In our study, the participation rate for colonoscopy was 55.56%, which is considerably higher than the rates reported in previous studies, ranging from 42.5% in China (14) and 45.5% in Korea (15) to 37.2% in Canada. Additionally, the participation rate among the urban population (62.60%) was significantly higher than in the rural population (43.62%). However, the findings from these studies collectively indicate a low recruitment of individuals for colonoscopy (16). This low participation can be attributed to factors such as limited knowledge about colon cancer and available screening tests, being asymptomatic, lack of recommendations for screening by primary care doctors, and various fears and misconceptions related to cancer prevention (17). In our study, feeling embarrassed and fearing pain emerged as the most significant barriers to undergoing a colonoscopy. A scoping review study highlighted five major factors influencing participation in CRC screening: access, knowledge, culture, trust, and health perception and beliefs (18).
The FIT positivity rate in our study was 7.65%, which was consistent with previous studies reporting a rate of 6.9% (19).
Regarding the detection rate of CRC through screening, we found that among urban residents, it was 0.10%, which is lower than the rates previously reported as 0.25% and 0.23% (20, 21). The rate of cancer diagnosis was almost similar between men and women, both at 0.15%. Furthermore, there was an increasing trend in the rate of cancer diagnosed with older age, with a rate of 0.12% in the age group of 50–59 and 0.2% in the age group of 60–69. These findings suggest that CRC screening based on FIT is particularly effective in the elderly population.
In our research, we observed that the PPV of FIT for adenoma was approximately 15.74%. This percentage exceeds the 12.0% reported in a previous study conducted among average-risk participants (22). Moreover, our findings revealed a notable overall rate of CRC at 3.61%. This figure is significantly higher than the previous report in Iran, which was 0.84%. It is worth noting that the number of cases that underwent colonoscopy was higher in their study, which could contribute to the difference in the CRC detection rate.
The PPV of adenomas and hyperplastic polyps in a study with a large sample size was reported as 16.1% and 6.9%, respectively. In our study, the PPVs for adenomas and hyperplastic polyps were found to be 15.74% and 6.88%, respectively, which is inconsistent with their published data (23).
Our study identified a notable discrepancy in pathological findings between men and women, with men showing a significantly higher prevalence of abnormalities compared to women. This observation underscores the importance of developing customized approaches to address gender-specific risk factors and screening strategies.
Urban residents exhibited a higher incidence of pathological findings compared to their rural counterparts. This contrast between urban and rural areas highlights the potential impact of environmental factors, lifestyle choices, and healthcare accessibility on the prevalence and characteristics of pathologies.
Among individuals aged 50 to 69 years, the subgroup of 60 to 69-year-olds showed a notably higher prevalence of pathological findings compared to the 50 to 59-year-old group. This finding suggests that individuals in the older age bracket may have an increased susceptibility to certain pathologies, highlighting the importance of tailored screening strategies and preventive interventions for this age group.
Interestingly, individuals categorized as employed (referring to a specific employment category) exhibited a higher prevalence of significant pathological findings compared to other employment categories. This observation implies a possible association between occupational factors, stress levels, possibly sedentary lifestyle in employed ones, or work-related exposures and the development of specific pathologies. These findings provide insight into the intricate interconnections among gender, residential location, age, and employment status and their influence on pathological outcomes. Further research and analysis are necessary to elucidate the underlying mechanisms that drive these associations and to guide the development of more personalized healthcare interventions.
While previous studies conducted in Iran have primarily focused on various aspects of FIT test utilization, such as population awareness and participation, our study provides valuable insights into the results of stool-based CRC screening using FIT, specifically among individuals of Persian ethnicity. The study population consisted of average-risk adults who were consecutively assessed at a well-equipped gastroenterology clinic, thereby increasing the likelihood of generalizability of the presented statistics to the average-risk population in Iran. Nevertheless, to comprehensively evaluate the quality of FIT test for CRC screening in Iran, further studies with larger sample sizes are warranted.