TEST - Marilyn 7 July 2026 - Improving Colorectal Cancer Screening in Primary Care - Outcomes of a CME Bulletin Educational Intervention

Background: The Burden of Colorectal Cancer

Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer-related death in the United States. (1) Approximately 150,000 Americans receive a new CRC diagnosis each year, with around 50,000 attributable deaths. (1) Globally, 1.9 million new cases were recorded in 2020, with an estimated 930,000 deaths. (2) These figures firm ly place CRC among the most consequential preventable malignancies in modern medicine. CRC develops through a stepwise progression from adenomatous polyps to invasive carcinoma, a sequence that creates a clear and exploitable window for early detection and prevention. (3) Lifestyle factors including physical inactivity, obesity, alcohol consumption, cigarette smoking, and a diet high in red meat are independently associated with elevated risk. (3) Conversely, high-fiber vegetable consumption confers meaningful protection. (3) At the molecular level, genomic instability, encompassing microsatellite instability (MSI), chromosomal instability, and CpG island methylation, drives carcinogenesis and increasingly informs therapeutic decisions. Targeted ther apies such as cetuximab and immune checkpoint inhibi tors such as pembrolizumab are now standard options for patients with specific molecular profiles. (4) Despite these advances in treatment, prevention through early detection remains the most powerful tool available to clinicians. The 5-year survival rate for CRC detected at a localized stage exceeds 90%, falling to below 15% once the disease has metastasized. The evi dence base for screening is robust: Population screening programs reduce both CRC incidence and mortality. Yet, screening rates in the United States remain suboptimal and disparities compound the problem—African Ameri cans experience higher CRC incidence and mortality than other demographic groups and the American College of Physicians (ACP) recommends screening from age 40 for this population. (5) Closing these gaps requires primary care providers to act as the primary drivers of screening uptake. This report presents the outcomes of a CME edu cational intervention designed to equip them to do so. Rationale for Educational Intervention Family physicians conduct an estimated 192 million pa tient visits annually in the United States, representing 48% more visits than any other specialty. (6) They are the first point of contact for preventive care and the pro fessionals most likely to initiate a screening conversation. Yet, significant knowledge gaps exist across this critical workforce. A formal needs assessment conducted prior to this program identified four discrete gaps: • Gap 1: Epidemiology and risk factors. Many provid ers lacked sufficient depth in CRC epidemiology to communicate the case for screening persuasively to patients. • Gap 2: Screening methods. Awareness of the full range of available tests, including emerging blood-based assays, was uneven, limiting providers’