Abstract Organised colorectal cancer (CRC) screening reduces mortality, yet participation routinely falls short of policy targets, a gap most acute in structurally disadvantaged, insular, and rapidly ageing populations. The Azores, an outermost European Union archipelago, exemplifies this challenge: CRC accounts for 10% of regional cancer diagnoses and is the second leading oncological cause of potential years of life lost, with 2024 mortality (24.9 per 100,000) exceeding mainland Portugal.
