Factors predictive of an advanced stage of colorectal cancer at presentation - a bi-national study

Factors influencing colorectal cancer screening decisions among Saudi women: A qualitative study

BACKGROUND

Colorectal cancer (CRC) is a major global health challenge and one of the most prevalent cancers in Saudi Arabia. Studies show that young Saudi women are often diagnosed with CRC at more advanced stages, leading to poorer prognoses. Despite the recent launch of the first Saudi national CRC screening program, public awareness and acceptance of CRC screening (CRCS) remain limited.

METHODS

We conducted semi-structured interviews with 17 women aged 40 or older to explore their awareness, views, and attitudes toward CRC and CRCS. Data were analyzed using reflexive thematic analysis, and the Social Ecological Model was applied to guide the structuring and organization of the developed themes.

RESULTS

We identified a multifaceted interplay of knowledge, beliefs, and social-cultural factors influencing CRCS decisions among Saudi women. Although there was a general awareness of CRC, understanding of risk factors, signs, and symptoms was limited. Many participants adopted a reactive approach to screening, prompted by symptom manifestation or family history, rather than preventive health measures. Concerns such as fear of a cancer diagnosis and discomfort with the stool sample collection process hindered screening participation. Social support from family and community, and physician recommendations were crucial in encouraging screening uptake. Logistic and digital literacy challenges in accessing health services were noted for older adults. Participants stressed the need for increased CRC awareness, equitable access to screening services, and reminders to improve CRCS participation.

CONCLUSION

Factors influencing CRCS uptake among Saudi women are complex and multifaceted. Comprehensive and tailored health promotion interventions that meet community needs are essential. Further research is needed to develop and evaluate the effectiveness of these interventions in increasing screening uptake.

Temporal trends in age and stage-specific incidence of colorectal cancer in Saudi Arabia: A registry-based cohort study between 1997 and 2017

BACKGROUND

In Saudi Arabia, colorectal cancer (CRC) is the most common cancer in men and the third in women, posing a significant health burden. A comprehensive report of CRC incidence rates and trends in Saudi Arabia is lacking. This study aims to examine trends in CRC incidence among the Saudi population.

METHODS

We used data from the Saudi Cancer Registry to examine CRC age-specific incidence rates (ASIR) and age-standardized incidence rates (ASR) between 1997 and 2017. Joinpoint regression analysis was used to determine the magnitude and direction of observed trends stratified by age, sex, and CRC stage at diagnosis. Trends were measured using the annual percentage change (APC) and the average annual percentage change (AAPC) in CRC incidence rates.

RESULTS

In total, 19,463 new CRC cases were identified during the study period. Since 1997, ASR for CRC has steadily increased in men and women overall, irrespective of disease stages. The ASIR increased across all age groups and was more pronounced in older patients. Women aged 40-49 had a higher increase in incidence than men (AAPC= 5.3 % vs.4.7 %). Males aged 70-79 had an AAPC of 10.2 %, twice that of females (AAPC= 4.9 %). A consistent rise in ASIR was observed across all CRC stages and age groups in males and females. In recent years, males under 50 had a higher APC for distant CRC than females, while females aged 50-74 experienced a steeper increase in distant CRC than males.

CONCLUSION

We report a marked increase in the incidence of CRC over time in Saudi Arabia, affecting men and women across all age groups and disease stages at diagnosis. Our findings underscore the need to identify underlying risk factors and to develop and implement effective prevention policies and strategies, including screening programs to facilitate early detection and treatment.

Demographic and clinical characteristics associated with advanced stage colorectal cancer: a registry-based cohort study in Saudi Arabia

BACKGROUND

In Saudi Arabia, approximately one-third of colorectal cancer (CRC) patients are diagnosed at an advanced stage. Late diagnosis is often associated with a worse prognosis. Understanding the risk factors for late-stage presentation of CRC is crucial for developing targeted interventions enabling earlier detection and improved patient outcomes.

METHODS

We conducted a retrospective cohort study on 17,541 CRC patients from the Saudi Cancer Registry (1997-2017). We defined distant CRCs as late-stage and localized and regional CRCs as early-stage. To assess risk factors for late-stage CRC, we first used multivariable logistic regression, then developed a decision tree to segment regions by late-stage CRC risk, and finally used stratified logistic regression models to examine geographical and sex variations in risk factors.

