Citywide Colorectal Cancer Control Coalition (C5)

• C5 Summit: Register for free to attend this coalition-wide event.
• C5 Newsletter: Share your upcoming events and stay updated through this periodic publication.
• Patient and Provider Materials: Readily access patient-facing and provider resources that promote public health efforts, including colorectal cancer screening.
• Professional Networking: Connect and collaborate with other C5 members in scholarly output and outreach efforts.
• Special Symposiums: Participate in opportunities, including NYC Health Department- or C5-sponsored webinars or panels (some with CME accreditation), and be part of a “Call for Topics” to suggest new content.
• Partnership: Increase local individual and institutional cooperation toward public health efforts in NYC.

• Champion best practices of colorectal cancer screening within your practice or institution.
• Conduct outreach and education on colorectal cancer screening.
• Engage in NYC Health Department or C5 activities through the dissemination of resources, ideas and opportunities that promote public health.
• Regularly attend the C5 Summit with the option to share feedback on methods and success of colorectal screening methods in your target population.

The C5 is composed of both individuals who solely represent themselves and individuals who represent institutions, agencies, organizations, or corporations. All of these individuals share a common interest in colorectal cancer.

Becoming a member: Those interested in becoming a member can directly request membership in the C5 by completing the C5 membership form online (Join the Citywide Colorectal Cancer Control Coalition), which will be reviewed by C5 program staff and co-chairs of the C5 Steering and C5 Membership Committees for approval.

Active Membership

Active members may participate in all C5 meetings and activities, including, but not limited to, receiving mailings and notices, joining C5 Subcommittees, voting, and holding elected office within the C5. To maintain active membership, active members are expected to attend one general membership meeting yearly (C5 Summit). Active members are encouraged to participate in at least one C5 Subcommittee.

Eligibility: Individuals eligible for active membership are researchers, educators, healthcare providers, cancer survivors, cancer patients undergoing treatment, patient navigators, administrators, public health workers, and others in roles focused on colorectal cancer, or who represent institutions, agencies, or organizations working toward colorectal cancer prevention, without a limit on the number of individuals per organization. Corporations or industries, and individuals representing corporations or industries, are not eligible for active membership but are eligible for associate membership. Individuals as described above who are also employed by corporations or industries, but who do not represent those corporations or industries, are eligible for active membership but must fully disclose any conflicts of interest.

Associate Membership

Associate members may receive C5 mailings and notices, and may attend one general membership meeting yearly, the C5 Summit, but do not hold privileges of voting nor can they hold elected office within C5.

Eligibility: An interested individual or organization that does not qualify to be, or does not desire to be, an active member may apply for associate membership, with a limit of up to two associate members per qualifying corporation or industry represented. Those businesses that have affiliation with cancer prevention and screening products that aid colorectal cancer screening, prevention and treatment are eligible, and the efficacy of those products must be supported by scientific research.

To maintain associate membership, associate members that are corporations or industry or represent corporations or industry must abide by all of the following criteria: Operate in the New York City area, not solicit products or services to any other C5 members through coalition channels, will not be provided with contact information for other C5 members, and may not use C5 mailing lists or contact information without approval from C5 staff and C5 Steering Committee co-chairs. Associate membership in C5 does not allow use of the C5 logo and cannot be used for an endorsement or promotion of a commercial product or for personal financial gain.

In 2021, the Community Health Survey showed that rate of colon cancer screening for adults ages 45 to 75 in NYC was 63.3% (70.8% among Black non-Latino, 66.6% among White, 62.2% among Latino, and 48.1% among Asian/Pacific Islander adults).

Colorectal cancer screening has contributed to decreased incidence and mortality. However, racial disparities in health outcomes persist. Overall colorectal cancer incidence rates decreased 2.7% yearly from 57.7 to 35.5 per /100,000 population from 2000 to 2018. Mortality rates decreased 3.3% yearly from 19.0 to 10.4 overall, at similar rates for all racial/ethnic groups in NYC from 2001 to 2018. However, colorectal cancer incidence remained higher among Black non-Latino New Yorkers (40.5 per 100,000) than among White (38.9), Latino (32.8) and Asian New Yorkers (35.0) from 2014 to 2018. Black non-Latino New Yorkers also had higher mortality rates (14.8), than White (11.8), Latino (9.8) and Asian New Yorkers (8.5) from 2014 to 2018.

