Addressing Disparities in Outcomes of Screening for Colorectal Cancer in Primary Health Care: A Systematic Review
Keywords:
Colorectal cancer; primary care; screening disparities; fecal immunochemical test (FIT); early detection; risk assessment; implementation science; preventive medicine; underserved populations; public health innovationAbstract
Background: Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality globally. Despite well-established screening guidelines, disparities in access and adherence persist, particularly among underserved populations. Primary care plays a pivotal role in increasing CRC screening uptake.
Objective: To synthesize recent empirical evidence on colorectal cancer screening implementation, equity-focused strategies, and emerging technologies within primary care settings.
Methods: This systematic review followed PRISMA 2020 guidelines. Studies were sourced from peer-reviewed journals between 2010 and 2024. Eligible studies evaluated CRC screening delivery, interventions, disparities, or innovations in adult populations, with a focus on primary care contexts. Data were synthesized narratively due to heterogeneity in design and outcome measures.
Results: Twenty-seven studies met the inclusion criteria. Evidence supports that primary care-based strategies such as mailed FIT kits, reminder systems, and risk-tailored decision tools substantially improve screening uptake. Disparities were evident across racial and socioeconomic groups, but targeted interventions reduced these gaps. Technological advances, including blood-based DNA tests, show promise but require further integration and evaluation in real-world primary care settings.
Conclusion: Effective CRC screening in primary care hinges on equitable outreach, consistent provider engagement, and adaptable workflows. Interventions that blend evidence-based guidelines with patient-centered tools are crucial to improving screening adherence and reducing health disparities.
