The Citywide Colorectal Cancer Control Coalition (C5) is a group of public health professionals, clinicians, non-profit partners and researchers with expertise in colorectal cancer prevention that advises the NYC Department of Health in its mission to prevent and control colorectal cancer.
This public-private partnership offers strategic direction and expertise on Health Department initiatives, including educational campaigns, clinical guidelines and clinical practice improvement. C5 helps disseminate Health Department programs to stakeholders, working to increase awareness of and screening for colorectal cancer.
C5 Membership Benefits
C5 Membership Responsibilities
Data and Targets
Since C5’s inception in 2003, the screening colonoscopy rate among adults ages 50 and older in the city has increased by 71% (from 42% to 72% in 2020). The inequities by race/ethnicity in colorectal cancer prevention evident in 2003 had been eliminated by 2010. In 2020, the New York City Community Health Survey found all racial and ethnic groups had similar timely colorectal cancer screening rates (73% among Black non-Latino and White, 74% among Latino and 67% among Asian/Pacific Islander adults), defined as having had a colonoscopy in the past 10 years.
Colorectal cancer screening has contributed to decreased incidence and mortality. However, racial disparities in health outcomes persist. Overall colorectal cancer incidence rates decreased 2.7% yearly from 57.7 to 35.5 per /100,000 population from 2000 to 2018. Mortality rates decreased 3.3% yearly from 19.0 to 10.4 overall, at similar rates for all racial/ethnic groups in NYC from 2001 to 2018. However, colorectal cancer incidence remained higher among Black non-Latino New Yorkers (40.5 per 100,000) than among White (38.9), Latino (32.8) and Asian New Yorkers (35.0) in 2014 - 2018. Black non-Latino New Yorkers also had higher mortality rates (14.8), than White (11.8), Latino (9.8) and Asian New Yorkers (8.5) in 2014 - 2018.
Further C5 efforts are needed to reach the goals of equity in colorectal cancer health outcomes and to achieve the national target of 80% screened.
Public Health Education Campaigns
C5 provides content expertise and guidance to the Health Department on the messaging and dissemination of colon cancer public health education campaigns. These campaigns target both the general public and specific communities with low colorectal cancer screening rates. Past campaigns have included celebrity spokespeople on radio messages and poster ads in subway stations, bus shelters and public hospitals.
NYC Colorectal Cancer Screening Recommendations
C5 advises the Health Department in the development of colorectal cancer screening recommendations specifically tailored to the local health care environment. In 2020, these local recommendations were updated to address new data on increasing risk of colon cancer at younger ages and to increase screening rates, by encouraging patient choice and promoting shared decision making.
Recommendations for NYC health care providers:
Direct Endoscopic Referral System
C5 created the Direct Referral for Screening Colonoscopy (DERS) (PDF) form to streamline referrals for colonoscopies by eliminating pre-procedure consultations for eligible patients.
Primary care physicians can use the DERS form to assess their patients and identify those who are eligible for direct referral for colonoscopy. A referral that takes only one visit is more likely to result in a patient following through with a colonoscopy.
Colonoscopy Quality Initiative
From 2011 to 2015, the Colonoscopy Quality Initiative (CQI) improved the quality of screening colonoscopies in the city and identified disparities in the quality of screening colonoscopies. The Health Department collected and analyzed data and disseminated collected performance reports to participating providers. Over the course of the initiative, nearly 300 endoscopists representing 21 sites reported site-level information on eight quality measures for roughly 95,000 screening colonoscopies. The Health Department also provided technical assistance to support accurate and complete data submission.
CQI is funded by the Centers for Disease Control and Prevention, the New York State Department of Health and the Fund of Public Health in New York.
Since 2003, C5 summits have brought together leading professionals and stakeholders in colorectal cancer prevention and control. The summits offer an opportunity for experts at all levels of care to meet and develop new tools and initiatives to increase colorectal cancer screening rates in the city.
The Steering Committee governs C5 coalition operations, oversees subcommittees and provides recommendations to the Health Department. This committee also plans colorectal cancer prevention initiatives that stakeholders can implement in their respective institutions or programs. Additionally, it confirms new subcommittees, identifies new members and expands the reach of the City’s colorectal cancer initiatives.
Co-chairs: David Greenwald, MD; Matthew Weissman, MD, MBA, FAAP
Colonoscopy Quality Committee
The Colonoscopy Quality Committee aims to improve the quality of screening colonoscopy by developing educational initiatives and tools for providers and their staff.
Co-chairs: Brett Bernstein, MD, FASGE, AGAF; Benjamin Lebwohl, MD, MS; Felice Schnoll-Sussman, MD
Community Health Center Committee
The Community Health Center Committee works to improve access to appropriate, timely and quality screening colonoscopies for uninsured patients at community health centers. This committee supports the work of the NYC Community Cares Project.
Chair: Diane Ferran, MD, MPH; Daniel Napolitano, MD, AAHIVS
Screening Guidelines Committee
Since 2003, the Health Department has issued NYC-specific colorectal cancer screening guidelines (PDF). The Screening Guidelines Committee is an advisory panel that reviews these guidelines and recommends revisions as necessary.
Co-chairs: Steven Itzkowitz, MD; Bernard Levin, MD, FACP
Health Equity Committee
As part of the City’s efforts to advance health equity, this committee examines the health inequities relating to colorectal cancer screening, including racial/ethnic and socioeconomic disparities.
Co-chairs: Francesca Gany, MD, MS; Joseph Ravenell, MD
80% Screened Committee
The 80% Screened Committee strategizes how C5 can achieve its goal of having 80% of eligible patients in the city receive colorectal cancer screenings.
Co-chairs: Mark Pochapin, MD; Kristina Thomson, LCSW
Publications are listed in reverse chronological order based on publication date.
Colon Cancer Brochures
Colon Cancer Test Fact Sheets