5th Annual Early Age Onset Colorectal Cancer Summit - Session III: Earliest Possible Diagnosis and Treatment Through Timely Recognition of Symptoms and Signs of Young Adult CRC

54. EAO CRC delays in diagnosis and the consequences:
Reducing late stage diagnosis and improving outcomes
Whitney F. Jones, MD
Founder, Colon Cancer Prevention Project
Gastroenterology Health Partners, PLLC
5th International EAO CRC Symposium
May 2-3, 2019. New York City

55. Financial Disclosures
• Myriad – Speaker, Honorarium
• Pfizer – Consultant, Fees
• Premier Surgery Center – Physician Partner

56. Source: SEER 18 registries, 2005-2011.
33%
38%
26%
3%
40%
35%
20%
5%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Localized Regional Distant Unknown
< 49 years
50+ years
Stage distribution: early vs. later onset

57. Stage distribution: early vs. later onset
33%
38%
26%
3%
40%
35%
20%
5%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Localized Regional Distant Unknown
< 49 years
50+ years
Source: SEER 18 registries, 2005-2011.

58. Factors influencing sporadic advanced stage
CRC at time of diagnosis – gap focus
Can be changed
• Improve awareness
of symptoms
• Seek medical help for
symptoms
• Reduce delays in
definitive diagnostic
evaluation
Will not change
• Tumor biology
• Lack of family Hx
• Screening program
for sporadic (2019)

59. EAO CRC Tumor Biology:
“Earliest stage” Dx wild card
Case #1 : 48 yo healthy male
• Painless rectal bleeding x 1 day, one episode,
no FHx cancer
• Diagnostic colonoscopy 2 days post onset
symptom
• 2.5 cm sigmoid pedunculated polyp
• Path high grade dysplasia. Completely
resected.
• Genetic testing “not indicated”
Case #2 : 24 yo healthy male
• Painless rectal bleeding x 1 day, one episode, no
FHx cancer
• Diagnostic colonoscopy 2 days post onset
symptom
• 2.5 cm sigmoid pedunculated polyp
• Path Invasive mucinous adenoCA involving
margin of stalk
• Preop Multigene panel test (-)
• Single microfocus of tumor in 1/24 LN. Final
stage T3N1M0

60. Sporadic
1. occurring at irregular intervals or only in a
few places; scattered or isolated.
2.not happening or appearing in
a pattern; not continuous or regular:
3. Synonyms: occasional, infrequent,
irregular, periodic, scattered, isolated,
odd, intermittent, uneven, spasmodic,
random, fitful, desultory, erratic,
unpredictable.
https://dictionary.cambridge.org/us/dictionary/english/sporadic
adjective:
established

61. Sporadic
1. occurring at irregular intervals or only in a
few places; scattered or isolated.
2.not happening or appearing in
a pattern; not continuous or regular:
3. Synonyms: occasional, infrequent,
irregular, periodic, scattered, isolated,
odd, intermittent, uneven, spasmodic,
random, fitful, desultory, erratic,
unpredictable.
https://dictionary.cambridge.org/us/dictionary/english/sporadic
adjective:
4. Translation to EAO-CRC
all adults > 21
established

62. Symptom presentation: established
• Clinical complaints
• Rectal bleeding **
• Change in bowel habits**
• Unexplained abdominal pain, N, V
• Unexplained weight loss, fatigue
• Physical examination
• Rectal exam - blood or mass**
• Abdominal mass or pain
• Laboratory results
• Iron deficiency anemia
• Thrombocytosis
• Occult blood +
• Calprotectin
• Abnormal LFT’s
https://bjgp.org/content/67/658/e336, Stapeley et al.

63. Studies suggesting delays in diagnosis impact stage of disease in EAO-CRC
Study Type Sx onset to Eval MD eval to dx Delay associated
with more
advanced stage?
2018 CCA NTY Survey
n= 1622
63% > 3 mo 27% > 3 MD 71% stage 3, 4
suggestive
2015 Bowel cancer
Uk.org NTY
Survey
N=400
28%> 3 mo
56% < 6 wk
56% > 3 GP visits
20% > 5 GP visits
Eval < 2 GP visits
stage 1 56%
stage 4 33%
suggestive
Cl Gastro Hep 2017
Chen et al
Retrospective case
control. N = 253
Vs > 50 yo
Sx duration 90 vs 60
P <.01
Eval time 31 v 22 d
P <.05
Stage 3, 4 had
shorter duration of
Sx v stage 1,2.
Not suggestive
Biomed Res Intnl.
2015. Siminoff et al
Retrospective MDO’s
N= 252 patients
n/a Each additional MD
doubles MDO risk
<50 independent
risk factor for MDO
No final stage info
supplied
Amer J Surgery
2016. Scott, et all
Retrospective case
control. N = 56
< 50 yo 121 d
> 50 yo 21 d
P < .001
Symptom  Tx
< 50 217 d
>50 58 d
P < .001
No difference in
stage at diagnosis
Not suggestive

