People with intellectual disabilities are significantly less likely to participate in colorectal cancer screening and complete follow-up diagnostic testing, according to a nationwide cohort study. The findings highlight persistent inequities in preventive cancer care and underscore the need for tailored screening strategies to improve access and outcomes.
Colorectal Cancer Mortality
Colorectal cancer mortality is known to be higher among individuals with intellectual disabilities, potentially due to delayed diagnosis. To better understand screening participation, researchers analysed Danish national registry data from adults aged 50–74 years invited to free biennial colorectal cancer screening between 2014 and 2023. The study included 17,117 people with intellectual disabilities and more than 149,000 individuals without such disabilities, enabling a large-scale comparison of participation rates and diagnostic follow-up.
Overall, screening participation was markedly lower among people with intellectual disabilities. Only 30.2% returned a stool sample within 90 days of invitation, compared with 56.1% of those without intellectual disabilities. Although stool sample return increased with disability severity, researchers observed higher rates of non-analysable samples in this population, suggesting additional barriers during the screening process.
Disparities extended beyond initial participation. Among participants who received a positive screening result, just 70.5% of people with intellectual disabilities underwent a follow-up diagnostic examination, most commonly colonoscopy, within 60 days, compared with 90.2% of those without intellectual disabilities. Completion of diagnostic testing declined further with increasing disability severity, and colonoscopies were more frequently incomplete in this group.
The authors suggest that practical, cognitive, and systemic challenges may contribute to these gaps, including difficulties with sample collection, communication barriers, and limited support during complex procedures. These findings emphasise that simply offering free screening programmes may not be sufficient to achieve equitable healthcare access.
Personalised, Decision-Supportive Interventions
Importantly, the study highlights the need for personalised, decision-supportive interventions tailored to the needs of people with intellectual disabilities. Potential strategies could include adapted communication materials, caregiver involvement, enhanced clinical guidance, and procedural adjustments to improve completion rates.
As many countries continue expanding population-based colorectal cancer screening initiatives, the researchers stress that equity-focused approaches are essential. Addressing the unique barriers faced by individuals with intellectual disabilities may help reduce diagnostic delays, improve early cancer detection, and ultimately narrow disparities in colorectal cancer outcomes.
Reference
Horsbøl TA et al. Colorectal cancer screening among people with intellectual disabilities. JAMA Netw Open. 2026; 9(1):e2557013.
