Non-participants in colorectal cancer screening in Germany: reachability through the healthcare system

OBJECTIVE: It is often hypothesized that persons not participating in cancer screening are difficult to reach through the healthcare system. We aimed to investigate this hypothesis for non-participants in colorectal cancer (CRC) screening in Germany. METHODS: Using health claims data covering ~20% of the German population, we included persons aged 59 years in 2020 who had undergone neither fecal occult blood testing nor screening colonoscopy by the age of 59 years. We assessed (preventive) healthcare contacts and utilization of (reimbursable) CRC screening counseling between the ages of 50 and 59 years. RESULTS: Among 71 575 included persons (38% female), 99% had at least one physician contact between 50 and 59 years (mean age at first contact: 50.3 years). A total of 87% of women and 80% of men utilized any other preventive measure such as the general health check-up; the latter was utilized by 71% of women and men. Counseling about CRC screening was coded in 38% of women (men: 34%). CONCLUSION: Non-participants in CRC screening in Germany are reachable through the healthcare system and the vast majority has preventive healthcare contacts. This suggests that new structures are not needed, but rather it should be investigated how existing structures could be better used for counseling about CRC screening.