Abstract
INTRODUCTION: Colorectal cancer (CRC) is the second most prevalent cancer in Saudi Arabia and the leading cause of gastrointestinal cancer-related mortality. Despite effective screening methods, participation remains low, resulting in delayed diagnoses and poor outcomes. Barriers include limited awareness, cultural beliefs, healthcare system constraints, and insufficient physician recommendations. Existing studies show variable findings, highlighting the need for a comprehensive synthesis. OBJECTIVE: To identify and categorize barriers to CRC screening in Saudi Arabia by examining individual, healthcare system, and sociocultural factors, and to provide recommendations for improving screening uptake. METHODS: A systematic search of PubMed, Embase, Google Scholar, the Saudi Digital Library, and the Cochrane Library was performed. Eligible studies examined barriers to CRC screening among Saudi adults using quantitative or qualitative methods. Non-Saudi, non-human, review, or methodologically unclear studies were excluded. Two independent reviewers conducted data extraction and quality assessment using ROBINS-I for observational studies and the Cochrane Risk of Bias Tool for RCTs. Heterogeneity was evaluated with Cochran's Q and I², while publication bias was assessed using Begg's test. RESULTS: Of 130 studies screened, 14 met the inclusion criteria. The most frequent barriers were lack of knowledge, absent physician recommendation, cultural stigma, gender-related concerns, and limited access. Meta-analysis revealed high heterogeneity (I² = 83.9%, p < 0.001). Physician recommendation was the strongest predictor of participation, while stigma and access issues were key deterrents. No publication bias was detected (Begg's test p = 0.296). CONCLUSION: CRC screening in Saudi Arabia is hindered by multifactorial barriers. Targeted awareness, physician-driven initiatives, improved access, and culturally sensitive interventions are essential to enhance participation and reduce CRC mortality.