International MENA region - Colon cancer screening
BSG International Section Project: Colorectal Cancer Screening in the MENA Region
Dr Laith Al-Rubaiy - BSG Zonal Lead – MENA region
The British Society of Gastroenterology (BSG) International Section recently supported a major project examining colorectal cancer (CRC) screening across the Middle East and North Africa (MENA). Published in Gastrointestinal Disorders (August 2025), this narrative review and expert survey highlights the current state of CRC screening, the barriers faced by clinicians and patients, and practical solutions to improve early detection in the region .
Why focus on colorectal cancer?
Colorectal cancer remains one of the leading causes of cancer death worldwide, responsible for nearly one million deaths each year . High-income countries such as the UK, USA, and Canada have seen falling incidence and mortality thanks to structured screening programmes. In contrast, most MENA countries are experiencing rising CRC rates, often linked to increasing life expectancy and the adoption of more Western lifestyles .
Evidence shows that organised screening can cut mortality by up to 57%, yet uptake in the MENA region remains poor. For example, participation is less than 10% in the UAE and around 17% in Turkey, compared with 60–70% in Western nations .
The BSG-funded study
This project combined two approaches:
Narrative review: A focused literature review summarised available data on national programmes, guidelines, barriers, and facilitators of CRC screening across MENA .
Expert survey: The BSG International Section convened the MENA-CRC Screening and Prevention Collaborators, gathering input from 17 gastroenterologists across countries including Egypt, Saudi Arabia, Lebanon, UAE, Jordan, Turkey, and Iraq .
Key findings
Current practices:
Most clinicians (82%) reported that screening is opportunistic, not organised .
Common starting ages for screening varied (40 years in 42% of cases, 45 years in 35%, and 50 years in 18%).
Colonoscopy was universally available, while stool tests (88%), sigmoidoscopy (59%), and CT colonography (47%) were less common .
Barriers identified:
Patient-level: fear of discovering cancer (88%), embarrassment (82%), lack of awareness (77%), and cultural sensitivities .
System-level: cost and lack of insurance coverage (71%), limited recommendations from primary care (42%), and shortages of trained staff (35%).
Recommendations
The collaborators agreed that structured, population-based programmes are essential to improve outcomes. The report makes several recommendations:
Tailored public health campaigns: Culturally sensitive awareness campaigns are needed, addressing embarrassment, misconceptions, and gender-specific barriers.
Training and accreditation: Greater investment in workforce development and accreditation of endoscopists is vital. Currently, fewer than 12% reported accredited bowel screening colonoscopy programmes .
Regional guidelines: Locally adapted guidelines should be developed, building on international models but reflecting resource variation, as seen in the World Gastroenterology Organisation’s “cascade” approach .
BSG’s role and next steps
The findings provide a roadmap for clinicians, policymakers, and health authorities to design effective, culturally appropriate programmes.
The BSG will continue working with partners across the region to:
Promote education and training initiatives,
Support guideline development,
Strengthen international collaboration.
Conclusion
This project reinforces a clear message: colorectal cancer screening saves lives, but access and uptake remain limited across much of the MENA region. With targeted investment, culturally sensitive strategies, and strong regional collaboration, it is possible to replicate the success seen in high-income countries.
The BSG is proud to have supported this initiative and will remain committed to reducing the burden of colorectal cancer globally.
View the publication here
International MENA region - Colon cancer screening
Colorectal cancer (CRC) is a significant public health issue, representing one of the greatest causes of both cancer diagnosis and mortality globally. While the incidence is highest in high-income countries, it is rising across the world, including in the Middle East and North Africa (MENA) region.
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