Participation in colorectal cancer screening trials after first-time invitation: a systematic review

Endoscopy. 2011 Dec;43(12):1059-86. doi: 10.1055/s-0031-1291430. Epub 2011 Dec 1.


Background and study aim: Colorectal cancer (CRC) screening is implemented by an increasing number of countries. Participation rates of screening programs influence the health benefit and cost-effectiveness of the applied method. The aim was to systematically review participation rate after first-time invitation for CRC screening with fecal occult blood test (FOBT), sigmoidoscopy, colonoscopy, and/or computed tomography (CT) colonography.

Methods: A systematic literature search was performed prior to October 1 2009. Prospective CRC screening studies of unselected populations reporting participation rates were included.

Results: After meta-analyses, overall participation rates were found to be 47 % for FOBT, 42 % for fecal immunologic tests (FITs), 35 % for sigmoidoscopy, 41 % for sigmoidoscopy combined with FIT/FOBT, 28 % for colonoscopy, and 22 % for CT colonography. Studies comparing screening methods showed higher participation rates for less invasive methods. Studies comparing invitation methods showed higher participation rates with general practitioner involvement, a more personalized recruitment approach, and reduction of barriers that discourage participation.

Conclusions: Knowledge of identified factors affecting CRC screening participation can be used to improve screening programs.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Aged
  • Colonography, Computed Tomographic
  • Colonoscopy
  • Colorectal Neoplasms / diagnosis*
  • Female
  • Humans
  • Male
  • Mass Screening*
  • Middle Aged
  • Occult Blood
  • Patient Acceptance of Health Care*
  • Sigmoidoscopy