Equity-focused interventions to increase colorectal cancer screening

This report examines the equity-focused interventions that can improve access to colorectal cancer screening and increase screening rates among specific populations across Canada

How health equity affects colorectal screening rates

Canada’s national target is for 60% of people eligible for colorectal cancer screening to participate in cancer screening—a target no province or territory has yet achieved. With screening numbers especially low among some groups of recent immigrants and low-income households, and with the incidence of colorectal cancer especially high in rural and remote communities, more needs to be done to protect these populations.

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Recommendations

To increase colorectal screening rates in Canada, health system leaders must change the way screening services and systems are created, working with local communities and specific populations to develop tailored approaches that better meet the diverse needs of all people in Canada.

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Factors affecting colorectal cancer screening rates in Canada

This report examines the barriers that make it difficult for people in these groups to access screening–and the strategies that can be used to overcome those barriers.

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Income

People in low-income households are less likely to be screened for colorectal cancer.

Q1 lowest income screening rate is 32%, Q2 is 42%, Q3 is 46%, Q4 is 44%, Q5 highest income is 46%

Immigration

Nearly two-thirds of recent immigrants said they hadn’t been tested because they didn’t know the test existed or was needed.

61%

Geography

People living in rural and remote areas are more likely to be diagnosed with colorectal cancer.
Rate per 100,000 is 53 for urban area, 60 for rural, 63 for rural-remote, 66 for rural-very-remote

Health status

People with multiple chronic conditions are more likely to get screened for colorectal cancer.

People with 0 conditions have 57% rate, 1 condition 66%, 2 to 3 conditions 73%, 3 or more 77%

Barriers and inequities

Barriers that make it difficult for some people to access colorectal cancer screening include:

  • Healthcare provider barriers, such as not having a regular healthcare provider, or not getting a screening recommendation from their provider
  • Health system barriers, such as difficulty navigating or accessing the health system, or systemic racism prejudice
  • Support and education barriers, such as fear of and misconceptions about screening, scheduling conflicts or language barriers
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Strategies to improve screening rates

To raise overall colorectal screening rates, efforts should focused on making improvements across three strategic areas:

  • Community demand—by using participant reminders, small media (e.g., letters, brochures) and education
  • Community access—by reducing system-level access barriers and minimizing participants’ out-of-pocket costs
  • Provider delivery—by providing culturally appropriate and safe care, implementing recall and reminder systems, and offering provider education, assessment and feedback approaches
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