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Geographical Disparities in Faecal Immunochemical Test-Based Colorectal Cancer Screening Participation and Positivity

Melkalem Mamuye Azanaw1,2, Erin L Symonds1,3, Geraldine Laven-Law4

  • 1Department of Medicine, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.

Health Promotion Journal of Australia : Official Journal of Australian Association of Health Promotion Professionals
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PubMed
Summary

Geographical disparities exist in colorectal cancer screening participation. Rural areas in Europe showed higher faecal immunochemical testing (FIT) use, while Australian remote areas had lower participation, highlighting screening access issues.

Keywords:
colorectal neoplasmscommunity participationfaecal occult blood testhealth status disparitiesmass screening

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Area of Science:

  • Public Health
  • Epidemiology
  • Cancer Prevention

Background:

  • Limited evidence exists on colorectal cancer (CRC) prevention disparities in rural/remote populations.
  • Faecal immunochemical testing (FIT) is a key CRC screening method.
  • Understanding geographical variations in FIT uptake is crucial for equitable cancer control.

Purpose of the Study:

  • To systematically review and meta-analyze geographical disparities in participation and positivity rates of FIT-based CRC screening.
  • To identify variations in FIT screening based on rurality and remoteness.

Main Methods:

  • Systematic review and meta-analysis of studies published until June 2024.
  • Included average-risk individuals (40-74 years) with location-based or geospatial analysis of FIT screening.
  • Random-effects models used to pool participation, positivity rates, and geographical odds ratios.

Main Results:

  • 35 studies were included, 21 in the meta-analysis; overall FIT participation was 49.9%.
  • Europe: Rural areas had higher FIT participation (POR: 1.20). Australia: Remote areas had lower participation (POR: 0.75).
  • Overall FIT positivity rate was 8.70%, with no significant rural vs. urban difference (p=0.24).

Conclusions:

  • Significant disparities in FIT-based CRC screening participation were observed based on geographical definitions of rurality and remoteness.
  • Further research is needed to understand the drivers of these disparities (sociocultural, healthcare access, policy).
  • Targeted strategies are essential to improve screening access and address barriers for underserved populations.