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The case for philanthropic investment to increase colorectal cancer screening rates: A novel paradigm to address a public health challenge.

  • Carmeli, Ariel1
  • Dranikoff, Lee2, 3
  • Kundu, Arnab4
  • Ladabaum, Uri5
  • 1 Biden Cancer Initiative, Washington, DC, USA.
  • 2 Colorectal Cancer Alliance Board of Directors, Washington, DC, USA.
  • 3 American Securities, New York, NY, USA.
  • 4 Clarify Health Solutions, New York, NY, USA.
  • 5 Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
Published Article
Cancer Medicine
Publication Date
Dec 05, 2019
DOI: 10.1002/cam4.2745
PMID: 31808317


Colorectal cancer (CRC) remains a leading cause of cancer-related death despite being highly preventable. Efforts to increase participation in CRC screening have not met national goals. We developed a novel approach: building a business case for philanthropic investment in CRC screening. A taskforce representing the public health community, professional societies, charitable foundations, academia, and industry was assembled to: (a) quantify the impact of improving CRC screening rates; (b) identify barriers to screening; (c) estimate the "activation cost" to overcome barriers and screen one additional person; (d) develop a holistic business case that is attractive to philanthropists; and (e) launch a demonstration project. We estimated that of 50 600 CRC deaths annually in the US, 55% occur in 50- to 85-year-olds and are potentially addressable by improvements in CRC screening. Barriers to screening were identified in all patient journey phases, including lack of awareness or insurance and logistical challenges in the pre-physician phase. The cost to activate one person to undergo screening was $25-175. This translated into a cost of $6000-36 000 per CRC death averted by philanthropic investment. Based on this work, the Colorectal Cancer Alliance launched the effort "March Forth" to prevent 100 000 CRC deaths in the US over 10 years, with the first pilot in Philadelphia. A holistic business plan can attract philanthropy to promote CRC screening. A simple message of "You can save a life from CRC with a $25 000 donation" can motivate demonstration projects in regions with high CRC rates and low screening participation. © 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

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