RESULTS

Of all cases, 29% had a late-stage diagnosis, and 71% had early-stage CRC. Young (< 50 years) and unmarried women had an increased risk of late-stage CRC, overall and in some regions. Regional risk variations by sex were observed. Sex-related differences in late-stage rectosigmoid cancer risk were observed in specific regions but not in the overall population. Patients diagnosed after 2001 had increased risks of late-stage presentation.

CONCLUSION

Our study identified risk factors for late-stage CRC that can guide targeted early detection efforts. Further research is warranted to fully understand these relationships and develop and evaluate effective prevention strategies.

Improving Global Surgical Oncology Benchmarks: Defining the Unmet Need for Cancer Surgery in Ghana

BACKGROUND

The Lancet Commission on Global Surgery (LCoGS) recommended an annual surgical rate at which low- and middle-income countries (LMICs) could achieve most of the population-wide benefits of surgery. However, condition-specific guidelines were not proposed. To inform rates of surgery for cancer, we sought to assess the current met and unmet need for oncologic surgery in Ghana.

METHODS

Data on all operations performed in Ghana over a one-year period (2014-15) were obtained from representative samples of 48/124 first-level and 12/16 referral hospitals and scaled-up for nationwide estimates. Procedures for cancer were identified by indication. Using modified LCoGS methodology with disease prevalence, Ghana's annual rate of cancer surgery was compared to that of New Zealand to quantify current unmet needs.

RESULTS

232,776 surgical procedures were performed in Ghana; 2,562 procedures (95%UI 1878-3255) were for cancer. Of these, 964 (37%) were surgical biopsies. The annual rate of procedures treating cancer was 2115 surgeries/100,000 cancer cases, or 21% of the New Zealand benchmark. Cervical, breast, and prostate cancer were found to meet 2.1%, 17.2%, and 32.1% of their respective surgical need.

CONCLUSIONS

There is a large unmet need for cancer surgery in Ghana. Cancer surgery constitutes under 2% of the total surgeries performed in Ghana, an important proportion of which are used for biopsies. Therapeutic operative rate is deficient across most cancer types, and may lag behind improvements in screening efforts. As cancer prevalence and diagnosis increase in LMICs, cancer-specific surgical capacity must be increased to meet these evolving needs.

Factors associated with advanced colorectal cancer differ between young and older adults in England: a population-based cohort study

AIM

Advanced stage presentation of colorectal cancer is associated with poorer survival outcomes, particularly among young adults. This study aimed to determine whether demographic risk factors for advanced stage presentation differed between young and older adults.

METHOD

Individual-level data on all incident colorectal cancers in people aged 20 years and above were extracted from the National Cancer Registration and Analysis Service database for the years 2012 to 2015. Patients were divided into two cohorts: young-onset colorectal cancer (YOCC) if aged 20-49 years and older-onset colorectal cancer (OOCC) if aged 50 years and above. Logistic regression was used to identify risk factors for advanced stage presentation, defined as TNM Stage III or IV, in each cohort.

RESULTS

There were 7075 (5.2%) patients in the YOCC cohort and 128 345 (94.8%) patients in the OOCC cohort. Tumours in the YOCC cohort were more likely to be at an advanced stage (67.2% vs 55.3%, P < 0.001) and located distally (63.7% vs 55.4%, P < 0.001). No demographic factor was consistently associated with advanced stage presentation in the YOCC cohort. Among the OOCC cohort, increased social deprivation [OR (Index of Multiple Deprivation quintile 5 vs 1) = 1.11 (95% CI 1.07-1.16), P < 0.001], Black/Black British ethnicity [OR (baseline White) = 1.25 (95% CI 1.11-1.40), P < 0.001] and residence in the East Midlands [OR (baseline London) = 1.11 (95% CI 1.04-1.17), P = 0.001] were associated with advanced stage presentation.

CONCLUSION

Demographic factors associated with advanced disease were influenced by age. The effects of social deprivation and ethnicity were only observed in older adults and mirror trends in screening uptake. Targeted interventions for high-risk groups are warranted.