64. Figure 1
https://June 2016Volume 211, Issue 6, Pages 1014–1018 RB Scott et aldoi.org/10.1016/j. https://doi.org/10.1016/j.amjsurg.2015.08.031amjsurg.2015.08.031R
https://doi.org/10.1016/j.amjsurg.2015.08.031

65. EAO-CRC Awareness:
0
5
10
15
20
25
30
35
40
45
50
Stage 1 Stage 2 Stage 3 Stage 4
Bowel Cancer Awareness vs CRC Stage at Dx
% Awareness
https://bowelcancerorguk.s3.amazonaws.com/Test%20images/NeverTooYoungreport2015.pdf
NOT Established

66. Breaking out of the Echo Chamber:
Sporadic EAO-CRC
Research Awareness Action
100%
0%
Epidemiology ReactiveClinicians < 50 population
PCP?
Spec?
Etiology
5-10%?

67. Timeline of delays: Months
3-12 months 1-2
months
Awareness of sx
(vs. knowledge of
importance of sx)
Make appt
1
month(?)
PCP/Frontline
Provider
Specialist
 scope
Dx
Tumor
Biology
Onset of Sx

68. Timeline of delays: Months
3-12 months
1-2
months
Awareness of sx
(vs. knowledge of
importance of sx)
Make appt
1-2
months
PCPFrontline
Provider
Specialist
--> scope
Dx
Tumor
Biology
Onset of Sx
- Onset of Sx
- Awareness of sx and
importance of sx
- Make appointment
Dx
2-4
Weeks
2
Weeks
GOAL
Weeks

69. Timeline of EAO-CRC and Sporadic CRC
Messaging: BOGO
40yr 45/50yr
Current Message Package
18-21 years 40 45-50 >75

70. Timeline of EAO-CRC and Sporadic CRC
Messaging: BOGO
40yr 45/50yr
Current Message Package
Family history + test

Lifestyle modification

ID + evaluate symptoms

Early Message Package
18-21 years 40 45-50 >75

71. Conclusions:
Gap 2.
Sporadic
EAO–CRC
Delayed
Diagnosis
Delays in diagnosis may contribute to
advanced stage diagnosis, not conclusive
BOTH low population >> low provider
awareness THE major contributors
Effective knowledge around and messages for
prevention and earliest stage diagnosis
already exist. Not delivered on time or with
adequate frequency
Awareness/action resources messaging:
Fully integrated, emphasized and
delivered to > 21 adult population,
proportionate to anticipated incidence
trends

72. Delayed Sporadic CRC Diagnosis
Patient Awareness of
symptoms
Recognition of
need for
evaluation
Patient
Delay in
seeking
medical
attention
Delay in
actually getting
medical
evaluation
Provider
Awareness
gap -
MDOs
Primary
care 
Specialist

73. Awareness Gap for Sporadic EAO-CRC
Researchers
Epidemiology
(Not Etiology)
GI/CRC
Primary care
Acute care
ER
Ob-Gyn
General
population
Others
Health systems,
Medical education,
Insurers,
Employers, Medicaid
100%
50%
~25%
<10%<10%

74. Studies suggesting delays in diagnosis impact
stage of disease in EAO-CRC
Study Type Sx onset to Eval MD eval to dx Delay associated
with more advanced
stage?
2018 CCA NTY Survey
n= 1622
63% > 3 mo 27% > 3 MD 71% stage 3, 4
suggestive
2015 Bowel cancer
Uk.org NTY
Survey
N=400
28%> 3 mo
56% < 6 wk
56% > 3 GP visits
20% > 5 GP visits
Eval < 2 GP visits
stage 1 56%
stage 4 33%
suggestive
Cl Gastro Hep 2017
Chen et al
Retrospective case
control. N = 253
Vs > 50 yo
Sx duration 90 vs 60
P <.01
Eval time 31 v 22 d
P <.05
Stage 3, 4 had shorter
duration of Sx v stage
1,2.
Not suggestive
Biomed Res Intnl.
2015. Siminoff et al
Retrospective MDO’s
N= 252 patients
n/a Each additional MD
doubles MDO risk
<50 independent risk
factor for MDO
No final stage info
supplied

