funding. 84% of clinics maintained patient reminder systems. Automated systems for patient outreach, like text message reminders, were relatively easy to keep running even without external funding. 71% of clinics continued small media campaigns. Many clinics had developed materials that could be reused without ongoing costs.
However, the situation was far more precarious for more personalized and resource-heavy interventions. Only 26% of clinics sustained patient navigation services. These services rely heavily on dedicated staff to work one-on-one with patients, a role that often disappears when funding vanishes. Just 21% retained Community Health Workers. Despite their crucial role in reaching marginalized populations, many clinics could not afford to keep such staff. 61% of clinics reported they lacked the funding stability to maintain colorectal cancer screening efforts long-term. Without secure financial resources, core supporting activity strategies like patient navigation and community outreach were at risk.
Funding stability emerged as the linchpin of sustainability. Programs such as patient navigation and Community Health Worker support require staffing, training, and community engagement, all of which depend on reliable funding. Clinics with strong financial support were far more likely to maintain these high-impact services. For example, the clinics that could sustain patient navigation were often those serving insured populations, allowing them to bill for some services. In contrast, clinics primarily serving uninsured patients found themselves unable to continue offering these personalized services.
The study also highlighted structural barriers beyond funding. Transportation issues, limited clinic hours, and language barriers were all cited as ongoing challenges to colorectal cancer screening access. Without patient navigators and Community Health Workers, these obstacles become even harder to overcome.
Dr. Omelu and his colleagues stress that sustainability doesn’t happen by accident, it requires deliberate planning and collaboration. They recommend that health systems integrate colorectal cancer screening into core operations. By embedding patient reminders, provider prompts, and data tracking into everyday workflows, clinics can reduce their reliance on temporary funding.
Clinics can also strengthen partnerships. Collaboration with organizations such as the American Cancer Society and local health departments can provide additional resources and support. Seeking additional funding sources could also help. Exploring multi-agency grants, state health programs such as Medi-Cal, community fundraising, and other stakeholder-based funding can help fill financial gaps. Investing in data and technology may also help to bridge the gap. Optimizing electronic health records ensures that clinics can track patient progress, identify screening gaps, and sustain key interventions with minimal cost.
Ultimately, Dr. Ndukaku Omelu and his team’s work highlights a critical truth: fighting colorectal cancer is about more than just medical tests, it’s about building systems that last. Their research offers a blueprint for sustaining colorectal cancer screening programs and many other public health programs, even in the face of funding challenges. As we move forward, their insights remind us that a healthier future requires not only innovation but also commitment, collaboration, and strategic planning.
Colorectal cancer is preventable, but only if the tools and support systems needed to catch it early are kept alive. With the right strategies, we can ensure that every community, regardless of funding cycles, has access to life-saving screening programs.
