BACKGROUND: The CDC's Colorectal Cancer Control Program (CRCCP) partners with health system clinics to implement evidence-based interventions (EBIs) to increase colorectal cancer (CRC) screening prevalence. The sustainability of those EBIs is critical for the long-term success and impact of the CRCCP. This paper examines various aspects of the sustainability of these EBIs, including the factors associated with sustainability. METHOD: We used Clinic Data collected by CDC for program evaluation. The study employed two definitions of sustainability and conducted a comprehensive analysis including all available information on sustainability in the Clinic Data. Our descriptive analysis included comparing frequencies and means of the outcome variable as defined in the study. Logistic regression methods were used to explore the association of multiple explanatory factors with EBI sustainability. RESULTS: The results highlighted significant variations in the sustainability of different EBIs. Provider reminders were reported as sustainable by 82.0% of the clinics, while reducing structural barriers were reported as sustainable by 55.6% of the clinics. The percentage of clinics able to sustain each of the four EBIs trended upwards over time, ranging from 13 to 34 percentage points increase. Clinics that had implemented EBIs before CRCCP involvement, those that integrated multiple interventions, and those with dedicated screening champions were more likely to sustain EBIs in the long term. CONCLUSIONS: We found substantial improvement in the sustainability of EBIs over the 5-year program period, although results varied by EBIs and room for improvement remains. The findings offer valuable insights for future implementation and sustainability of EBIs.

OBJECTIVE: To examine prostate cancer trends by demographic and tumor characteristics because a comprehensive examination of recent prostate cancer incidence rates is lacking. PATIENTS AND METHODS: We described prostate cancer incidence rates and trends using the 2001-2007 National Program of Cancer Registries and Surveillance, Epidemiology, and End Results Program data (representing over 93% of US population). Because of coding changes in cancer grade, we restricted analysis to 2004-2007. We conducted descriptive and trend analyses using SEER *Stat. RESULTS: The overall prostate cancer incidence rate was stable from 2001 to 2007; however, rates significantly increased among men aged 40-49 years (APC = 3.0) and decreased among men aged 70-79 years (APC = 2.3), and 80 years or older (APC = -4.4). About 42% of localized prostate cancers diagnosed from 2004 to 2007 were poorly differentiated. The incidence of poorly differentiated cancer significantly increased among localized (APC = 8.0) and regional stage (APC = 6.1) prostate cancers during 2004-2007. CONCLUSIONS: The recent trend in prostate cancer incidence was stable but varied dramatically by age. Given the large proportion of poorly differentiated disease among localized prostate cancers and its increasing trend in more recent years, continued monitoring of prostate cancer incidence and trends by demographic and tumor characteristics is warranted.

Lynch syndrome is the most common cause of inherited colorectal cancer, accounting for approximately 3% of all colorectal cancer cases in the United States. In 2009, an evidence-based review process conducted by the independent Evaluation of Genomic Applications in Practice and Prevention Working Group resulted in a recommendation to offer genetic testing for Lynch syndrome to all individuals with newly diagnosed colorectal cancer, with the intent of reducing morbidity and mortality in family members. To explore issues surrounding implementation of this recommendation, the Centers for Disease Control and Prevention convened a multidisciplinary working group meeting in September 2010. This article reviews background information regarding screening for Lynch syndrome and summarizes existing clinical paradigms, potential implementation strategies, and conclusions, which emerged from the meeting. It was recognized that wide-spread implementation will present substantial challenges, and additional data from pilot studies will be needed. However, evidence of feasibility and population health benefits and the advantages of considering a public health approach were acknowledged. Lynch syndrome can potentially serve as a model to facilitate the development and implementation of population-level programs for evidencebased genomic medicine applications involving follow-up testing of at-risk relatives. Such endeavors will require multilevel and multidisciplinary approaches building on collaborative public health and clinical partnerships.