S577 Unequal Access, Unequal Outcomes: A Systematic Review of Rural and Urban Disparities in CRC Screening

Introduction: Colorectal cancer (CRC) is a major trigger of cancer-related indisposition and mortality in affluent countries. Preventive screening minimizes CRC societal health cost, but rural populations may confront hindrances impeding screening adherence and clinical testing accessibility. Aim of this study is to evaluate outcomes of rural versus urban dwellers on CRC screening rates, adherence to standardized timeframes, and clinical assessment methods among moderate-risk adults aged 45 and older in first world countries between 2015 and 2025. Methods: A systematic review was carried out in accordance with the PRISMA guidelines. PubMed, Embase, Scopus, and Web of Science were searched for previous research published from January 2015 to April 2025. Cross-sectional studies, cohort studies, and population-based analyses were used to analyze rural-urban discrepancies in CRC screening among adults at standard risk. The primary outcomes were screening uptake, adherence to recommended intervals, and screening modality. Rurality was determined by geographical or administrative criteria. Results: Eight studies matched selection standards. Rural adults were 20 to 34 percent less prone to receive CRC screening compared to urban counterparts. Reported barriers included long distance travels, inadequate access to endoscopy, paucity of specialists, and financially constrained, academically limited levels. Adherence to screening guidelines was impoverished in rural areas. Following the 2021 United States Preventative Services Taskforce standards lowering screening age to 45, overall uptake improved, but rural, uninsured, and newly eligible adults remained disproportionately under screened. Colonoscopy was the prevailing procedure in both settings, but rural residents more often used stool-based tests such as fecal occult blood test or fecal immunochemical testing. Family physicians performed an increased proportion of colonoscopies in rural areas, though this proportion declined over time. Conclusion: Continued inequalities in developed countries are linked with substantially lower rates of CRC screening implementation, low adherence to established protocols, and greater reliance on stool-based screening techniques. Persistent disparities, especially among low-income, and underserved rural adults, highlight the need for policy-driven solutions to ensure equitable access to preventive care and early detection. This systematic review aims to provide the latest aggregation of evidence and advise initiatives to mitigate inequities in colorectal cancer outcomes in high-income nations.