Sociodemographic factors and strategies in colorectal cancer screening: a narrative review and practical recommendations

Background: Worldwide colorectal cancer is a frequently occurring cancer with a high disease burden. It is the second most frequent cancer in women and the third in men. The incidence of colorectal cancer is increasing because of ageing and unhealthy lifestyles. Aim: We aimed to perform a narrative literature review on methods and strategies for screening for colorectal cancer prior to colonoscopy. Design: Narrative literature review. Methods: The databases PubMed, Web of Science, Embase and The Cochrane Library were searched using keywords: 'colorectal cancer', '(mass) screening', 'occult blood', 'prevention', 'socioeconomic status', 'early diagnosis', 'Europe' and 'ethnicity'/'ethnic groups'. Results: 18 articles were included. Multiple randomised controlled trials have shown that screening programmes with faecal occult blood tests (FOBT), guaiac-FOBT (gFOBT) and immunochemical FOBT (iFOBT) represent a valid prevention strategy. Most studies favour iFOBT, because of ease to use, resulting in a higher uptake of screening, as well as a higher detection rate. A higher uptake is also achieved by mailing of the test. Overall the uptake of screening is higher in women, although more cancers are diagnosed in men. This can be explained by a lower sensitivity of FOBT in women. Furthermore, a strong correlation was found between a low socio-economic status and a low uptake of screening. The screening age lies between 50-74 years. Conclusion: Colorectal cancer is characterized by a significant incidence, morbidity and mortality. Systematic screening is effective for early detection. A non-selective test with iFOBT currently has the best validity with a higher sensitivity in men.