Awareness, barriers, and uptake of colorectal cancer screening among first-degree relatives: A cross-sectional study

Background: First-degree relatives (FDRs) of colorectal cancer (CRC) patients are at increased risk for CRC. Colonoscopy is the recommended screening modality, yet uptake in this high-risk group remains poorly characterized, particularly in Saudi Arabia. Methods: We conducted a cross-sectional study of FDR of patients diagnosed with CRC at a tertiary academic center. They completed a structured questionnaire assessing awareness of CRC screening, previous screening practice, and perceived barriers to undergoing a colonoscopy. Results: Among 346 FDRs, 122 (35.3%) were aware of CRC screening recommendations and 78 (22.5%) had undergone colonoscopy. Among participants who had not undergone colonoscopy and provided complete barrier-response data ( n = 268), the most commonly reported barrier was lack of information or inadequate counseling (51.9%, n = 139), followed by psychological fear (17.9%, n = 48) and financial barriers (16.4%, n = 44). Colonoscopy uptake did not differ by gender (23.4% vs. 19.7%, P = 0.423) but was higher among those with higher educational attainment and medical backgrounds ( P = 0.001). Conclusion: CRC screening awareness and colonoscopy uptake among FDRs of CRC patients are suboptimal. Family-centered counseling at diagnosis, structured patient navigation, and tailored education programs are needed to improve screening participation in this at-risk population.