A Colorectal Cancer Screening Programs in Middle-Income Countries: A Scoping Review

Abstract

Background: Colorectal cancer (CRC) is the 3rd most common cancer worldwide, and a major contributor to cancer-related mortality. In contrast to declining CRC incidence and mortality rates across high-income countries, the CRC burden is increasing in low- and middle-income countries. Although CRC screening has been shown to be a cost-effective intervention that decreases CRC incidence and mortality, screening programs remain an unmet need in most low- and middle-income countries. This article reviews evidence on existing CRC screening efforts in middle income countries, where the majority of new CRC cases and deaths are projected to occur over the next decade. Aims: The aim of this study was to identify and describe opportunistic and organized CRC screening programs in middle income countries and to identify barriers and facilitators of such programs. Methods: We identified countries defined as middle income countries by the World Bank and conducted a scoping literature review using PubMed, Google Scholar, and ScienceDirect. For each country, we identified whether CRC screening guidelines or programs exist on the national, regional, or local levels, and summarized data on screening methods and uptake, when this information was available. We also summarized published literature describing barriers and facilitators to CRC screening in middle income countries. Results: Of the 108 countries defined as middle income countries by the World Bank, we identified CRC screening programs in six lower-middle income countries and 23 upper-middle income countries. Most countries have opportunistic CRC screening guidelines/programs. Countries with organized CRC screening programs had higher screening uptake rates, although very few have achieved CRC screening coverage rates of >50% of the eligible population. Most programs were initiated less than 10 years ago, limiting ability to evaluate effect on CRC incidence and mortality. Several barriers to CRC screening were identified, including lack of physician buy in, participant knowledge and resources, and participant fear of screening. Conclusions: While there has been growth of CRC screening programs in the last decade with the initiation of both opportunistic and organized screening programs in middle income countries, there remain significant barriers to the uptake and implementation of such programs.