Equity-focused interventions to increase colorectal cancer screening

Overcoming barriers to increase colorectal screening for all Canadians

icon intestinesColorectal cancer is the third most diagnosed cancer and the second-leading cause of cancer death in Canada. Regular screening can reduce mortality rates by allowing for more effective therapies to be started sooner and by identifying pre-cancerous polyps that can be removed before they cause cancer. However, not every Canadian has equal access to screening.

This report shows that screening participation rates are lower among some groups of immigrants and low-income households. As well, the incidence of colorectal cancer is especially high in rural and remote communities–making it critical that these groups be screened regularly.

To increase these screening rates, the barriers that keep them low need to be examined and addressed. For example:

  • People who don’t have a regular healthcare provider or whose provider hasn’t recommended a test are less likely to participate in screening.
  • Low health literacy (including not being aware of the test) and difficulty navigating the health system can keep people from getting screened. Language and cultural barriers sometimes contribute to these issues.
  • Fear or embarrassment about handling fecal samples, misconceptions about the screening processes, and negative attitudes about testing kept some people from getting screened.
  • Some people simply didn’t have time or had trouble scheduling a test around their work or family responsibilities.

This report on equity-focused interventions to increase colorectal screening draws on the best available evidence to describe participation in colorectal cancer screening by various population groups. It is intended to inform decision-making by governments and cancer programs so that services and care can be adapted to the specific needs of diverse population groups.

The report includes sections on:

  • Screening rates among low-income populations, immigrants, different ethnic/cultural groups, remote and rural populations, and people living with disabilities, mental health conditions and/or chronic conditions.
  • Barriers to and facilitators of screening, as well as evidence-based interventions that can be used to co-create approaches to increase screening uptake and equity among specific populations.


Some key terms used in this report

  • When we talk about colorectal cancer screening, the most common test is a fecal test. This simple, non-invasive test checks for hidden blood in the stool that may be a sign of colorectal cancer or other problems. These tests often involve collecting a sample at home and sending it to a doctor or laboratory for testing.
  • An organized colorectal cancer screening program is a provincial/territorial initiative that handles recruitment, reminder and promotional strategies to invite eligible individuals to get screened according to set guidelines. These programs have been shown to increase screening uptake and improve cancer outcomes.
  • Screening rates are determined using two measures. The participation rate is the percentage of the eligible population who successfully completed a fecal test as part of an organized cancer screening program within a two-year period. Up-to-dateness addresses how recently individuals have been tested. People are considered “up to date” with their colorectal screening if they have completed a fecal test in the past two years, a sigmoidoscopy within the past ten years or a colonoscopy within the past ten years.

Learn more about the other terms used in this report on our Definitions page.

First Nations, Inuit and Métis self-determined action

To understand inequities in colorectal cancer screening for First Nations, Inuit and Métis, more and better data will be needed to support the co-development and implementation of interventions with and for these diverse populations. First Nations-, Inuit- and Métis-governed research and data systems will be needed in order to advance this work, which is a priority of the Canadian Strategy for Cancer Control.  

To address the unique rights to self-determination, and to provide culturally appropriate and safe health care, a priority focus must be placed on first developing healthcare systems, institutions and allies that are responsive to the needs of First Nations, Inuit and Métis communities.   

Download our 2019–2020 environmental scan to learn more about strategies being implemented across Canada to improve access and increase screening participation among First Nations, Inuit and Métis.