Barriers to colorectal cancer screening: insights and opportunities for enhanced participation

Abstract Background Czechia exhibits an elevated colorectal cancer (CRC) burden, with incidence and mortality rates among the highest in Europe. Despite the availability of organised national screening, participation remains suboptimal (29%) and cases are diagnosed at late stages (54%). As screening reduces CRC burden, understanding barriers to screening participation is critical to improving uptake, adherence, and ultimately, health outcomes. We analysed characteristics of CRC screening participants and non-participants, and explored reported barriers among non-participants. Methods Our cross-sectional study is based on 2568 observations from the 2022-2023 Survey of Health, Ageing, and Retirement in Europe (SHARE) drop-off questionnaire. We conducted descriptive statistics, followed by logistic regression to identify predictors of CRC screening non-participation. Results In Czechia, 55% of respondents were lifelong non-participants of CRC screening. Non-participation was associated with sex (female: OR 1.37, CI 1.15-1.63), age (50-54 years: OR 3.52, CI 2.21-5.76), education (primary: OR 1.39, CI 1.07-1.79), and income (low: OR 1.55, CI 1.18-2.05). Lifestyle factors were not significant predictors of non-participation, except for smoking (current smokers: OR 1.30, CI 1.03-1.63) and doctor visits (rarely: OR 1.80, CI 1.42-2.29). The most frequently reported barriers included lack of symptoms (54%), uncertainty about participation (17%), and fear of examination, side effects, and diagnosis (14%). Conclusions Demographic and socio-economic factors are central determinants of CRC screening non-participation, with reported barriers primarily involving low perceived susceptibility, limited awareness of screening, and screening-related emotional distress. Our findings offer critical insights to optimise CRC screening strategies in Czechia. Further, they highlight the need for cancer surveillance systems to collect granular data on barriers and facilitators to preventive measures. Key messages • To facilitate effective prevention of CRC, population- and behavioural- level determinants should be considered; the availability of CRC screening alone does not prompt participation. • Our study provides evidence to support the design of targeted interventions aimed at bridging the CRC screening participation gap in Czechia.