75. make
the
diagnosi
s?Chelsea L. Boet, MD
Internal Medicine and Pediatrics
Spectrum Health Medical Group
Grand Rapids, MI

76. Early onset colorectal cancer
86 percent of patients diagnosed under the age of 50 are
symptomatic at diagnosis, and despite this, they have a more
advanced stage at diagnosis and poorer outcomes
Related to delay in diagnosis
Up to 35% of early onset colorectal cancer is associated with a known
genetic mutation.
Other medical issues can be risk factors for early colorectal cancer

77. Who sees the patient?
The average early onset colon cancer patient has multiple visits, often
with multiple different specialties, prior to diagnosis
Primary care (internal medicine, family medicine, pediatric and adolescent
medicine)
OB/Gyn
Emergency medicine
Gastroenterology
General or Colorectal surgery

78. Primary care physicians/providers
Symptoms present prior to diagnosis
Bleeding (rectal, melena, GI)
Anemia
Change in bowel habits
Abdominal pain
Weight loss
Bleeding and change in bowel habits had a PPV of 14%
With other symptom had increased PPV as well

79. OB/GYN
Increased diagnosis of CRC during pregnancy related to delayed child
bearing and increased early onset diagnosis.
1 in 13,000 pregnancies
Delay in diagnosis associated with pregnancy?
Anecdotal
Symptoms consistent with hemorrhoids and pregnancy associated
constipation
Should be getting thorough gynecologic oncology family history.
Family history of endometrial cancer raises concern for Lynch
Syndrome

80. Emergent vs. non emergent diagnosis
Over 20% of CRC is diagnosed as an emergency presentation.
Over 95% of patients (both emergency and non emergency
presenters) had consulted their physician in the 6-12 months prior to
diagnosis, typically with non specific symptoms
Emergency presenters are less likely to present to their doctor with
relevant or red flag symptoms
Relevant symptoms: abdominal pain, constipation, diarrhea, weight loss,
fatigue
Red flag symptoms: anemia, rectal bleeding, change in bowel habits

81. Emergency presenters are less likely to be treated with curative
intent, and have decreased survival even when controlled for stage at
diagnosis
PCP visits present opportunity for earlier diagnosis
Earlier, non emergent diagnosis, improves outcomes
Presentation with typical red flag symptoms associated with more
prompt evaluation and non emergency diagnosis of CRC

82. References
Macrae, F. Colorectal cancer: Epidemiology, risk factors, and protective factors. UpToDate
https://www.ccalliance.org/about/never-too-young/survey/2018-young-onset-colorectal-
cancer-survey-report
Ewing, M et al, Identification of patients with non-metastatic colorectal cancer in primary care:
a case-control study. Br J Gen Pract. 2016 Dec; 66(653):
Mork ME. Et al. High Prevalence of Hereditary Cancer Syndromes in Adolescents and Young
Adults With Colorectal Cancer. J Clin Oncol. 2015 Nov 1;33(31):3544-9.
Jane E. Rogers et al. The Treatment of Colorectal Cancer During Pregnancy: Cytotoxic
Chemotherapy and Targeted Therapy Challenges. Oncologist. 2016 May; 21(5): 563–570
C Renzi, et al. Do colorectal cancer patients diagnosed as an emergency differ from non-
emergency patients in their consultation patterns and symptoms? A longitudinal data-linkage
study in England. Br J Cancer. 2016 Sep 27; 115(7): 866–875.

83. Colorectal Cancer Detection:
Raising Public Awareness

84. Outline
• Colorectal cancer (CRC) incidence and age, NYC
• Change in CRC death rate over time, NYC
• CRC prevention and gaps in screening, NYC
• Changing direction in public health
• Provider tools and education
• Public health detailing
• Patient tools and media

86. CRC Incidence and Age, NYC, 2003-2015,
New York State Cancer Registry
Source: DOHMH analysis of data from the New York State Cancer Registry, 2003 - 2015

87. CRC Incidence Rates in NYC, All Races Combined, Ages 20 – 49 Years,
1975 - 2015
*The Annual Percent Change (APC) is statistically significantly different: all rates are age-adjusted.
Reference: Van Beck et al. JNCI Cancer Spectrum 2018; 2(4)

