North Dakota Uses GIS, Maps to Improve Colorectal Cancer Screening Access

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Submission Date: July 2019

State/Territory Submitted on the Behalf of: North Dakota

States/Territories Involved: North Dakota

Funding Source: CDC

CDC Funding:


CDC Funding (Specified):

Other CDC Funding

Domain Addressed:

Epidemiology and Surveillance

Public Health Issue:

  • Colorectal cancer (CRC) is the third most commonly diagnosed type of cancer and ranks second in late-stage diagnosis among all cancers.
  • The public health community in North Dakota has prioritized improving colorectal cancer screening rates, which are currently at 64.7%.
  • Mapping the location of facilities performing colonoscopy, each facility’s capacity, and the age-eligible population for CRC screening aids stakeholders in understanding population distribution, service availability, and opportunities for interventions to increase CRC screening rates.

Program Action:

  • Staff from the North Dakota Department of Health (NDDoH) attended Geographic Information Systems (GIS) training offered through the CDC Division for Heart Disease and Stroke Prevention, National Association of Chronic Disease Directors and the Children’s Environmental Health Initiative at Rice University.
  • NDDoH staff used ArcGIS to merge population data and colonoscopy capacity data by census tract and geocode ambulatory surgical centers and hospitals providing colonoscopy services. A map was generated showing the location of facilities performing colonoscopy, each facility’s capacity, and the age-eligible population for CRC screening by census tract.
  • The age-eligible population for CRC screening, defined as the total population aged 50 to 74 years, was obtained by census tract from the U.S. Census Bureau’s American Community Survey.
  • A telephone survey, adapted from the 2012 Survey of Endoscopic Capacity (SECAP), of 5 ambulatory surgical centers and 48 hospitals was conducted in March 2016 to attain measures for colonoscopy capacity.
    • Annual maximum capacity of colonoscopies per year ranged from 25 to 9,100 colonoscopies. The median annual maximum capacity for all facilities was 612.
    • The proportion of the maximum capacity used at each facility ranged from 13.8% to 100% with the average being 65.4 percent. Six facilities reported being at 100% capacity.
    • Overall, 60.7% of the statewide capacity was used.


  • Maps were used by the North Dakota Colorectal Cancer Roundtable to initiate discussions regarding a) increasing state capacity for CRC screening and b) improving access to CRC screening services.
  • Mapping highlighted differences in the distribution of facilities across the state: specifically, between the eastern portion of the state and the western portion, and between rural and urban areas.
  • NDDoH is currently working with Federally Qualified Health Centers (FQHCs) to increase CRC screening using alternative testing such as the fecal immunochemical test (FIT). They are focusing their efforts in areas where health systems, surgical services, and resources are limited in capacity or not available at all.
  • NDDoH continues to work with partners including the American Cancer Society, the ND Colorectal Cancer Roundtable, the ND Cancer Coalition, insurers, FQHCs, and others to collect data, implement surveys, conduct focus groups, and develop action plans to increase overall CRC screening rates and reduce the burden of CRC mortality among North Dakotans.

Program Areas:

Cancer, Epidemiology and Surveillance

State Contact Information:

Jesse Tran
North Dakota Department of Health

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