Decreasing participation in Dutch population-based cancer screening programs: Trends from 2018 to 2022

Objective: Population-based screening programs for breast, cervical, and colorectal cancer have been proven effective in detecting cancer at an early or precancerous stage, thereby enabling better patient outcomes. For screening programs to remain effective at a population level, high participation rates are essential. Methods: Data on participation in the three nationwide screening programs in the Netherlands from 2018 to 2022 were obtained from the national screening information system (ScreenIT). Participation rates were calculated to assess trends over time, stratified by invitation round (first vs. subsequent) and sex (for colorectal cancer only). Results: Participation was consistently lower for the first invitation rounds and men compared to subsequent rounds and women. Decreasing participation rates were observed for all programs and subgroups. In five years' time, overall participation decreased from 76.9 % to 70.7 % for breast cancer (-8.0 %), 55.5 % to 48.6 % for cervical cancer (-12.4 %), and 73.0 % to 68.4 % for colorectal cancer (-6.2 %). Conclusion: While some logistical factors may have contributed to decreasing participation rates, the consistent decline observed across all three nationwide screening programs remains unclarified. Our results emphasize that continuous monitoring of screening programs is crucial, and accessibility of cancer screening should be prioritized.