Background: Colorectal cancer (CRC) is a leading global malignancy, ranking third in incidence and second in mortality. Screening and early diagnosis can reduce CRC burden, but quantifying the preventive impact of screening requires reliable estimates of program participation and coverage.
Objectives: Screening coverage varies widely across settings, and few studies have systematically summarized the global landscape and coverage of CRC screening programs. We aimed to characterize CRC screening programs worldwide, estimate screening coverage, and assess temporal trends across countries.
Methods: A systematic literature search was conducted in the PubMed and Embase databases from inception to March 2025. Data sources included peer-reviewed literature and grey literature (e.g., official government websites, WHO reports, and documents from national screening agencies). Studies reporting population-based CRC screening coverage were eligible for our analysis. The coverage rate of CRC screening was defined as the proportion of eligible individuals in the target population who underwent screening within a specified period. The risk of bias of the included studies was assessed based on a modified version of the American Agency for Healthcare Research and Quality (AHRQ) guideline considering the characteristics of the study types. We provided a comprehensive overview of essential information and the most recent coverage rates for global screening programs. Furthermore, we performed a temporal trend analysis of coverage rates and subgroup analyses by sex and age.
Results: Our review yielded a total of 35 studies that reported CRC screening coverage rates across 33 countries. Globally, there are currently 49 national CRC screening programs across 45 countries or regions, including 8 programs from Asia, 31 from Europe, 5 from North America, 3 from South America, and 2 from Oceania . Among these, 27 countries reported the latest available coverage rates. We illustrates the wide variation in the most recently reported CRC screening coverage rates across countries, from as low as 1.0% in China (2020) to as high as 79.4% in Finland (2021). The coverage of screening program differed slightly between men and women in most countries (men: IQR, 25.3% - 52.7%; women: IQR, 23.0% - 65.1%). Twenty countries reported age-specific coverage data. Coverage increased with age and generally peaked between 65 - 69 years. The screening coverage rates in Latvia, the United Kingdom, and Slovenia have shown statistically significant increasing trends over time, with Average Annual Percent Change (AAPC) values of 7.93, 2.39, and 0.94, respectively. Our findings suggest that CRC incidence and mortality rates among screening-targeted populations have remained relatively stable in most countries over time, with eight countries, including Denmark, Italy, the Netherlands, and Slovenia, showing a statistically significant downward trend.
Conclusions: This evidence synthesis maps the distribution and characteristics of national CRC screening programs and demonstrates substantial international variation in screening coverage. Strengthening population participation, especially in settings with low coverage or rising CRC burden, will be critical to improve the population-level effectiveness of CRC screening and reduce inequities in cancer prevention outcomes.

Coverage rate of colorectal cancer screening programs worldwide using the latest available data