Colorectal cancer screening in low- and middle-income countries

: a focus on Uganda

Abstract

While colorectal cancer (CRC) incidence appears to be increasing in the majority of low- and middle- income countries (LMICs) like Uganda, efforts for prevention, including screening, have not yet been prioritised. Previous research examining the epidemiology of CRC in Uganda is limited. This thesis  aimed to provide baseline data in order to guide and inform efforts on CRC prevention and control in Uganda with potential application to other parts of Africa. The first study was a systematic review and meta-analysis which aimed to investigate the age profiles of CRC cases at diagnosis in Africa. The pooled mean age of CRC cases at diagnosis was 53 years with a relatively high proportion of cases diagnosed <40 and <50 years at 22% and 38%, respectively. The second study retrospectively examined the epidemiology of CRC in Uganda using population-based data from Kampala (2000-2019) and Gulu (2015-2020) cancer registries. Results showed a higher age-standardised CRC incidence rate (ASIR) in Kampala compared to Gulu cancer registry (9.2 vs. 2.0, per 100,000). In the KCR, the ASIR CRC increased annually by 2.1% (p<0.001) and 5-year relative survival was poor at 4.5%. The third study qualitatively explored stakeholder perspectives (n=11) on initiating a CRC screening program in Uganda. The stakeholders perceived more barriers than opportunities of initiating a CRC screening program. Limited resources, lack of government priority for CRC prevention programs and limited facilities and equipment for CRC screening were the key barriers to CRC screening program initiation. The final study examined the level of knowledge on CRC and on mythical cancer causes in central Uganda via a cross-sectional survey (n=428). Results demonstrated that 57.9% and 55.8% of participants had good awareness of CRC warning signs and risk factors, respectively while only 1.6% of participants had good awareness on the mythical cancer causes. This thesis generally highlights that whereas the incidence of CRC is still low in Uganda, survival of those with the tumour is very poor which calls for urgent efforts for a screening program, which as yet, may not be feasible due to the vast barriers likely to influence its development and initiation. 

Thesis is embargoed until 31 December 2027.

Date of Award	Dec 2023
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	Queen's University Belfast & Northern Ireland Department for the Economy
Supervisor	Charlene McShane (Supervisor) & Helen Coleman (Supervisor)