About the ASGE CRC Screening Project

The ASGE CRC Screening Project was designed to increase colorectal cancer (CRC) screening and completion colonoscopy rates for underserved patients across the US.

More specifically, the project’s goal was to “develop a financially sustainable and replicable model to ensure the timely follow up of colonoscopy following a positive stool-based test in vulnerable populations with best practices that can be broadly expanded across all populations and regions.”

The project’s target outcomes included:

Increasing the CRC screening rate for underserved populations
Reducing the time between abnormal stool-based tests and completion colonoscopy
Gaining a better understanding of the CRC screening continuum
Creating a free online screening and advocacy playbook that can be replicated in various community settings across the US
Developing a sustainable model that can be replicated with public and private funding across the country

ASGE selected Community Health Care Systems (CHCS), a federally qualified health center, and MedChi Network Services (MNS), a subsidiary of the Maryland State Medical Society, to administer developmental projects in Georgia and Maryland.

CHCS cares for a number of uninsured patients in rural parts of middle and east Georgia. MNS worked with the Menocal Family Practice, which cares for a lot of undocumented and Spanish-speaking patients in Frederick, Maryland – which is a city of about 80,000 some 45 miles northwest of Baltimore.

CHCS and MNS assisted hundreds of uninsured patients get screened for CRC using a stool-based DNA test.

CHCS and MedChi used patient navigation professionals to guide these patients thru the full CRC screening continuum.

The patients who elected to participate in the ASGE CRC Screening Project did not have to pay for this care.

ASGE used the data it collected from the projects in Georgia and Maryland to develop this Playbook – as well as an ASGE CRC Screening Project Qualitative Outcomes Report and an ASGE CRC Screening Project Infographics Data Report.

Since the beginning of the project, ASGE has also been advocating for sustainable sources of state funding to ensure that underserved people get screened for CRC and have a timely completion colonoscopy if they have an abnormal stool-based test result. This includes patients who don’t qualify for public healthcare assistance or Medicaid or don’t otherwise have timely access to a completion colonoscopy, including those who can’t afford to purchase a health insurance plan on the federal exchange – even if they are employed and receive a subsidy (see the Step-By-Step Advocacy Strategies section of this Playbook for more information).

ASGE collaborated on this project with physicians and allied health care professionals, patient navigators, legislators and regulators, state and local advocacy organizations, community leaders and other key stakeholders.

The ASGE CRC Screening Project included three phases, including:

Phase One (2023): This included building the project’s foundation (e.g., establishing the project’s metrics and creating the data collection system and patient navigation protocols), selecting the demonstration sites and beginning to educate legislators and other key stakeholders.
Phase Two (2024-2025): This included patient screening, completion colonoscopies, data collection and the aforementioned advocacy efforts in Georgia and Maryland.
Phase Three (2026): This included completing the patient screening and completion colonoscopy efforts in Georgia and Maryland, finalizing the quantitative and qualitative data collection and analysis process and completing this Playbook.

In 2023 and 2025, ASGE hosted national CRC screening summits at its Institute for Training and Technology in Downers Grove, Illinois to address the challenges associated with CRC screening and completion colonoscopy in different regions and communities. Participants included some of the nation’s leading clinicians, patient navigators, advocacy organizations and other key stakeholders. In addition to updates on ASGE’s developmental projects in Georgia and Maryland, the events featured presentations and panel discussions on key issues like quality metrics, model CRC screening programs, technology, open access colonoscopy and blood-based CRC screening tests.

The project teams in Georgia and Maryland consisted of:

ASGE leadership and staff, including a full-time project administrator
The primary site teams, including [part-time] senior leadership, a project champion and allied staff
Primary care physicians and other health care professionals
Gastroenterologists and general surgeons
Patient navigators

ASGE supported the primary sites with funding to cover community outreach, data collection and patient navigation. ASGE also hired government relations consultants to support its advocacy efforts in Georgia and Maryland.

The project was overseen by a blue-ribbon advisory council.

The primary sites recorded patient data in an online form that was created by ASGE. This included information and notes on demographics, quantitative outcomes (e.g., dates screening tests were ordered and resulted), bowel preparation, completion colonoscopy outcomes, the patient navigation process and barriers. This data served as the basis for this Playbook and the ASGE CRC Screening Project Qualitative Outcomes Report and the ASGE CRC Screening Project Infographics Data Report.

