National Guidelines for Colorectal Cancer Screening in Saudi Arabia with strength of recommendations and quality of evidence

Abstract

BACKGROUNDColorectal cancer is the most common cancer among Saudi men and the third commonest among Saudi women. Given the predominance of colorectal cancer compared with other cancers in Saudi Arabia, context-specific guidelines are needed for screening.METHODSThe Saudi Centre for Evidence-Based Healthcare assembled a panel of experts from the Saudi Society of Colon and Rectal Surgery, Saudi Gastroenterology Association, the Saudi Oncology Society, the Saudi Chapter of Enterostomal Therapy, the Family Medicine and Department of Public Health at the Saudi Arabian Ministry of Health and a patient advocate. The panel collaborated with a methodological team from McMaster University, Canada to develop national guidelines for colorectal cancer screening. After identifying key questions, the panel conducted a systematic review of all reports on the utility of screening, the cost of screening for colorectal cancer in Saudi Arabia and on the values and preferences of Saudi patients. Meta-analyses, when appropriate, were performed to generate pooled estimates of effect. Using the GRADE approach, the panel used the evidence-to-decision (EtD) framework to assess all domains important in determining the strength and direction of the recommendations (benefits and harms, values and preferences, resource implications, equity, acceptability, and feasibility). Judgments related to the EtD domains were resolved through consensus or voting, if consensus was not reached. The final recommendations were developed during a two-day meeting held in Riyadh, Saudi Arabia in March 2015. Conflicts of interests among the panel members were handled according to the World Health Organization rules.LIMITATIONSThere is lack of national data on the incidence of adenomatous polyps or the age groups in which the incidence surges. There were no national clinical trials assessing the effectiveness of the different modalities of screening for colorectal cancer and their impact on mortality.CONCLUSIONThe panel recommends screening for colorectal cancer in Saudi Arabia in asymptomatic Saudi patients at average risk of colorectal cancer. An infrastructure should be built to achieve that goal.

Knowledge and utilization of colorectal cancer screening in Saudi society

“…In SA, clinical practice guidelines for CRC have been published. 4 However, there is no national policy for CRC screening despite increasing disease incidence. 12,20 Moreover, due to lack of knowledge, the Saudi population is less likely to undergo screening for CRC than for other screening-amenable tumours, such as breast and cervical cancer.…”

“…22 However, the national guidelines of SA recommend lowering the age to 45 years for individuals at average risk and even further for those at high risk. 4 This recommendation was based on reports of increased incidence of CRC in young individuals from Saudi presenting with a more advanced stage of the disease. 4,23,24 The proper age for the screening of CRC in healthy individuals was incorrectly perceived by most respondents; responses tended to recommend lower than 45 years of age.…”

“…Screening at a proper age is important for prevention and control, and further, it is considered cost-effective. 4 It is anticipated that a policy of screening for CRC will decrease the burden on the government and improve the health of the Saudi population.…”

“…All these screening procedures should be performed by highly skilled and experienced staff in well-equipped medical centers. 4 The aim of this study was to measure the utilization and the knowledge of CRC screening in the Saudi population, to investigate the awareness of CRC incidence and risk factors in the society, and to emphasize the importance of screening and early prevention among the population by establishing an effective educational program.…”

Assessment of Knowledge and Perceived Barriers About Colorectal Cancer Screening Among Ministry of Health Primary Health Care Physicians in Makkah Al-Mokarramah City, 2016.

“…Personal history of childhood exposure to abdominal radiation therapy. (2,19) Several barriers may affect CRC screening such as the cost, shortage of insurance coverage, fear and discomfort of screening tests, lack of awareness by both the patient and the physicians, which mean that there is need to increase the awareness among them to make preventive services more efficient. The knowledge of primary health care physicians (PHCPs) is essential where the main role of is to provide CRC screening and other preventive services through health education, counseling, conducting screening tests, referring patients for advanced care, and follow-up care.…”