88. CRC Incidence Rates in NYC, White Adults,
Ages 20 – 49, 1975 - 2015
*The Annual Percent Change (APC) is statistically significantly different: all rates are age-adjusted.
Reference: Van Beck et al. JNCI Cancer Spectrum 2018; 2(4)

89. CRC Incidence Rates in NYC, Black Adults,
Ages 20 – 49, 1975 - 2015
*The Annual Percent Change (APC) is statistically significantly different: all rates are age-adjusted.
Reference: Van Beck et al. JNCI Cancer Spectrum 2018; 2(4)

90. Note: All data are age adjusted.
Source: New York City DOHMH analysis of data from Vital Statistics. Death/Mortality Data 2000-2016.
21.0
19.0
18.0
18.6
17.2 17.4 17.0
16.5 16.1 15.9
14.9
14.0 13.7 13.9
0
5
10
15
20
25
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Age-AdjustedDeathRateper100,000
Change in CRC Death Rate per 100,000
Population, All Ages, NYC, 2003-2016

91. Source: Analysis of data from the NYC Community Health Survey, 2003-2017. Data are age-adjusted.
41.7
52.2
55.2
59.7
61.7
65.6 66.0 67.5 68.6 68.5 69.0 69.9 69.9 68.5 69.9
0
10
20
30
40
50
60
70
80
90
100
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
TimelyColonoscopy(%)
CRC Prevention: Timely Colonoscopy among NYC
Adults Ages 50+ Years, 2003-2017

92. CRC Prevention:
Colonoscopy by Age, NYC, 2017
Age % No colonoscopy in
the past 10 years
NYC CHS, 2017
People (N)
45 – 49 years* 71.7 320,000
50 – 74 years 31.0 644,000
75+ years 29.4 123,000
Source: DOHMH analysis of the NYC Community Health Survey 2017
To increase screening we will need a change in practice.
*45 is the ACS recommended age to begin screening, but we
have yet to see if it will be covered.

93. How to Change Direction in Public Health: the DOHMH Experience
• Recommendations for healthcare providers
• Healthcare provider tools
• Public health detailing for PCPs
• Colon cancer prevention public education
• Colon cancer prevention media

94. DOHMH CRC Prevention Recommendations for Healthcare Providers:
CHI, 2009

95. DOHMH Healthcare Provider Tools: DERS Forms

96. Public Health Detailing Approach
• Allow at least 9-12 months for campaign development
• Train knowledgeable and persuasive Health Department Representatives and
teams
• Disease content knowledge (DOHMH expertise)
• Selling and communications skills
• 12-20 week campaigns; target is 2 visits per contact per campaign
• Assess current practice: tailor presentation to each contact
• “Sell” key recommendations and offer supporting campaign-specific materials

97. DOHMH Public Health Detailing Action Kits
• Clinical tools
• Provider resources
• Patient Education
• Developed using best-practices and
qualitative research methods
• Expert interviews
• Research existing campaigns/messaging
• Provider interview
• Consumer focus groups
2008 Action Kit

98. NYC DOHMH Key Recommendations for Change: Internal Medicine and
Family Practice
• Colon Cancer Screening 2004, 2006
• Refer patients aged 50 years, or with a family history of colon cancer, for a
colonoscopy
• Colonoscopy is the NYC–recommended screening method
• Any screening method is better than no screening method at all
• Colon Cancer Screening 2008
• Refer patients aged 50 years or patients aged 40 years with a family history of
colon cancer for colonoscopy
• Directly refer appropriate patients for colonoscopy rather than first sending
patients to a gastrointestinal consultation
Dresser MG et al. Public Health Detailing of Primary Care Providers
Am J Prev Med 2012;42(6S2):S122–S134)

99. Public Health Detailing of Primary Care Providers: NYC’s Experience,
2003–2010
Year Target Neighborhood Clinical
Sites
Provider
Contacts
Provider +
Staff
Contacts
Contacts
per Site
2004 South Bronx, East &
Central Harlem, North
& Central Brooklyn
193 530 982 5
2006 Staten Island 254 599 1489 6
2008 South Bronx, East &
Central Harlem, North
& Central Brooklyn
189 413 1424 8
Dresser MG et al. Public Health Detailing of Primary Care Providers
Am J Prev Med 2012;42(6S2):S122–S134)
• DOHMH studied effectiveness of the CRC screening-focused Public Health
Detailing Program in helping PCPs and their staff improve patient care

