Uptake of Colorectal Cancer Screening in Low- and Middle-Income Countries: a Systematic Review and Meta-analysis

Abstract

Background: Colorectal cancer (CRC) remains a major global health burden with higher mortality rate in low- and middle-income countries (LMICs). It is well established that CRC screening reduces CRC incidence and mortality. However, data regarding uptake of CRC screening remains scarce in LMICs. Therefore, we aimed to quantify uptake of CRC screening in LMICs.

Methods: We searched for scientific literature published in any language using four online databases (Scopus, Embase, PubMed, and Web of Knowledge) from their inception to 1 August 2024. We included observational studies reporting the prevalence of uptake of CRC screening modalities in LMICs. A random-effects model was used to estimate pooled prevalence with 95% confidence intervals (CIs). Subgroup analyses and meta-regression were used to investigate potential sources of heterogeneity.

Results: Sixty-nine studies encompassing data from 19 LMICs were eligible for final inclusion in this systematic review. The pooled prevalence of self-reported uptake of screening colonoscopy was 5.2% (95% CI, 3.1-7.8). The pooled proportion of individuals who self-reported undertaking screening gFOBT was 11.5% (95% CI, 8.2-15.3). Pooled prevalence of self-reported uptake of any CRC screening modalities was 9.1% (95% CI, 6.2-12.5). Subgroup analyses showed that uptake of CRC screening did not vary significantly across available study-level variables.

Conclusion: This meta-analysis revealed low colorectal cancer screening rates, impeding early detection at the population level. LMICs should prioritize context-specific strategies to improve screening uptake.

Keywords: Colorectal cancer; Early detection; Low- and middle-income countries; Meta-analysis; Screening.