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Health Equity After a Colorectal Cancer Screening Program
Xuechen Xiong1,2, Carmen S Ng1, Yikun Zhang1
1School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
JAMA Health Forum
|June 12, 2026
Summary
Hong Kong's colorectal cancer screening program increased participation and reduced socioeconomic disparities over nine years. However, overall screening rates remain low, necessitating targeted efforts to improve health equity.
Area of Science:
- Public Health
- Cancer Epidemiology
- Health Services Research
Background:
- Colorectal cancer (CRC) is a leading cause of cancer death globally, with early detection crucial for improved survival.
- Hong Kong implemented an organized colorectal cancer screening program (CRCSP) in 2016 to address this.
- Assessing the CRCSP's impact on screening participation equity across socioeconomic groups is vital.
Purpose of the Study:
- To evaluate the association between the CRCSP and health equity in cancer screening participation.
- To analyze trends in fecal testing and colonoscopy uptake among different socioeconomic strata over a 9-year period.
Main Methods:
- Analysis of individual-level data from 14,602 adults (aged 50-75) via three territory-wide population surveys (2014-2022).
- Assessment of screening disparities using concentration curves and indices by socioeconomic status and income.
- Application of generalized logistic regression models to identify factors associated with screening participation.
Main Results:
- Colorectal cancer screening participation increased: fecal testing from 19.88% to 27.15%, colonoscopy from 17.65% to 27.28%.
- Socioeconomic disparities in screening uptake narrowed significantly, indicated by declining concentration indices.
- Screening participation was positively associated with older age, higher education, income, and socioeconomic status.
Conclusions:
- The CRCSP led to increased colorectal cancer screening participation and reduced socioeconomic disparities in Hong Kong.
- Despite improvements, overall screening uptake remains low, with persistent disparities in younger, lower-income, and public housing resident groups.
- Targeted interventions are essential to enhance screening participation and achieve greater health equity in CRC prevention.
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