Getting a simple at-home test for colon cancer shouldn't depend on your zip code. But a new review of global screening programs suggests it might. The analysis pooled data from dozens of studies on the FIT test, which checks for hidden blood in stool. It found that where people live is linked to whether they take the test, but the pattern isn't the same everywhere. In Europe, people in rural areas were slightly more likely to participate than those in cities. In Australia, the opposite was true—people in remote areas were less likely to take part compared to those in metropolitan regions. The good news is that for those who did the test, the chance of a positive result—which signals a need for a follow-up colonoscopy—was the same regardless of location. This means the test itself works equally well everywhere. It's important to remember this data comes from observing existing screening programs; it doesn't prove that geography causes the difference in participation. The studies were also varied, making it hard to pin down a single reason for the gap. The takeaway is clear: we need to understand these geographical barriers better to make sure everyone has a fair shot at early cancer detection.
Meta-analysis finds geographical disparities in FIT-based colorectal cancer screening participationWhere you live may affect your chance of getting screened for colon cancer
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Key Takeaway
Note geographical disparities in FIT screening participation, but interpret as observational association.
This systematic review and meta-analysis examined geographical disparities in participation and positivity rates for fecal immunochemical test (FIT)-based colorectal cancer screening. The analysis included 35 studies (with 21 used for meta-analysis) involving average-risk individuals aged 40-74. The comparator was geographical location, specifically rural/remote versus urban/metropolitan areas.
The overall pooled FIT participation rate was 49.9% (95% CI: 40.6, 59.2). The analysis revealed geographical disparities: in Europe, participation was higher in rural areas compared to urban areas (pooled odds ratio [POR]: 1.20; 95% CI: 1.01, 1.42). Conversely, in Australia, participation was lower in remote areas compared to metropolitan areas (POR: 0.75; 95% CI: 0.65, 0.87). The overall pooled FIT positivity rate was 8.70% (95% CI: 6.50, 11.70), and there was no statistically significant difference in positivity rates between rural and urban settings (p = 0.24).
Safety and tolerability data were not reported. Key limitations, including study heterogeneity and potential confounding factors, were not detailed in the provided evidence. The findings are based on observational data pooled in a meta-analysis, which establishes association but not causation. The practice relevance of these findings is that they highlight variable geographical patterns in screening uptake, but the underlying mechanisms for these disparities and their generalizability to all regions remain unclear.
What this means for you:
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View Original Abstract ↓
BACKGROUND: People in rural and remote areas often participate less actively in colorectal cancer (CRC) prevention practices, including faecal immunochemical testing (FIT). However, the evidence on this is limited.
OBJECTIVE: The aim of this systematic review and meta-analysis was to summarise geographical disparities in participation and positivity of FIT-based CRC screening.
METHODS: Six databases were searched for articles published until June 2024. We included studies reporting FIT-based CRC screening among average-risk individuals aged 40-74, examining geographical disparities using location-based or geospatial methods. Two reviewers independently screened, assessed bias, and extracted data. Random-effects models estimated pooled participation, positivity rates, and odds ratios for geographical effects.
RESULTS: Of 8532 articles, 35 were included in the review, with 21 used for meta-analysis. The overall FIT participation rate was 49.9% (95% confidence interval [CI]: 40.6, 59.2). In Europe, individuals in rural areas had higher participation rates compared to urban areas (pooled odds ratio [POR]: 1.20; 95% CI: 1.01, 1.42), while in Australia, remote areas exhibited lower odds of participation than metropolitan areas (POR: 0.75; 95% CI: 0.65, 0.87). The overall FIT positivity rate was 8.70% (95% CI: 6.50, 11.70), with no significant difference between rural and urban areas (p = 0.24).
CONCLUSIONS: A notable disparity in the FIT-based CRC screening participation rate was observed using the geographical definition of rurality and remoteness. Further research is needed to identify the sociocultural, healthcare access, and policy factors driving these differences and develop targeted strategies to improve screening and address barriers for underserved populations.
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