Further C5 efforts are needed to reach the goals of equity in colorectal cancer health outcomes and to achieve the national target of 80% screened.

Practical Approaches to Improving Colorectal Cancer Screening Rates in the Community Healthcare Setting, March 20, 2023

Watch: Practical Approaches to Improving CRC Screening Rates in the Community Healthcare Setting

Learning Objectives:

• Options to increase colorectal cancer screening and improve follow-up of positive stool-based tests.
• Increasing colorectal cancer screening rates and how fecal immunochemical tests (FIT) can be best utilized in NYC community health.
• Strategies to ensure prompt follow-up of positive or abnormal FIT test results with colonoscopies.
• Strategies for overcoming barriers to getting timely FIT+ results followed-up and implementing practice changes to increase colorectal cancer screening rates in communities served.
• Data reconciliation among community health centers and large health systems to increase screening rates.

Evidence and Implementation of New Colon Cancer Screening Guidelines, March 9, 2022

Watch: Evidence and Implementation of New Colon Cancer Screening Guidelines

Learning Objectives:

• Review recent trends in colorectal cancer (CRC) incidence in the US and NYC.
• Discuss updates on new CRC screening guidelines to start screening at age 45.
• Understand the yield of neoplasia and adenoma detection rates in 45 to 49 year olds.
• Understand the challenges and possible solutions on how to reach this new age group.
• Identify and reduce racial and ethnic health disparities in CRC screenings.
• Review current and future options for CRC screening.

Colorectal Cancer Screening in the Post-Pandemic Era, June 23, 2021

Watch: Colorectal Cancer Screening in the Post-Pandemic Era

Learning Objectives:

• Highlight the NYC screening guidelines and the updated USPSTF guidelines.
• Describe NYC screening rates pre-COVID-19.
• Identify the barriers of colorectal cancer (CRC) screening during the COVID-19 pandemic and the racial/ethnic and socioeconomic disparities.
• Compare CRC testing alternatives.
• Review common pitfalls and challenges in CRC screening and discuss ways to address them including through the use of telehealth.

C5 advises the Health Department in the development of colorectal cancer screening recommendations specifically tailored to the local health care environment. In 2020, these local recommendations were updated to address new data on increasing risk of colon cancer at younger ages and to increase screening rates, by encouraging patient choice and promoting shared decision making.

Recommendations for NYC health care providers:

• Screen individuals at average risk of colorectal cancer beginning at age 45.
• Screen individuals at average risk using the following options:
• Colonoscopy every 10 years OR
• Stool-based testing at recommended intervals and all positive results must be followed up with a timely colonoscopy
• Options include a fecal immunochemical test (FIT) annually, a high-sensitivity guaiac-based fecal occult blood test (HSgFOBT) annually, or a multi-target stool DNA test (FIT-DNA) every three years
• Individuals at familial or other increased risk may need to be screened before age 45. Consult a specialist for screening recommendations

C5 created the Direct Referral for Screening Colonoscopy (DERS) (PDF) form to streamline referrals for colonoscopies by eliminating pre-procedure consultations for eligible patients.

Primary care physicians can use the DERS form to assess their patients and identify those who are eligible for direct referral for colonoscopy. A referral that takes only one visit is more likely to result in a patient following through with a colonoscopy.

From 2011 to 2015, the Colonoscopy Quality Initiative (CQI) improved the quality of screening colonoscopies in the city and identified disparities in the quality of screening colonoscopies. The Health Department collected and analyzed data and disseminated collected performance reports to participating providers. Over the course of the initiative, nearly 300 endoscopists representing 21 sites reported site-level information on eight quality measures for roughly 95,000 screening colonoscopies. The Health Department also provided technical assistance to support accurate and complete data submission.

