Key Message: This report thoroughly assesses the colorectal cancer (CRC) screening program in Saudi Arabia from 2021 to 2023. Evidence shows substantial enhancements in the extent of screening coverage, rates of engagement, and adherence to follow-up protocols while highlighting significant variations based on geographical location and gender.
Colorectal cancer (CRC) is the third leading cause of cancer-related mortality worldwide and is increasing in developing countries[1]. It constitutes 10% of all cancer diagnoses[2]. Colorectal cancer (CRC) is the predominant form of cancer among men and ranks as the third most prevalent cancer among women in Saudi Arabia[3]. Colorectal cancer (CRC) can be detected early with colonoscopy and FIT[4]. Saudi Arabia started a colorectal cancer screening program in 2017 to study its causes and dangers[5]. The program targets symptom-free 45-75-year-olds without polyps or family history. Polyps, first-degree relatives, many second-degree relatives, ulcerative colitis, Crohn's disease, and others are risk factors[3,6]. Analysis of participation and performance measures assessed the national CRC screening program's efficacy and improvement potential.
A retrospective cross-sectional design was utilized to analyze data from the nationwide CRC screening campaign for adults aged 45–75. This helped us gain crucial insights and draw important conclusions. The Cancer Control Program (CCP) and General Administration of Health Programs and Chronic Diseases provided secondary datasets. Fecal immunochemical assays (FIT) and colonoscopies were performed on positive or high-risk patients. Coverage, participation, FIT positive, colonoscopy referral, and compliance rates were investigated meticulously.
The study indicated significant enhancements in many crucial performance metrics across the three-year duration. The coverage rate rose significantly, from 1% in 2021 to 3.4% in 2023 (p < 0.001). The number of persons examined increased substantially from 30,641 in 2021 to 100,340 in 2023 (p < 0.001). Although the FIT positivity rate remained consistent at about 5.7%, there was a substantial rise in the total number of positive FIT readings (p < 0.001). The referral rate for colonoscopy was continuously high, and adherence to colonoscopy sessions showed significant improvement, increasing from 30% in 2021 to 51.2% in 2023 (p < 0.001). Gender and geographical discrepancies were apparent, with a small majority of female participants (51.5%) and notable variances in screening outcomes across different locations.
Colorectal cancer screening was performed in Saudi Arabia from 2021 to 2023. Performance measures improved, with 45-75-year-old screening rates and overall screenings rising. Fecal immunochemical test positivity was maintained at 5.7%. The program's success is evidenced by its high referral rate and therapy adherence. Females constituted 51.5% of the total population. The majority of individuals fell within the age range of 45 to 64. In contrast, men exhibited greater susceptibility. The study highlights the importance of ongoing monitoring and tailored interventions to decrease the incidence of colorectal cancer in Saudi Arabia. Additionally, it fosters disparities between regions and facilitates the gathering of data.
Research on colorectal cancer screening strives to enhance accuracy, thoroughness, and precision. The recommendation proposes transitioning to primary data sources, thorough information verification, and adopting a prospective longitudinal study design. To provide a more comprehensive explanation of the results, it is important to consider factors such as lifestyle, genetics, and socioeconomic background. Local healthcare resource and infrastructure gaps must be addressed to offer fair and equal screening services. A unique identity for each participant can improve monitoring and long-term results. Data on the cause of death and stage of illness is also needed for early detection and treatment. Beneficial participant feedback can improve program efficacy.
Figure1: Annual Coverage Percentage of CRC Screening in Regions of Saudi Arabia (2021-2023)
Table 1: Time trends of performance indicators of the colorectal cancer screening program in Saudi Arabia, 2021-2023.
| 2021-2023 | P value | 2023 | 2022 | 2021 | Performance indicators |
| - | - | 2713033 | 2768401 | 2796365 | No. of individual eligible for screening |
| 174284 | <0.001 | 92723 | 54357 | 27204 | No. of Invited individual for screening targeted age group only |
| (6.2%) | <0.001 | (3.4%) | (2%) | (1%) | (Coverage rate %) |
| 181764 | <0.001 | 97873 | 55927 | 27964 | No. of Invited individual for screening |
| 181222 | <0.001 | 100340 | 50241 | 30641 | No. of individual screened |
| 173742 | <0.001 | 95190 | 48671 | 29881 | No. of individual screened from the targeted age group (Saudi from 45-75 years) |
| 7480 | <0.001 | 5150 | 1570 | 760 | No. of individual screened out the targeted age group (Saudi from 45-75 years) |
| 95.6% | <0.001 | 97.3% | 87.0% | 106.9% | Participation rate % |
| 171871 | <0.001 | 93565 | 48469 | 29837 | No. of individual screened by FIT test |
| 9316 | <0.001 | 5335 | 2285 | 1696 | No. of individual with positive FIT test |
| (5.4%) | <0.001 | (5.7%) | (4.7%) | (5.7%) | FIT Positivity (%) |
| 11187 | <0.001 | 6960 | 2487 | 1740 | Total positive screened individual |
| 8960 | <0.001 | 5532 | 1983 | 1445 | No. of individual referred for colonoscopy |
| (80.1 %) | <0.01 | (79.5 %) | (79.7 %) | (83 %) | (Referral rate %) |
| 2706 | <0.001 | 2376 | 253 | 77 | No. of individual with high risk factor |
| (24.2 %) | <0.05 | (34.1 %) | (10.2 %) | (4.4 %) | Individual with high risk factor % |
| 4998 | <0.001 | 3561 | 915 | 522 | No. of individuals having attended a colonoscopy examination |
| (44.7 %) | <0.001 | (51.2 %) | (36.8 %) | (30 %) | (Colonoscopy Compliance %) |
References:
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