# Geographical Disparities in Faecal Immunochemical Test‐Based Colorectal Cancer Screening Participation and Positivity Rates: A Systematic Review and Meta‐Analysis

## TL;DR

This study finds that rural and remote areas show mixed participation rates in colorectal cancer screening using FIT, with some regions showing higher and others lower rates compared to urban areas.

## Contribution

The study provides a systematic review and meta-analysis of geographical disparities in FIT-based CRC screening participation and positivity rates.

## Key findings

- Overall FIT participation rate was 49.9%, with rural areas in Europe showing higher participation than urban areas.
- Remote areas in Australia had lower participation rates compared to metropolitan areas.
- FIT positivity rates showed no significant difference between rural and urban areas.

## Abstract

People in rural and remote areas often participate less actively in colorectal cancer (CRC) prevention practices, including faecal immunochemical testing (FIT). However, the evidence on this is limited.

The aim of this systematic review and meta‐analysis was to summarise geographical disparities in participation and positivity of FIT‐based CRC screening.

Six databases were searched for articles published until June 2024. We included studies reporting FIT‐based CRC screening among average‐risk individuals aged 40–74, examining geographical disparities using location‐based or geospatial methods. Two reviewers independently screened, assessed bias, and extracted data. Random‐effects models estimated pooled participation, positivity rates, and odds ratios for geographical effects.

Of 8532 articles, 35 were included in the review, with 21 used for meta‐analysis. The overall FIT participation rate was 49.9% (95% confidence interval [CI]: 40.6, 59.2). In Europe, individuals in rural areas had higher participation rates compared to urban areas (pooled odds ratio [POR]: 1.20; 95% CI: 1.01, 1.42), while in Australia, remote areas exhibited lower odds of participation than metropolitan areas (POR: 0.75; 95% CI: 0.65, 0.87). The overall FIT positivity rate was 8.70% (95% CI: 6.50, 11.70), with no significant difference between rural and urban areas (p = 0.24).

A notable disparity in the FIT‐based CRC screening participation rate was observed using the geographical definition of rurality and remoteness. Further research is needed to identify the sociocultural, healthcare access, and policy factors driving these differences and develop targeted strategies to improve screening and address barriers for underserved populations.