Preventive Cancer Screenings Quick Reference Guide


Increasing Cancer Screenings With a Focus on Best Practices

Health screenings are a vital aspect of comprehensive health care. Cancer screenings are the best way to identify cancer in the earliest stages, before it causes symptoms and while it is most likely to be curable. Consider these statistics on the national prevalence for breast, colorectal and cervical cancers:

Breast Cancer
1 in 8 women (12.5%) will develop invasive breast cancer over the course of her lifetime.

Colorectal Cancer
149,500 U.S. adults will be diagnosed with colorectal cancer—104,270
cases of colon cancer (roughly the same percentage of cases for men as women) and 45,230 cases of rectal cancer (59% men; 40% women).

Cervical Cancer
About 14,480 new cases of invasive
cervical cancer will be diagnosed this year.

Cancers rank among the costliest diseases to treat. Early detection through preventive screenings may improve the quality of life, improve health outcomes and decrease the total cost of care related to treatment and health maintenance.

Why Cancer Screenings Matter

With the pandemic slowing down annual wellness visits for many people, screenings for all types of cancer have never been more critical. Certain cancers are taking center stage as a priority for physician practices. Breast, colorectal and cervical cancer represent about a quarter of estimated new cases among the most common types of cancer.

  • 281,550 cases Breast cancer
  • 149,500 cases Colorectal cancer
  • 14,480 cases Cervical cancer

1/4 of 1.9 Million Total Cancer Cases that will be diagnosed in 2021

  • 608,570 Cancer Deaths in the United States in 2021

$246 billion in Annual Costs for Cancer Care estimated by 2030

Let’s work together to increase cancer screenings.
Sources: National Cancer Institute, National Center Institute: State Cancer Profile, Centers for Disease Control and Prevention, Vanderbilt Ingram Cancer Center, National Cancer institute: Cancer Trends Progress Report, American Cancer Society’s Cancer Statistics Center

Learn more in the VHAN Quality Measures Toolkit, which provides useful tools and resources to help practices improve quality measures, close clinical gaps and advance patient care.



Strategies for Optimizing Preventive Cancer Screening Engagement

VHAN has collected best practices on cancer screening from across the network and coupled these successful approaches with the data and resources we provide to your practice.

The following roadmap will help identify patient opportunities and optimize engagement by illustrating how practices can apply foundational, intermediate and advanced methods to increase preventive cancer screenings

Take the Practice Assessment

To determine which strategies best apply to your practice, an assessment tool has been developed. The brief assessment below should take about 5-10 minutes to complete. Once the assessment is completed and reviewed, a network quality team member will work with your practice to develop a customized plan.

Foundational Strategies



Find more information on VHAN’s quality measure process in the Quality Measure Toolkit, available on the VHAN Hub.

If your practice needs assistance with chart review to identify patients who would benefit from outreach, contact the VHAN Quality Impact Specialist Team at

Promoting Cancer Screenings in the Primary Care Setting

Annual check-ups are an opportune time to educate your patients about cancer screening options and encourage them to schedule their appointments. Start by assigning a clinic staff member and physician as champions of educational and promotional initiatives. Here are some ideas:

  • Use visual management boards in the primary care clinic to educate staff and patients on national cancer campaigns, such as Breast Cancer Awareness Month in October.
  • Display data on cancer screening rates to build awareness of how early detection saves lives.
  • Create a friendly competition between teams or other practices and offer prizes to incentivize staff to schedule screenings and improve completion rates.



Breast Cancer Awareness Month

National Colorectal Cancer Screening Awareness Month

Cervical Cancer Awareness Month


Increase Colorectal Cancer Screenings With Shared Decision Making

When patients participate in decisions and understand their options, they are more likely to follow through with recommended care. Discussing Colorectal Cancer Screening (CRCS) with patients has been shown in studies to increase compliance:

  • According to CA: A Cancer Journal for Clinicians, in comparing two studies, 74.7% of patients who discussed CRCS with their provider completed the screening. In contrast, only 23.8% completed the screening when no discussion took place.
  • The Colorectal Cancer Screening Messaging Guidebook states that 68% of unscreened people name their doctor as the most trusted source of screening information, yet 60%o f them do not recall discussing CRCS with their doctor.
  • A study in Archives of Internal Medicine found that offering two screening options, including a stool-based screening, can increase compliance over a colonoscopy by 81%.

