Colorectal Cancer Screening Practices and Participation Factors
Summary
Colorectal cancer screening is a cornerstone of public health strategies aimed at reducing incidence and mortality through early detection. Common modalities include endoscopic examinations (colonoscopy and sigmoidoscopy) and non-invasive stool-based tests, notably the faecal immunochemical test (FIT) and the older guaiac-based faecal occult blood test (FOBT). Population-based mail-out programmes, supplemented by invitations, reminders and primary care endorsements, have been implemented across Europe, North America, Asia and Oceania. Uptake varies widely, often influenced by sociodemographic factors such as age, sex, socioeconomic status and geographic location. Psychological determinants including perceived susceptibility, defensive information processing and aversion to stool handling also play a crucial role. Practical issues—such as test complexity, timing and follow-up logistics—further shape participation. Evidence supports multifaceted interventions, combining behavioural prompts, professional endorsement and simplified procedures, to boost adherence among both first-time invitees and previous non-responders. Recent efforts emphasise consumer co-design to tailor reminders and toolkit layouts, recognising that many eligible individuals intend to participate but succumb to forgetfulness or discomfort. Collectively, these advances highlight the global significance of optimising both the delivery and the user experience of screening, with the twin goals of maximising reach and minimising inequalities.
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Colorectal Cancer Screening Practices and Participation Factors publication trend
The graph below shows the total number of articles in colorectal cancer screening practices and participation factors across all publications each year (not limited to Nature Index journals).
Technical terms
Fecal immunochemical test (FIT): A non-invasive screening tool that detects human haemoglobin in stool, requiring no dietary restrictions and offering improved sensitivity over older occult blood tests.
Defensive Information Processing (DIP): A psychological construct describing how individuals minimise perceived threats by denying urgency or excluding themselves from recommended health actions.
Mail-out screening programme: A public health initiative that sends test kits directly to eligible individuals’ homes, often accompanied by instructional materials and follow-up reminders to encourage completion.
References
- Colorectal cancer population screening programs worldwide in 2016: An update. World Journal of Gastroenterology (2017).
- Strategies for increasing participation in mail-out colorectal cancer screening programs: a systematic review and meta-analysis. Systematic Reviews (2019).
- Co-designing planning interventions to facilitate participation in mail-out bowel cancer screening. BMC Public Health (2024).
- Exploring non-participation in colorectal cancer screening: A systematic review of qualitative studies. Social Science & Medicine (2023).
- The role of defensive information processing in population‐based colorectal cancer screening uptake. Cancer (2023).
- Factors associated with use and non-use of the Fecal Immunochemical Test (FIT) kit for Colorectal Cancer Screening in Response to a 2012 outreach screening program: a survey study. BMC Public Health (2015).
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