Factors Associated with Participation and Fecal Immunochemical Test( FIT) Return in the Colorectal Cancer Screening Program among the Population Covered by Mashhad University of Medical Sciences

Abstract

Background and Objectives: The aim of the present study is to examine factors associated with participation and FIT test return in the colorectal cancer screening program.

Methods: This population-based cross-sectional study was conducted in 2023. The study outcomes were participation and return of the test. Potential determinants included sociodemographic characteristics and colorectal cancer risk factors. A total of 486,111 individuals were included. Multivariable logistic regression analysis was used to assess associations between potential factors and participation and adherence outcomes.

Results: Participation and adherence to test return were 26.65% and 38.58%, respectively. Multivariable logistic regression analysis showed that older age, the presence of suspicious gastrointestinal symptoms, and a positive family history of colorectal cancer were associated with higher adjusted odds of participation compared with the reference groups; however, these factors were associated with lower adjusted odds of test return. Among older adults, the adjusted odds of returning the test were lower in women than in men (rural population: aOR = 0.64 in older women vs. 0.78 in older men; urban population: aOR = 0.71 in older women vs. 0.83 in older men). Insufficient physical activity was associated with higher adjusted odds of non-participation and non-adherence in both urban and rural populations.

Conclusion: Given that the FIT is provided free of charge and has a limited expiration period, the findings of this study can substantially inform resource allocation and planning strategies to enhance participation and completion of colorectal cancer screening programs.