100. Self-Reported Changes in Clinical Practice: DOHMH Public Health
Detailing Campaigns
Year Measure Baseline Follow-up
2004 Recommends colonoscopy as the primary
CRC screening method
26% 42%
Has an office system in place to promote
CRC screening
52% 62%
2006 Colonoscopy recommended 82% 97%
FOBT (stool-based test) recommended 10% 1.5%
2008 Uses DERS referral form for screening 9% 16%
Dresser MG et al. Public Health Detailing of Primary Care Providers
Am J Prev Med 2012;42(6S2):S122–S134)
CRC=colorectal cancer

101. DOHMH Colon Cancer Prevention Public Education

102. DOHMH Colon Cancer Prevention Media, 2019
• Targeted to NYC neighborhoods with
high levels of CRC mortality
• Bus shelter placement
• Staten Island ferry
• Ethnic newspaper ads
• Radio announcements
• Social media sharing
• Translated to Spanish, Chinese, and
for radio, Haitian Creole

103. Colon Cancer Prevention Media, 2019

104. Summary
• Number of new cases of CRC each year is declining among New Yorkers ages 50+
• But it is increasing among ages 20 – 49
• Yearly deaths from CRC declined as screening increased
• Screening at younger ages is a practice change
• Change in public health practices may be facilitated by:
• Recommendations for healthcare providers
• Healthcare provider tools
• Public health detailing for PCPs
• CRC prevention public education
• CRC cancer prevention media

105. Thank you!
Questions?

106. 10
6
Tony Foleno
Senior Vice President, Strategy & Evaluation, Ad Council
President, Society for Health Communication
5th International EAO CRC Symposium
May 2, 2019
LESSONS LEARNED:
WHAT HAVE WE LEARNED FROM PAST PUBLIC
HEALTH COMMUNICATIONS SUCCESS STORIES?

107. 107
Question:
how can we harness the power of media, marketing
& tech
to advance our objectives?

108. Mission
Identify a select number of significant public issues and
stimulate action on those issues through communications
programs that make a measurable difference in our society.

109. Integrated, Multi-discipline Process
109
Data & insights infuse the entire process.

110. We have our work cut out for us
• Media fragmentation
• Message clutter
• Competition for donated media
• The need for focus & clarity
• Logic vs. emotion
Smart planning helps us navigate these waters

111. 111

112. 112
Exposure
Awareness
Engagement
Impact
Donated, earned,
owned, shared media
Issue and campaign awareness
Digital, social & website analytics
Behavior change
Campaign evaluation framework

113. What Works
Research, Research,
Research
Measurable Objectives
A Big,
Single-Minded Idea
A Clear Call-to-Action
Creative Excellence –
Don’t Settle!
Relevance &
Emotion
A Media Mix That Is
Both
Broad and Deep
Social Utility
…and, of course, puppies.

115. Campaign Overview
115
Help achieve health equity by educating and
inspiring black women to understand their risk.
Engage women with information and tools that can
promote early detection.
Objective
Black women, 30-45 years old (halo ages 45-55).
Target
Go to KnowYourGirls.org for the facts you
need on breast health.
Call to Action
Black women in America are dying of breast
cancer at rates 40% higher than white women.
They are more likely to be diagnosed at later
stages with more aggressive forms of the
disease.
The Issue

116. Our Strategic Imperative
Shift her mindset from one of
fear around breast cancer
to empowerment around her breast health.

118. 360° Campaign
Video
Print &
Outdoor
Digital
Social
Radio
Local
activation

119. Results: May 2018 – March 2019
$18MM
Donated/earned media
473MM
Media impressions
10%  15%
Visited a website for info
about breast health
45%
Campaign
awareness (net)
25% 29%
Discussed breast health
with family & friends
26%  29%
Talked to their doctor
about their risk

120. 12
0
Tony Foleno
SVP, Strategy & Evaluation
tfoleno@adcouncil.org
Thank you

121. EAO Summit
Andrew Albert, MD, MPH – Medical Director, Digestive Health
Advocate Illinois Masonic Medical Center
May 1, 2019
5th International EAO CRC Symposium
May 2-3, 2019. New York City

122. EAO- CRC National Clinical Alert:
Symptoms & Signs Index
Details:
Degree of Urgency
Compelling Statistics
Overview of EAO Signs and Symptoms
Statistics relevant to family history
Ways practitioners can help

123. What Providers Can Do?
• Educate the Public and Clinical Staff about EAO and Family History
• Ob/Gyn, PCP, ER, Surgery, Occupational Health, Community Health
• Early assessment with physical exam
• Educate patients on “basics” of digestive health (Health Literacy)
• Help all clinical staff members to understand importance
• Success?!