ASGE also created an array of outreach and education resources, including brochures, reports, forms, checklists, sample letters (in English and Spanish) and talking points to help primary care professionals discuss CRC test results with their patients.

The patients who elected to participate in the project were required to sign an authorization form.

Finally, ASGE covered up to $1,500 per patient (all-inclusive) for the completion colonoscopies that were required and up to $200 for round-trip transportation costs (e.g., gasoline cards or rideshares) to ensure that patients and their escorts could get to and from their colonoscopy.

The project was funded with grants from Exact Sciences and additional support from Ironwood Pharmaceuticals and Sebela Pharmaceuticals’ Braintree Laboratories affiliate.

Resources

ASGE CRC Screening Project Web Page

Primary Care ASGE Project Workflow Roles

Colorectal Cancer Screening Tests

Today’s CRC screening options include colonoscopy, flexible sigmoidoscopy, CT or virtual colonoscopy, fecal immunochemical (FIT), stool MT-sDNA (Cologuard) and blood-based tests.

It is important to remember that colonoscopy is still required if a stool test or CT scan finds any abnormalities.

Any test is better than no test.

- Jennifer Christie, MD, MASGE, AGAF

Colonoscopy

Flexible Sigmoidoscopy

Colonoscopy is used to detect polyps, which are small growths that develop on the lining of the colon. Removing these polyps significantly reduces a patient’s risk for developing colorectal cancer. During this procedure, the gastroenterologist passes a flexible and slender endoscope tube through the patient’s rectum and into their colon. The gastroenterologist then examines the colon for polyps or any other abnormalities. If they detect any polyps, they remove them using a small device known as a snare that is passed through the endoscope. Most colorectal cancer can be prevented by removing these polyps.

ASGE Understanding Colonoscopy Brochure

A flexible sigmoidoscopy is a test that gastroenterologists perform to examine a patient’s rectum and sigmoid colon for signs of colorectal cancer, although this may not be suitable for finding precancerous polyps in other parts of the colon.

CT or Virtual Colonography

CT or virtual colonoscopy uses specialized x-rays and software to create two- and three-dimensional images of the colon that are used to detect colorectal cancer and polyps.

FIT

A fecal immunochemical test (FIT) is used to detect blood that is hidden in a patient’s stool, which can be an early sign of colorectal cancer. This is a convenient and widely utilized test that people can conduct at home. These tests are normally conducted on an annual basis once a person meets the criteria for colon cancer screening.

Mailed FIT Outreach for CRC Screening

MT-sDNA (Cologuard)

Multi-target stool DNA (mt-sDNA) or “Cologuard” detects blood and identifies biomarkers in the stool that are associated with colorectal cancer and polyps. This is a simple, non-invasive stool test that people can conduct at home.

Blood-Based Tests

ASGE recognizes the potential for blood-based tests to increase CRC screening, especially for patients who are unwilling to use the other screening options. However, ASGE does not recommend that blood-based tests be used as a first line CRC screening option. ASGE has determined that blood-based tests are inferior to colonoscopy and stool-based tests, especially when it comes to detecting advanced precancerous lesions – which can develop into CRC. Despite the increased availability and public interest in blood-based CRC screening, the scientific evidence does not support using these tests as a first line screening tool.

ASGE Position on Blood Tests

The Right Test at the Right Time

There are several ways to get screened for CRC and colon polyps. Primary care physicians and gastroenterologists can help their patients determine which CRC screening test is appropriate for them, keeping in mind that the best method varies for everyone based on their unique history and risk factors.

National guidelines recommend that everyone should be screened for CRC as soon as they turn 45 years old – even if they haven’t exhibited or experienced any problems or symptoms – and patients who have a higher risk of developing CRC may need to be screened before they turn 45 and/or need more frequent screening.

Those who are at higher risk include, but are not limited to, people who have a personal or family history of CRC, people who have had pre-cancerous polyps removed and people who have a long-standing history of inflammatory bowel disease (i.e., ulcerative colitis or Crohn’s disease).

ASGE ultimately believes that the best CRC screening test is the one that gets done.

ASGE The Right [CRC] Test for Your Risk Poster