Title : Assessment of community awareness for colorectal cancer screening and prevention in North and Central Asian countries: A scoping review
Objectives: Colorectal cancer incidence and mortality rates are increasing in low- and middle-income countries (LMIC) including North and Central Asian Countries (NCAC). Colorectal cancer (CRC) is preventable by screening and risk factor reduction, but prevention is affected by community awareness. The review assessed community awareness about CRC screening and prevention in NCAC to facilitate cancer control policies.
Study type: Scoping review
Methods: PubMed/Medline, Embase and Cochrane Library were searched for articles related to community awareness about CRC screening and prevention in NCAC according to inclusion and exclusion criteria. Specifically, we aimed to summarize (1) awareness of the availability of CRC screening and modalities for CRC screening, (2) awareness of the symptoms of CRC, (3) knowledge of CRC risk factors, and (4) other barriers to CRC screening amenable to community health education.
Results: We identified 677 publications through the database search until May 14, 2020. After screening, we included six eligible studies in our analyses. Three of the included studies were full manuscripts, and three were conference abstracts. Most of the studies utilized survey design. We found few studies evaluating community health awareness related to CRC in NCAC. The results indicated a low awareness of the availability of CRC screening, symptoms and screening modalities. Some countries also lacked CRC screening programs. Among identified studies, potential barriers for CRC screening utilization were low awareness about CRC screening, poor perception of CRC risk and concern about the cost implications. System-based factors such as availability of CRC screening programs, availability of comprehensive population registers and resources to facilitate CRC screening and follow-up of patients who require colonoscopy were identified as barriers across NCAC.
Conclusion: Community unawareness is a significant barrier to screening program utilization and sustenance. Community health awareness programs (CHAP) are needed to improve the uptake of CRC screening in NCAC. NCAC should include CHAP as an integral component of CRC control plan. CRC screening in a true sense according to international guidelines is strenuous goal for LMICs to achieve and sustain amid their other priorities. Hence long-term cancer control in LMIC could be adapted using the step ladder pyramidal approach. In stage 1, community awareness and resources should be allocated to increase CRC testing rates amongst symptomatic or high-risk people, including people with a family or personal history of CRC to increase cancer diagnosis yield rate (number of cancers detected per number of testing). CHAP could play an important role in this phase and should be an integral component of a cancer control program. In next stage, CRC screening testing should be introduced as once-a-lifetime testing for asymptomatic high yield group (age 60-70 years). In the last phase, efforts should be made to implement international guideline-based CRC screening with fecal occult blood test yearly or fecal immunochemical test every 3 years or colonoscopy every 10 years for people in 50-75 years age group. WHO framework also recommends an early diagnosis program than a true screening program for LMIC to increase early diagnosis of cancer, thus preventing its related morbidity and mortality.
Audience Take Away Notes:
• Understanding role of community awareness in colorectal cancer screening and diagnosis.
• Barriers to cancer screening utilization and sustenance in low-to middle income countries
• Improving cancer control plan though community awareness