124. Reality….
• MeetingClinic visit Educate
Repeat MeetingClinic visit
• Speaking to same patients again and
again
• Providers/PCPs aren’t engaged
• Medical Community is very busy
• We aren’t reaching the right people
• We make assumptions about health
literacy

125. Reality continued…
“My Brother (33) Died of Colon Cancer, do I need to
be checked?”
How many of you know March is Colon Cancer
Awareness Month (0/1000)
“I’m so sorry Doctor, can you tell me what a colon is?”

126. Clinical Alert and Beyond…
• Need to take Alert one step further!
• Please share this alert with your colleagues (focus group)
• Invite other colleagues to champion this alert (15,000 Gastroenterologists)
• Share this information (beyond the Silos)
• Corporate, Community, Health Fair, Place of Worship
• Reach the bottom of the iceberg
• Do something/anything different: message needs to reach those who matter
most

127. Patient Awareness and Advocacy
EAO CRC Summit, May 2-3, 2019
Erin Peterson
Communications Director
Colon Cancer Coalition
@gyrig

128. 425 RESPONSES
429 total responses
INTERNAL SURVEY OF EAO PATIENTSSpring 2018
WERE YOU AWARE THAT YOUNG PEOPLE COULD
BE DIAGNOSED WITH COLORECTAL CANCER?
NO or MAYBE:
72.7%
YES: 27.3%
423 RESPONSES
YES: 74.9%
NO: 25.1%
DID YOU HAVE SYMPTOMS THAT YOU IGNORED
OR TRIED TO SELF-TREAT?

129. IF YOU HAD SYMPTOMS, WHAT WERE THEY?
● BLOOD IN STOOL
● RECTAL BLEEDING
● ANEMIA
● WEIGHT LOSS
● FATIGUE
● CONSTIPATION
● INCONTINENCE
● ABDOMINAL PAIN
● CHANGES IN BOWEL HABITS
● PAINFUL PASSING OF STOOLS
● CHANGES IN COLOR OF STOOL
● NARROWING OF STOOL
● UNRESOLVED BLOATING
● CONSTANT URGE TO HAVE
BOWEL MOVEMENT
372 RESPONSES

130. WHAT MESSAGES ABOUT YOUNG ONSET COLORECTAL CANCER
WOULD HAVE GOTTEN YOUR ATTENTION?
352 RESPONSES
BLOOD IN YOUR STOOL
DOES NOT ALWAYS MEAN
HEMORRHOIDS
BE MORE COMFORTABLE
TALKING ABOUT
BATHROOM HABITS
HEALTHY LIFESTYLE DOES
NOT EQUAL PREVENTION
IN YOUNG ADULTS
AGE IS NOT A FACTOR
YOUNG, ATTRACTIVE
PEOPLE TALKING ABOUT
YOUNG ONSET CRC
HEARING THE STORIES OF
YOUNG PEOPLE WITH CRC
MISCONCEPTION THAT
SYMPTOMS ARE FOR
OTHER ISSUES
THAT IT’S A POSSIBILITY
AND NOT A RARE CHANCE
STATS AND RISE AND
YOUNG ONSET
COLORECTAL CANCER

131. WHERE WOULD YOU HAVE BEEN MOST LIKELY TO SEE AN
AWARENESS MESSAGE?
333 RESPONSES
● FACEBOOK/SOCIAL MEDIA
● TV
● ONLINE ADS
● IN-APP ADS
● PUBLIC TRANSPORTATION
● MAGAZINE ADS
● MALL KIOSKS
● ADS IN PUBLIC SPACES
● DOCTOR’S OFFICES/MEDICAL
PAMPHLETS
● MOVIE THEATER PREVIEW ADS
● ADS IN PUBS/BREWERIES
● YOUTUBE
● PODCAST

132. RECYCLING KIOSKSBoston, Sept. 2018
Public Spaces
• $30,000 + in kind support
• 27 million impressions
40 three-sided kiosks
throughout downtown
Boston for four weeks
in September

133. METRO USBoston, Sept. 2018
Online & Magazine
• $5,000 + in-kind support
• 1.2 Million Impressions
Included front & back page print ads, ¼ page print ads, and one-month digital
75% of readers under age 55.
digitalsample
Metrobackpagead
Metrofrontpageheader,Sept.4,2018

134. Thank You & Questions
Erin Peterson
erin@coloncancercoalition.org
ColonCancerCoalition.org