Prevalence, determinants, and barriers to follow-up colonoscopy after a positive fecal immunochemical test in Qaemshahr, Iran: A population-based cross-sectional study from 2022 to 2023.

[OBJECTIVE] Fecal Immunochemical Test (FIT) screening reduces mortality by detecting early-stage colorectal cancer (CRC), but its success depends on follow-up colonoscopy after a positive result. Follow-up rates vary widely, influenced by several barriers, which need to be addressed. Thus, the present study aimed to assess the prevalence, determinants, and barriers to a follow-up colonoscopy after a positive FIT result.

[METHODS] This cross-sectional study evaluated FIT-based CRC screening from April 2022 to March 2023 in Qaemshahr, Iran. Positive FIT results triggered follow-up colonoscopies. Data on colonoscopy results and reasons for non-compliance were collected. Logistic regression was conducted to identify factors affecting follow-up rates.

[RESULTS] Of 14,784 screened, 294 (1.98 %) had positive FIT results; only 167 (56.80 %) underwent colonoscopy, with 73.65 % showing no abnormalities. Barriers included cost (18.89 %), perceived unimportance (41.73 %), fear (34.64 %), and lack of social support and appointment difficulties (4.72 %). Lower education levels (OR from 15.46 for illiterate to 3.79 for high school level, compared to university/college level), and asymptomatic status (OR: 1.86; 95 %CI: 1.01, 3.41) significantly reduced follow-up odds; while other demographics showed no association.

[CONCLUSION] This study reveals a concerning 56.80 % follow-up colonoscopy rate among FIT-positive patients, driven by cost, communication gaps, fear, and educational disparities.