# Colorectal cancer awareness and acceptance of fecal immunochemical test screening in Qassim, Saudi Arabia

## TL;DR

A study in Saudi Arabia found high initial acceptance but low adherence to colorectal cancer screening, highlighting the need for better public education and accessible services.

## Contribution

The study identifies barriers and facilitators to fecal immunochemical test uptake in a specific region of Saudi Arabia.

## Key findings

- FIT acceptance was high (88.3%) but annual adherence was low (43.1%).
- Poor CRC knowledge and self-perceived health were linked to reduced FIT uptake.
- Frequent physician visits and prior screening increased FIT uptake.

## Abstract

Saudi Arabia recently launched a national colorectal cancer (CRC) screening program. Successful control of CRC depends not only on public acceptance but also on sustained adherence and adequate knowledge of CRC symptoms and risk factors. This study evaluated the acceptance, adherence, and knowledge of CRC in the Qassim region, and explored the barriers and facilitators of fecal immunochemical test (FIT) uptake.

A cross-sectional survey of 2,050 average-risk adults aged 45–75 years was conducted at Qassim between December 2024 and February 2025. A structured questionnaire was used to collect socio-demographics, screening history, perceived barriers and facilitators, and knowledge of CRC symptoms and risk factors, utilizing a validated Cancer Awareness Measure (CAM). Logistic regression was used to identify predictors of FIT uptake.

Acceptance of FIT was high (88.3%), but adherence to annual testing was low (43.1%). Knowledge of CRC was poor (mean CAM score 8.2/22), and only 15.2% showed good knowledge. In the multivariable analysis, reduced uptake was independently associated with poorer self-perceived health (OR = 0.19, 95% CI 0.05–0.78) and low CRC knowledge (poor: OR = 0.34, 95% CI 0.16–0.73; intermediate: OR = 0.21, 95% CI 0.09–0.46), whereas more frequent physician visits (2–5/year: OR = 1.57, 95% CI 1.07–2.31; >5/year: OR = 6.07, 95% CI 1.84–19.99), prior screening (OR = 2.02, 95% CI 1.30–3.14) and previous FIT (OR = 6.50, 95% CI 3.61–11.69) predicted higher uptake. Misconceptions, fear, and logistical issues limited participation, while mailed kits, electronic results, and physician counseling encouraged uptake.

In Qassim, FIT screening was widely accepted but poorly maintained, and CRC knowledge was low. National control of CRC will require accessible, patient-centered services and stronger public knowledge of symptoms and risk factors to support prevention, regular screening, and timely help-seeking.