Barriers to CRC Screening

Low CRC screening rates can be attributed to multiple reported barriers at the patient, provider, and healthcare system levels.1-3 Often these barriers are perceived differently among patients and providers.1,2

The number one barrier to CRC screening reported by unscreened patients was lack of a provider recommendation/referral.1 In a separate study, providers perceived that the primary barriers were at the patient level2

Follow-up with colonoscopy after positive stool based CRC screening results is required for screening benefits to be achieved3


Tables showing Barriers for Screened and Unscreened patients
  • The number one barrier reported by unscreened patients was no recommendation/referral by a healthcare provider, followed by fear and finances1
  • Among screened patients, fear and logistics were cited as the major barriers1


Bar charts displaying provider and system barriers
  • Clinicians perceived that the number one provider barrier was lack of time to discuss screening2
  • Clinicians perceived that the main system barriers were lack of a reminder system and lack of support staff2
  • Clinicians were asked about their perceived patient barriers - they reported fear, finances, other health issues, lack of awareness, health literacy, and a fatalistic attitude toward cancer as the most common barriers2


Muthukrishnan M, Arnold LD, James AS. Patients’ self-reported barriers to colon cancer screening in federally qualified health center settings. Prev Med Rep. 2019;15:100896.

Wang H, Gregg A Qiu F, et al. Provider perceived colorectal cancer screening barriers: results from a survey of accountable care organizations. JOJ Public Health. 2017;1(2):555557.

Davidson KW, Barry MJ, Mangione CM, et al. Screening for colorectal cancer: US Preventive Services Take Force recommendation statement. JAMA. 2021;325(19):1965-1977. 



Cluster-randomized trial performed in 11 urban and rural safety-net primary care sites across two health systems aimed at evaluation of self-identified barriers to colorectal cancer screening (n=483). Data were collected through surveys administered in person, by phone or mail. Previously screened and unscreened participants (age ≥50) were asked about health insurance and access to care, and “What barriers/things got in the way of being screened?”

Fear related to CRC screening manifested in different ways, with patients expressing concerns related to the procedure, sedation, and outcomes of the procedure.

Other barriers include medical mistrust (n=4), lack of information on CRC screening (n=5), religious reasons (n=2), or they simply “don’t want to” (n=7).

Survey-based study of 93 primary care providers from 13 Accountable Care Organization clinics, primarily in rural communities.

Last updated: 3/31/2023