CQI is funded by the Centers for Disease Control and Prevention, the New York State Department of Health and the Fund of Public Health in New York.

• 2022: Bridging the CRC Screening Gap to Achieve Health Equity (Virtual Summit)
• 2020: Colorectal Cancer (CRC) Prevention in NYC in the Time of COVID-19 (Virtual Summit)
• 2018: Becoming a Change Agent for Colorectal Cancer Prevention in your Organization
• 2014: Increasing Colorectal Cancer Screening: Addressing Patient and Systems Barriers
• 2013: Practicing Prevention in a Changing Healthcare Environment: The Affordable Care Act
• 2010: Addressing Disparities in Colorectal Cancer Screening, Treatment and Outcomes
• 2009: Increasing High Quality Colorectal Cancer Screening in NYC
• 2008: Eliminating Barriers to Colonoscopy Screening in NYC
• 2007: Accepting the Challenge: Doubling Colonoscopies in NYC Through Partnerships
• 2006: Identify and Promote Community-Based Strategies to Increase Colorectal Cancer Screening Rates Throughout NYC
• 2004: Tackling Inequality in Cancer Prevention and Control
• 2003: Colorectal Cancer Screening Issues for the 21st Century

The Steering Committee governs C5 coalition operations, oversees subcommittees and provides recommendations to the Health Department. This committee also plans colorectal cancer prevention initiatives that stakeholders can implement in their respective institutions or programs. Additionally, it confirms new subcommittees, identifies new members and expands the reach of the City’s colorectal cancer initiatives.

The Membership Committee oversees new member outreach and communication to increase citywide participation in C5 colorectal cancer activities. Membership can be requested at the link: Join the Citywide Colorectal Cancer Control Coalition (C5).

The Risk Assessment and Screening Committee focuses on appropriate risk assessment and increased adherence to CRC screening across all racial and ethnic groups in NYC. Approaches include improving access to care and decreasing disparities by providing patients with more accessible methods.

The Colonoscopy Quality Committee aims to improve the quality of screening colonoscopy by developing educational initiatives and tools for providers and their staff.

The Community Health Center Committee works to improve access to appropriate, timely and quality screening colonoscopies for uninsured patients at community health centers. This committee supports the work of the NYC Community Cares Project.

Since 2003, the Health Department has issued NYC-specific colorectal cancer screening guidelines (PDF). The Screening Guidelines Committee is an advisory panel that reviews these guidelines and recommends revisions as necessary.

As part of the City’s efforts to advance health equity, this committee examines the health inequities relating to colorectal cancer screening, including racial/ethnic and socioeconomic disparities.

The 80% Screened Committee strategizes how C5 can achieve its goal of having 80% of eligible patients in the city receive colorectal cancer screenings.

Publications are listed in reverse chronological order based on publication date.

• Decreased colorectal cancer incidence and mortality in a diverse urban population with increased colonoscopy screening.
• Impact of a Citywide Benchmarking Intervention on Colonoscopy Quality Performance
• New York Citywide Colon Cancer Control Coalition: A public health effort to increase colon cancer screening and address health disparities
• The economic impact of a patient navigator program to increase screening colonoscopy
• Effect of a Patient Navigator Program on the Volume and Quality of Colonoscopy
• Increased Screening Colonoscopy Rates and Reduced Racial Disparities in the New York Citywide Campaign: An Urban Model
• Increased Colonoscopy Volume and Elimination of Racial Disparities are Enhanced by a Patient Navigator Program; Results From the New York City Health Department/C5 Program
• A Public Health Approach to Winning the War Against Cancer
• The volume and capacity of colonoscopy procedures performed at New York City hospitals in 2002
• Colon cancer screening practices in New York City, 2003
• Screening for Colorectal Cancer

• Stool-Based Screening Tests
• Colonoscopy
• Fact Sheets
• Brochures

• Direct Referral for Colonoscopy (PDF)
• Colon Cancer Screening Form (PDF)
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• NYC Health Department CRC Screening Recommendations (PDF)
• Get Checked for Colon Cancer (PDF)
• Birthday Card for Colon Cancer Screening Reminder (PDF)
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