Uptake of colorectal cancer screening in Hungary: results from a cross-sectional study

Abstract

Abstract Background Colorectal cancer (CRC) mortality in Hungary exceeds the European Union average, posing a significant public health challenge. After pilot screening programs were implemented, a nationwide, organized, population-based CRC screening program was launched in 2024. Objectives Assess participation in CRC screening among individuals aged 50–70 years, identify influencing factors, and evaluate colorectal cancer related knowledge. Methods A cross-sectional, questionnaire-based study was conducted in northern Hungary from November 2025 to January 2026 among individuals aged 50–70 years (n = 615). Data were collected via an online questionnaire that included the Brief Health Literacy Screening Tool (BRIEF).Descriptive and inferential analyses (chi-square tests, Mann–Whitney U tests, Kruskal–Wallis tests, and Spearman correlations) were performed (p < 0.05). Results The mean age was 58.0 years (SD = 6.01), and 52.5% (95% CI: 48-56) were female. Of those, 50.6% (95% CI: 47-55) reported receiving an invitation to screening. Among them, 30.0% (95% CI: 27-34) underwent fecal occult blood testing through their general practitioner. Only 24.6% (95% CI: 21-28) had participated in screening within the past two years. Notably, 43% (95% CI: 40-47) reported attending screening only if they were experiencing symptoms. Health literacy was adequate in 35.3% of participants (mean BRIEF: 14.9). Knowledge was moderate (symptoms: mean 5.15/11; risk factors: 4.78/10). Screening participation was significantly associated with age (p < 0.01) and positive attitudes toward screening (p < 0.001) but not with other sociodemographic factors. Conclusions Participation in colorectal cancer screenings remains suboptimal, with many individuals making decisions based on symptoms. Health literacy and attitudes are key determinants of knowledge and participation. Targeted health education and communication strategies are necessary to increase screening participation. Key messages • Despite the availability of an organized national program, participation in colorectal cancer screening was low, with only 24.6% of respondents screened within the recommended two-year interval. • The targeted communication of the newly implemented national screening program must be improved, as misconceptions and symptom-driven attitudes remain prevalent and significantly impact participation.