Abstract
Colorectal cancer has become a major public health concern in Saudi Arabia. It is the most prevalent cancer among men and the third most prevalent among women. Although screening for people aged 45-75 is recommended by national recommendations, screening uptake is still below 10%, and less than 1% of older persons have a colonoscopy. With regional differences that vary from age-standardized rates of 3.2 per 100,000 in Jouf to 21.8 per 100,000 in Riyadh among men, approximately 29% of cases are detected at late stages. Therefore, we assessed the epidemiological, social, and health-related systemic structures preventing effective colorectal cancer screening in the region. Important barriers to colorectal cancer screening include a lack of public knowledge, cultural taboos, healthcare system constraints, and gaps in physician knowledge. Although some initiatives, such as fecal immunochemical testing, appear promising, screening rates remain exceptionally low. Furthermore, the alarming increase in early onset colorectal cancer in individuals aged <50 years underscores the need to screen high-risk individuals at younger ages. This review highlights the pressing necessity for a nationwide colorectal cancer screening initiative, which should encompass the creation of a national registry, focused public education campaigns to overcome cultural obstacles, mobile screening units for rural regions, and the incorporation of artificial intelligence (AI)-assisted diagnostics to enhance the existing 5-year survival rates of 44-52%.