Inequalities in participation in colorectal cancer screening programmes: a systematic review

Abstract

Background Colorectal cancer (CRC) is a major public health problem due to its incidence and mortality. Screening programmes help decrease its impact on the population through early detection. However, the uneven distribution of social determinants of health can cause inequalities. The aim of this study is to identify the social inequalities in the participation in CRC screening programmes. Methods A systematic review of the literature was carried out, searching in both health and social databases for papers published since 2000 in English, Spanish, Portuguese and French. The search strategies combined terms regarding screening, CRC, participation and social inequalities. Included papers were quantitative or qualitative primary studies analyzing gender and socioeconomic inequalities in the participation in CRC screening programmes implemented by public and private health-care providers and addressing 45- to 75-year-old population. Results A total of 96 studies, described in 102 articles, were included. Most were quantitative observational studies and analyzed population-based screening programmes. They were carried out mainly in the UK (n=29) and the USA (n=18). Participation in screening programmes varied from 1.1% to 82.8% using several methods. A total of 87 studies assessed participation by sex and one focussed on men, but only two provided an analysis from a gender perspective. Although men are at a higher risk of developing CRC, they generally were less likely to participate in screening programmes. Screening attendance was higher among the least deprived areas. Conclusions Gender and socioeconomic inequalities in CRC screening participation should be addressed through the design of tailored interventions with a multidimensional focus.

The Impact of COVID-19 on Cancer Screening: Challenges and Opportunities

“…Social determinants of health could be understood as the condition in which people are born, grow, live, work, and age [ 25 ]. In other words, as opposed to biological factors (eg, genetic traits), social determinants of health are a range of social, economic, political, and environmental factors that contribute to individuals’ health conditions and disparities, such as inequalities in cancer screening [ 26 - 28 ]. Results show that patients who have poor social determinants of health, such as lack of insurance, low income, and living in a deprived neighborhood, are often less likely to adopt cancer screening [ 28 - 30 ].…”

Factors Related to Non-participation in the Basque Country Colorectal Cancer Screening Programme

“…Furthermore, according to the European Code Against Cancer, there are behaviors that help reduce the risk of developing cancer such as not smoking, reducing alcohol consumption, exercising, and eating healthy (12). Despite this, the literature studying the relationship between these factors and non-participation is scarce, as it focuses mainly on socioeconomic inequalities (13).…”

Colorectal Cancer Survival in 50- to 69-Year-Olds after Introducing the Faecal Immunochemical Test

“…These data indicate that a high percentage of patients are missed by the screening programme, and moreover, that they are individuals who are at high risk of CRC. One of the reasons for this may be that the screening participation rate is lower in men, while the rate of malignant lesions is 3-fold higher in men than women, as it is already known [18][19][20]. Additionally, rates of participation in these programmes and of malignant lesions also vary with socioeconomic status [3,[21][22][23][24].…”