Dear Editor, Colorectal cancer (CRC) has emerged as a critical and growing public health challenge in Saudi Arabia, now ranking as the most common cancer among Saudi males and the second most common among females.1 Age-standardized incidence rates have risen sharply, increasing by approximately 64% over the past two decades, with a notable shift toward diagnosis in younger age groups.2 This alarming trend coincides with rapid socioeconomic development and accompanying lifestyle changes, yet it starkly contrasts with the underutilization of a powerfully effective preventive tool: organized population screening. The Saudi National Cancer Registry reported that in 2022, over 45% of CRC cases were diagnosed at advanced stages (III or IV), where 5-year survival plummets below 15%.1 This underscores a critical failure in secondary prevention and a pressing need to re-evaluate our national screening strategy. The evidence for CRC screening efficacy is unequivocal. The introduction of the Saudi National Screening Program for Colorectal Cancer, advocating for fecal immunochemical testing (FIT) and colonoscopy for positive results, was a pivotal step. However, implementation has been suboptimal. Recent data indicates a screening participation rate of less than 25% among the eligible target population (ages 45–75), far below the target of 65% set by the Saudi Vision 2030 Health Sector Transformation Program.3 Key barriers identified include low public awareness, cultural hesitancy surrounding endoscopic procedures, and logistical challenges in accessing screening centers, particularly in non-urban regions.4 These systemic weaknesses echo the analogy presented by Almadi et al.,5 who compared the CRC care pathway to the Great Wall of China—a structure whose failure resulted from fragmented resources, inadequate support, and strategic vulnerabilities. Similarly, our screening program’s effectiveness is undermined by gaps in awareness, infrastructure and follow-up forming the “weakest links” in our preventive chain. The consequences of this prevention gap are multifold. Late-stage diagnosis imposes a severe burden on patients and the healthcare system, requiring complex, costly treatments with poorer outcomes. A recent study by Alhassan et al.6 highlights the tangible impact of delayed presentation: patients undergoing emergency surgery for colon cancer experienced higher rates of open surgery, stoma creation, ICU admissions, and longer hospital stays compared to those treated electively. These findings underscore the human and systemic cost of late detection and reinforce the urgent need for upstream prevention. Furthermore, the rising incidence in individuals under 50 suggests that future screening guidelines may need reconsideration, aligning with global trends to lower the starting age.2 From a gastroenterology and public health perspective, a multi-faceted intervention is urgently required. First, public awareness campaigns must be culturally tailored, leveraging community leaders and digital media to demystify screening, and emphasize its life-saving potential. Second, screening accessibility must be revolutionized through the deployment of mobile screening units and the integration of FIT kit distribution into primary health care centers.4 Third, we must invest in national capacity by training more gastroenterologists and endoscopy nurses to meet the demand for diagnostic and therapeutic colonoscopies, thereby reducing waiting times.7 As Almadi et al.5 rightly note, a robust screening program—like a strong wall—requires continuous iteration, adaptation, and systemic support to withstand evolving challenges. Colorectal cancer is a largely preventable disease. The rising incidence curve in Saudi Arabia is not an inevitability but a call to action. By strengthening every link in the prevention chain—from public education and accessible screening to timely diagnosis—we can alter the trajectory of this disease, reduce mortality, and alleviate the future burden on our healthcare system. The time for a decisive, nationwide push on CRC prevention is now. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Ahmed Abdulaziz Almohammadi (Tue,) studied this question.