Preventing Early-Onset Colorectal Cancer in the VA

Colorectal cancer is a leading cause of cancer death among Veterans. The starting age for colorectal cancer screening has been lowered from 50 to 45 years in response to the rising incidence of early-onset colorectal cancer (EOCRC), but how to best engage younger Veterans in screening is unclear. The investigators will 1) develop and validate a novel risk score for EOCRC derived from the VA electronic health record data, 2) conduct a multilevel screening intervention that targets individuals aged 45-49 years and informs high-risk individuals and their providers about their risk status for EOCRC, and 3) determine barriers and facilitators to implementing the intervention using a qualitative process evaluation. Aim 2 is the focus of the trial. The overall goal of this study is to create and test a risk stratification approach to prevent EOCRC, which may be especially useful for younger individuals who are less likely to participate in preventive care.

Sex

All

Minimum age

45 Years

Maximum age

49 Years

Inclusion Criteria:

* Age 45-49 years at screening

Exclusion Criteria:

* Up-to-date with CRC screening based on the USPSTF guideline (e.g., colonoscopy within the past 10 years or FIT within the past year)
* Prior CRC diagnosis
* Prior total colectomy
* Limited life expectancy (defined as terminal illness, hospice enrollment, or documented life expectancy \<6 months on the medical problem list or a health factor in the EHR
* Deactivated national CRC screening and surveillance reminder (due to risk level or comorbidities)