Factors associated with non-adherence to colonoscopy after a positive test in a population-based colorectal cancer...

To describe the sociodemographic and clinical profile of individuals with a positive fecal immunochemical test result in the population-based colorectal cancer screening program who refused the screening colonoscopy at the reference center, with no colonoscopy recorded thereafter, and to identify the reasons for such a refusal.

A descriptive, observational, cross-sectional, retrospective study including 128 participants who refused a colonoscopy at Clínic Barcelona after obtaining a positive fecal immunochemical test result through the population-based colorectal cancer screening program in 2022-2023. Data obtained from medical record reviews were described.

Individuals who refused colonoscopy had a mean age of 60.35±5.25 years, 90.63% were Spanish nationals, and 85.16% had a high socioeconomic status. The median number of participations in the colorectal cancer screening program was 3. Most participants had no prior history of cancer (64.06%), no family history of colorectal cancer (64.84%), and no symptoms suggestive of colorectal cancer (71.09%). The main reasons for refusal were a preference to undergo colonoscopy in a center outside the screening program (21.09%) and multimorbidity, severe disease, or a condition requiring medical clearance to undergo the procedure (20.31%).

Most people who declined the screening colonoscopy had a high socioeconomic status and one fifth preferred to undergo the procedure in an external center. The clinical profile of approximately one fifth of the subjects also corresponded to individuals with severe comorbidities, who required an individualized assessment of the risk-benefit balance of the procedure.