How to Incorporate Shared Decision Making in Your Practice

  • Incorporate a tool with a standard menu of CRCS options and educate providers on how to use it.
  • Add a menu of CRCS options within the practice EMR with a Best Practice Advisory to prompt shared decision making.
  • Encourage providers to be flexible when explaining CRCS options: Every patient is different.
  • If resources are limited, prioritize decision support for non-compliant patients.

Source: Inadomi JM, Vijan S, Janz NK, et al. Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies. Arch Intern Med. 2012;172(7):575-582.

From the VHAN Front Lines:
Increase Scheduled Mammograms With Creative Process Improvements

One VHAN practice added pink postcards to their clinic workflow to improve the rate of scheduled mammograms. In each exam room, the practice puts a stack of pink cards with clear directions for how to schedule a mammogram and a list of locations.

When patients are due for a mammogram, their provider gives them a card and instructs them to take it to the front desk to schedule their appointment. The scheduler completes the flip side of the card with appointment information. If the patient fails to schedule at check out, the pink card is still a reminder for them to self-schedule when they’re ready.


Cancer Screening Guidelines

Intermediate Strategies


    Increase Colorectal Cancer Screenings With the FluFIT Program

    The American Cancer Society’s FluFIT Program is an innovative way to increase colorectal cancer screenings in primary care settings. When patients come in for their annual flu shot, clinic staff provide a Fecal Immunochemical Test (FIT) kit to those who are also due for colorectal cancer screening. FITs look for hidden blood in the stool, an indicator of colorectal cancer. A study conducted at San Francisco General Hospital showed a dramatic increase in colorectal cancer screenings after implementing a FluFIT Campaign. At the conclusion of flu season, participants in the intervention group who received both a flu vaccine and FIT kit showed an increase in colorectal cancer screening rates from 54.5% at baseline to 84.3% at the conclusion of the study (Phengrasamy et al., 2009). Steps to implementation:

    □  Select a FluFIT Champion.

    □  Establish buy-in from providers, staff and patients.

    □  Create a clinic work-flow process and data capture plan.

    □  Plan a kick-off date for fall to align with flu campaigns.

    □  Order FIT kits in advance.

    □  Train staff on FIT instructions and FluFIT process.

    □  Strongly consider reminder outreach to patients.

    □  Assist all FIT-positive patients with colonoscopy completion.

    □  Assess data after completion of campaign.



    Advanced Strategies

    Creative Patient Outreach

    Consider innovative techniques to encourage patients to get their annual cancer screenings. Here
    are some general ideas, with more targeted to specific cancer screenings on the following pages:

    • Set up automated reminders to be sent via text or phone.
    • Promote self-scheduling via the EMR patient portal.
    • Provide bulk reminder messaging to patients via the EMR patient portal.
    • Send reminder letters with a QR code that directs the patient to schedule via a phone line, website or self-scheduling portal.
    • Use the VHAN quality measure and AWV opportunity reports to call patients in need of a screening. The VHAN Quality Impact Specialist team can assist with phone outreach as well

    Ways to Encourage Breast Cancer Screenings: Mammo Mondays Increase breast cancer screenings with creative
    Increase outreach programs such as Mammo Mondays, which combines an annual mammogram with a spa-like environment to make the experience more pleasant.

    Practices who implemented such programs experienced a 17% average increase in breast cancer screening rates.

    How to implement Mammo Mondays:

    • Provide patients with
      items such as light refreshments and beverages, complimentary shoulder massages, free valet parking, and goodie bags that include masks, water bottles, coupons or donated skin care samples.
    • Arrange for imaging centers to extend hours on Mondays during Breast Cancer Awareness Month in October.
    • Send reminders to women on practice gaps lists who need a mammogram and assist them in scheduling.
    • Track data to report on outcomes after completion of program.


