Skip to main content


Scaling Colorectal Cancer Screening through Outreach, Referral, and Engagement (SCORE) is working to improve access to colorectal cancer (CRC) screening in North Carolina. We envision a state-wide program that supports community health centers to reduce the burden of CRC in North Carolina and serve as a model for other states.

SCORE is funded by the National Cancer Institute’s Accelerating Cancer Screening and Follow Up through Implementation Science (ACCSIS) Program. The ACCSIS Program is a Beau Biden MoonshotSM Initiative dedicated to implementing multi-level interventions to increase CRC screening and follow-up. The principal investigator (PI) on the SCORE project is Dr. Dan Reuland.

Our Strategy

CRC screening rates are lower than they should be in North Carolina, and CRC remains our state’s second leading cause of cancer deaths. SCORE aims to support North Carolina’s community health centers to provide CRC screening, especially to medically vulnerable patient populations.

For patients at average risk for CRC, the US Preventive Services Task Force recommends several CRC screening options, including a fecal immunochemical test (FIT). FIT is a stool sampling test that patients, in consultation with their doctor, can do at home and mail to a pathology lab for analysis. Evidence shows that mailing stool tests to patients is an effective way to improve screening rates and can help overcome logistical barriers to screening, such as lack of transportation.

SCORE is testing a multi-level program that includes:

  • a screening registry to support mailed FIT outreach from a central location to community health center patients who are at average risk for CRC;
  • annual mailed FIT to patients in the registry from a mailing center;
  • laboratory processing of FIT samples; and
  • phone navigation to colonoscopy services for patients with a positive FIT result.