Overcoming geographical and socioeconomic limitations in colorectal cancer screening

Abstract

Despite colorectal cancer’s (CRC) high global incidence, residents of low- and middle- income countries, as well as low-income minorities in advanced economies have low screening rates. Observational studies demonstrate that in these groups higher incidence of CRC is observed, yet screening rates remain low for consistent reasons. Low income, low educational background, and lack of awareness in combination with inadequate social security of certain population groups impede access and compliance rates to CRC screening. On the other hand, despite the global availability of multiple screening approaches (colonoscopy, sigmoidoscopy, faecal occult blood test, faecal immunochemical test, computed tomography-colonography, etc.) with proven diagnostic validity, many low-income countries still lack established screening programs. The absence of screening guidelines in these countries along with the heterogeneity of guidelines in the rest of the world, demonstrate the need for global measures to tackle this issue comprehensively. An essential step forward is to develop a global approach that will link specific elements of screening with the incidence and available resources in each country, to ensure the achievement of at least a minimum screening program in low-income countries. Utilizing cheaper, cost-effective techniques, which can be carried out by less specialized healthcare providers, might not be equivalent to endoscopy for CRC screening but seems more realistic for areas with fewer resources. Awareness has been highlighted as the most pivotal element for the effective implementation of any screening program concerning CRC. Moreover, multiple studies have demonstrated that outreach strategies and community-based educational programs are associated with encouraging outcomes, yet a centrally coordinated expansion of these programs could provide more consistent results. Additionally, patient navigator programs, wherever implemented, have increased CRC screening and improved follow-up. Therefore, global coordination and patient education seem to be the main areas on which policy making needs to focus.

Keywords: Colorectal cancer; Screening; Low- and middle- income countries; Socioeconomic disparities; Cancer

Core Tip: The high colorectal cancer (CRC) mortality rate worldwide, despite the adequate availability of modern screening, diagnostic and treatment options, raises important research and clinical questions. In both low- and middle- income countries (LMICs), and minority populations of high-income countries, the paradox of underutilization of existing screening methods was observed. The lack of global, homogeneous guidelines and the absence of guidelines addressing CRC screening at the national level for LMICs, contribute to the confusing status in the management of screening of aforementioned populations. Global efforts should focus on medical education and vigilance of medical healthcare providers and patients, on exploring the socio-economic aspects, and on the use of technological innovations in telemedicine and artificial intelligence in clinical practice.