    Ways to Encourage Colorectal Cancer Screenings: FIT Outreach Programs

    Fecal Immunochemical Tests (FITs) are safe and convenient home tests that look for hidden blood in the stool, an indicator of colorectal cancer. A FIT outreach program allows health systems to screen thousands of patients who would otherwise go unscreened—and helps practices achieve colorectal screening performance measures.

    FIT has shown promising results in prompting patients to complete a colonoscopy, which remains the gold standard. Kaiser Permanente Northern California conducted a longitudinal study on an organized CRCS outreach program they implemented using FIT kits. The study found:

    • Patients who received colonoscopy following FIT increased from 41% to 83%.
    • The overall up-to-date status in screening increased from 39% in 2000 to 83% in 2015.
    • Reduction of annual CRC incidence was 25.5%, and the reduction in cancer mortality was 52%.

    Ways to Encourage Colorectal Cancer Screenings: Cologuard Home Tests

    Cologuard is a home test kit that screens for colorectal cancer by detecting altered DNA and the presence of blood in stool. A practice’s quality measure is met for three years with the completion of a Cologuard screening.

    Cologuard has a high sensitivity rate for cancer at 92.3%. Specificity rate is 86.6%. In one 12-month study, 393 patients ages 50-85 who were non-compliant with colorectal cancer screening had an 88.3% compliance rate when offered Cologuard. Out of the 51 patients who were positive, 96.1% were compliant with a follow-up diagnostic colonoscopy.


    Partner With a Vendor for Mailed FIT Outreach

    Some practices partner with preferred VHAN vendor Polymedco to target patients due for CRCS with a FIT test. Polymedco mails patients a FIT test with practice branding, a letter with education on the importance of the test, instructions in multiple languages, and a label with a barcode that includes the patient’s name, date of birth and reference account number. The kit comes with pre-addressed and postage prepaid return mailers to make it easy for the patient to return.

    The practice’s lab of choice receives the kit and processes the test. Results are uploaded to the practice EMR. Polymedco provides a reminder call and text to patients who have
    not returned their kit.


    Partner With a Vendor for Mailed Cologuard Outreach

    Some practices partner with preferred VHAN vendor Exact Sciences to target patients due
    for CRCS with Cologuard test.

    After receiving an order from a practice, Exact Sciences mails a Cologuard kit to the patient’s home. The patient then ships the completed kit back to Exact Sciences at no additional cost. The program features a 24/7 patient support line and reminder phone calls and letters. Results are faxed or mailed to the provider, or they can be uploaded to the practice EMR.


    Ways to Encourage General Cancer Screenings: Optimizing Your Practice’s EMR

    Put your EMR to work for you to help alert you to patients who need cancer screenings. Here are a few best practices:

    • Set up automated flags within the patient’s chart to alert providers that a test is needed. A resource like the Health Endeavors EMR Connector Tool can also alert providers
      about open measures for the Medicare population.
    • Create best practice advisories to remind providers about preferred guidelines. Train providers and care team members to view outpatient whiteboard health maintenance indicators.
    • Build benchmark reports to organize outreach and track outcomes.
    • Use bulk-ordering capabilities for home test kit campaigns.
    • Build self-scheduling options within the patient portal.
    • Establish data exchange with payors. Incorporate automated coding within the EMR to alert payors that a test has been completed or excluded.


    Payor Attestation Opportunities

    VHAN facilitates payor portal access and training to help practices attest quality measures that are showing as completed in the practice EMR but the payor data shows as incomplete. Our VHAN Quality Impact Specialty Team is available to assist with attestation within the requested payor portals. Contact the team at



    Next Steps

    • Complete the online practice assessment to benchmark your current performance. Your responses will be reviewed by your VHAN team and used to offer specific recommendations.
    • Review your practice’s dashboard and reports located in your Box folder. If your practice needs assistance with chart review to identify patients in need of outreach, contact the VHAN Quality Impact Specialist Team at
    • Visit the VHAN Hub to review both provider- and patient-facing resources, including payor cancer screening incentives. The VHAN quality team is constantly working to update those tools and resources to provide you with the latest information.