Factors associated with the use of fecal immunochemical tests and colonoscopy in the INSEF Portuguese population

Introduction: The incidence of colorectal cancer is increasing worldwide. However, the screening uptake is generally low. We analyzed the association between sociodemographic, economic, and access-to-healthcare factors and the use of exams that are the basis for colorectal cancer screening in Portugal. Methods: We conducted a cross-sectional study based on data from the 1st National Health Examination Survey. We used Poisson regression to estimate prevalence ratios and study factors associated with the use of fecal immunochemical tests (FIT) and colonoscopy in a Portuguese population aged 50-74 years (n = 2,489). Results: 45.7% of the individuals reported using FIT in the previous 2 years; 37.3% reported using colonoscopy in the previous 5 years. The use of FIT was associated with age group, health region, and having a family doctor. It was higher in older individuals (47.6% in the age group 70-74 years vs. 38.1% in the age group 50-54 years; adjusted prevalence ratio [aPR] = 1.32; 95% CI 1.05-1.65), and in individuals assigned to a family doctor (47.6 vs. 30.3%; aPR = 1.50; 95% CI 1.14-1.98). Colonoscopy was associated with age group, health region, higher education, economic capacity, and having a family doctor. It was higher in older individuals (45.3% in the age group 70-74 years vs. 25.6% in the age group 50-54 years; aPR = 1.85; 95% CI 1.42-2.40), individuals with a higher economic capacity (40.5 vs. 32.4%; aPR = 1.19; 95% CI 1.01-1.40), and individuals assigned to a family doctor (38.7 vs. 25.6%; aPR = 1.43; 95% CI 1.08-1.91). Discussion/Conclusion: In our analysis, the use of FIT and colonoscopy was influenced by sociodemographic, economic, and access-to-healthcare factors. This is relevant to guide interventions in this area. It is essential to ensure an equitable and uniform implementation of the screening program, with family doctors as an important part of the process.