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November 30, 2004 • Volume 1 / Number 46 E-Mail This Document  |  Download PDF  |  Bulletin Archive/Search  |  Subscribe

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Policies and Events Influencing Colorectal Cancer Screening
An Examination of State Policies and Significant Events that have Influenced Colorectal Cancer Screening

NCI's State Cancer Legislative Database Program presented a poster at the recent meeting of the American Public Health Association on events influencing state policies on colorectal cancer screening. The poster highlighted the influence of NBC Today host Katie Couric on public awareness of screening for colorectal cancer, and is excerpted here. For more information on colorectal cancer screening, see the Special Report "Prostate, Colorectal Screening Affected by Numerous Factors,"NCI Cancer Bulletin, July 20, 2004; information is also available at For additional information on the poster, contact the SCLD program office at

Finding (as of June 30, 2004)
Percentage of States with Laws Mandating Third-Party Reimbursement for Colorectal Cancer Screening
States with Laws Addressing Third-Party Coverage for Colorectoral Cancer Screening
Third-Party Coverage for Colorectal Cancer Screening by Type of Service
Background and Study Overview
  • Despite its prevalence, colorectal cancer has received less attention in general than other types of cancer.
  • We explored the timing and nature of efforts to increase awareness of and screening for colorectal cancer to determine whether there were similar increases in legislative attention to screening for colorectal cancer.
  • We analyzed data on state laws from NCI's State Cancer Legislative Database (SCLD) Program. We also obtained Web-based statistical data, news, and literature on risk factors, symptomology, prevalence, mortality, and various public awareness campaigns.

Prevalence of and Mortality from Colorectal Cancer

  • Colorectal cancers - cancers of the colon and rectum - are the second leading cause of cancer death for both men and women, surpassed only by lung cancer. Colorectal cancer is the third most commonly diagnosed cancer among men and women.
  • The American Cancer Society estimates that 56,730 Americans (28,320 men and 28,410 women) likely will die of colorectal cancer and that another 146,940 new cases (73,620 men and 73,320 women) will be diagnosed in 2004.
  • Incidence has decreased by 3% per year from 1998 to 2000, which researchers have attributed to increased screening and other preventive measures.
  • Colorectal cancers posed the third highest lifetime risk of dying from cancer for both men and women in the United States from 1999-2001. Lung cancer was first for both men and women, prostate cancer was second for men, and breast cancer second for women.

Risk Factors and Symptomology
Linkages posing higher than average risk for developing colorectal cancer:

  • Family or personal history of colorectal cancer
  • Age (risk increases after age 50)
  • Polyps (growths protruding from inner wall of colon or rectum)
  • Ulcerative colitis (causes inflammation and sores in the colon)
  • Diet high in fat and calories and low in fiber
  • Lack of regular exercise
Symptoms* may include the following:
  • Pain, aches, or cramps in the stomach
  • Blood in stool
  • Change in bowel habits
  • Unexplained weight loss
* Many who develop colorectal cancer exhibit no symptoms


  • More states passed laws addressing third-party reimbursement for screening tests as well as awareness resolutions after Ms. Couric's televised awareness campaign and other such activities were undertaken.
  • Ms. Couric's personal interest and high profile efforts provide a unique paradigm for examination because of their apparent efficacy, as confirmed both by reported anecdotal evidence from doctors and scientific study.
  • Another factor contributing to increased screening is the aging of the Baby Boomers who are far more knowledgeable about and active in seeking out preventive health care than earlier generations.
  • For this presentation, we did not quantitatively analyze whether a direct association or correlation exists between the seminal events (e.g., Ms. Couric's efforts) and the state legislative actions.
Significant Events Affecting Colorectal Cancer Screening Policy at State and Local Levels
1993: New Jersey enacts first state law addressing colorectal cancer screening reimbursement, but insurers are required only to offer coverage, not to provide it.
1998: Jay Monahan succumbs to the cancer at age 42, 9 months after diagnosis.

September 1998: First Lady Hilary Clinton launches a public education campaign by the National Colorectal Cancer Roundtable (NCCR) to spur colorectal cancer screening. NCCR is a joint project of the American Cancer Society and the Centers for Disease Control and Prevention.

April 1999: Nebraska becomes first state to adopt a colorectal cancer resolution, declaring April 23, 1999 Colorectal Cancer Awareness Day.
March 12, 2000: Time magazine cover story notes impact of Ms. Couric's efforts to heighten awareness and encourage screening.
2003: Cancer Research and Prevention Foundation sponsors 20-city, year-long Colossal Colon Tour. Traveling under the tag line "Check Your Insides Out," the tour features a 40-foot long, 4-foot crawl-through replica of the human colon.

University of Michigan study published in the Archives of Internal Medicine finds 20% increase in colonoscopies in the 9 months following Couric's March 2000 Today show colorectal cancer awareness campaign, dubbing the phenomenon "The Katie Couric Effect."

May 2004: At the annual conference of the American College of Obstetrics and Gynecologists, results of a survey conducted by Good Housekeeping for NCCRA are announced: 40% of women over 50 reported their doctors never recommended they be screened.
September 2004: A prime researcher who documented the Katie Couric Effect, Dr. A. Mark Fendrick, announces that he is studying the effects of health awareness campaigns by other celebrity spokespersons. He cites "evidence that celebrities can help eliminate the stigma associated with some diseases and encourage people to go to the doctor."
1997: NBC Today show co-host Katie Couric learns husband, Jay Monahan, is diagnosed with colorectal cancer.
March 2000: Katie Couric testifies before Congress on colorectal cancer issues and undergoes on-air colonoscopy to ease fears regarding the procedure. The Today show broadcasts the first in a series of week-long program segments focusing on colorectal cancer, which will air each March.
  • Ms. Couric co-founds the National Colorectal Cancer Research Alliance (NCCRA) within the Entertainment Industry Foundation, which promotes colorectal cancer education, fundraising, research, and early medical screening.
  • President Clinton proclaims National Colorectal Cancer Awareness Month, urging that such cancer screening become a routine part of preventive health care for anyone over age 50, particularly since the risk of developing colorectal cancer increases with age.
May 2000: Report in the journal Cancer documents an overall colorectal survival rate of 61%, which differs by stage. Those whose cancers were detected at Stage I had a 96% survival rate while those whose cancers were detected at Stage IV had only a 5% survival rate.
December 2000: Nine states have laws addressing colorectal screening reimbursement. Four states have resolutions declaring March as Colorectal Cancer Awareness Month.
April 2004: NCCRA and the American Gastroenterological Association release "2004 Colorectal Cancer Legislation Report Card," grading the states on the extent of their colorectal cancer screening coverage requirements.
June 30, 2004: Nineteen states and DC have laws addressing colorectal cancer screening reimbursement. Eleven states have resolutions recognizing March as Colorectal Cancer Awareness Month.
2004: Sponsored by the Cancer Research and Prevention Foundation, the Buddy Bracelet program encourages people to wear a bracelet as a reminder to have colorectal cancer screening, then pass the bracelet on to others once they have been screened.

Regina el Arculli, M.A. • Joanna M. King, J.D. • Jill Freudenwald, M.A.
NCI's State Cancer Legislative Database Program, Bethesda, Maryland •