Comparison of uptake of colorectal cancer screening based on fecal immunochemical testing (FIT) in males and females: A systematic review and meta-analysis

Background: Colorectal cancer is the third most common cancer in males and the second in females worldwide. Incidence and mortality are higher in men than women. Colorectal cancer screening is effective in reducing mortality. Internationally, fecal immunochemical testing (FIT) is increasingly being recommended as the primary screening test. This systematic review and meta-analysis aimed to determine whether uptake of FIT screening differs between men than women. Methods: We searched Pub Med and Embase for peerreviewed articles published in English during 2000-2013 for randomized controlled trials (RCT) or observational studies of screening using FIT that quantified numbers invited and participating by gender. Meta-analysis was performed using a random effects model. Results: Six hundred and eighty-five citations were identified, 19 meeting the inclusion criteria. Random effects meta-analysis found male uptake was significantly lower than female uptake [odds ratio (OR), 0.84; 95% confidence interval (CI), 0.75-0.95; P < 0.01]. This generally persisted throughout subgroup analysis of study design (RCTs vs. observational studies and study quality), screening organization (methods of invitation, number of samples, age range of screening, recommendations, and reminders), and setting. Conclusions: Meta analysis of FIT screening studies indicates significantly lower uptake among men. Impact: Further investigation is required into factors influencing acceptability and participation of FIT screening in both sexes.