Effectiveness of an Integrated Colorectal Cancer Screening in Saudi Arabia: A Pragmatic Randomized Trial

Study Overview
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Brief Summary
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The global burden of colorectal cancer (CRC) incidence among young age groups is rising and overwhelming. This new trend of young-onset CRC incidence is evident in western countries. Unfortunately, Asian countries have shown the same epidemic shift in the past few years. As a consequence, this situation might necessitate revisiting the current screening program in this region. Saudi Arabia has a two-fold increase in CRC incidence among young age groups in the last 18 years (9.6/100000 for male versus 9.3/100000 for female). This rising incidence ascribed to the lack of a screening program and suggested lowering CRC screening to 40. The low awareness about risk factors, signs, and symptoms of the disease causes late presentation of CRC cases. Therefore, most presenting cases are associated with a poor prognosis and short survival. Educational and screening programs are, by no means, considered valuable and essential as CRC tends to affect younger age groups.

Detailed Description
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CRC is cancer that starts in the innermost lining mucosa of the colon or rectum. According to the global cancer Observatory (GCO) 2018, CRC incidence is the third (10.2%) globally, after lung and breast cancers (11.6%). In Saudi Arabia, 2010 report, the incidence was 10.4/100,000 that slightly higher in male groups. Unfortunately, the incidence among young age groups is more than that in countries with high incidence. Most of the CRCs initially found as small benign growth or projections known as polyps inside the lumen of colorectal space. A polyp is precancerous if it is >1 cm or the presence of more than two polyps, or if dysplasia present after the polyp removal. There are two main types of polyps: precancerous and hyperplastic polyps or inflammatory polyps, which are not precancerous. The early resection will prevent future cancer development and total cure. Different lifestyle factors that could increase CRC's risk include lack of regular physical exercise, a diet low in fruit and vegetables, a low-fibre and high-fat diet, diary intake during adolescence, overweight and obesity, alcohol consumption and tobacco use. Adherence to CRC screening is essential to limit CRC cancer incidence and improve population health; and then, health providers need to understand the stages of the disease to recommend effective screening strategies.

Official Title
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Effectiveness of an Integrated Colorectal Cancer Screening System in Saudi Arabia: A Pragmatic Randomized Trial

Conditions
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Colorectal Neoplasms, Colorectal Cancer, Colonic Polyp, Occult Bleeding

Intervention / Treatment
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* Diagnostic Test: Stool for Occult Blood Test and Colonoscopy with comprehensive medical checkups


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The participants will be individuals with an average risk of colorectal cancer, age: 40 years and above of both genders Exclusion Criteria: Individuals age less than 40 years or severely ill individuals

Ages Eligible for Study
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Minimum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: List of health centres that randomly allocated to receive the intervention
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: List of health centers that randomly allocated to receive the intervention<br>The intervention is the integrated system which is composed of psychologist, endoscopy physician, family physician, community outreach, and audiovisuals in the waiting area. In addition to text messages of information, education and communication (IEC) delivered to the participants at the outreach, and education campaigns to mobilize individuals going for screening. | Diagnostic Test: Stool for Occult Blood Test and Colonoscopy with comprehensive medical checkups<br>* participants will be drawn from all public government institutions inside Tabuk city(outreach). The institution head will be requested to give wellness cards to the eligible employee to receive comprehensive testing for free in addition to CRC test in selected public health centres.<br>* Other names: Facilitated appointment to receive a digestive health check and a comprehensive medical checkups;|
| No Intervention: List of health centers that randomly allocated to receive routine care<br>The comparators will be individuals with an average risk of colorectal cancer of both genders attending the randomly selected health centres | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The percentage of individuals who screened positive in the intervention group vs. control group. | The comparison of rate positive screening between the intervention and routine care | 1 - 12 months | 
| The enrollment rate of individuals who underwent CRC screening in the intervention group vs. control group | The comparison of the enrollment rate between the intervention and routine care | 1 - 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The percentage of individuals who screened positive and enrolled in colonoscopy for follow-up in the intervention group vs. control group. | Per cent of enrollment in colonoscopy appointment and future follow-up | 1 - 12 months |