A multi-pronged approach can help improve colorectal cancer (CRC) screening uptake in Singapore, suggests a recent study.
“This requires moving beyond attempting to change individuals’ mindsets and behaviour, to better understand broader factors, including sociocultural, infrastructural, and governmental factors,” the investigators said.
“Crucially, efforts must involve collaboration and understanding amongst stakeholders, including participants, families, physicians, institutions, community-based organizations, and the government,” they added.
In the study, the investigators did a comprehensive search of PubMed, Web of Science, and Embase to identify relevant studies. Only those published in English were included.
Screening modalities
At present, several modalities for CRC screening exist, ranging from invasive, direct visualization modalities to noninvasive blood- and stool-based tests. Each approach has its unique performance characteristics. [Proc Singap Healthc 2026;doi:10.1177/20101058261451666]
However, CRC screening remains underutilized due to several reasons, including intrapersonal behavioural factors, interpersonal issues of family, culture and religion, and broader systemic issues of cost, access to healthcare, and policy.
Various interventions have been developed to improve CRC screening uptake, and multi-pronged, multi-targeted approaches have been shown to be most effective. Furthermore, CRC screening continues to evolve with newer screening modalities, which can influence screening uptake directly or indirectly.
“With these in mind, future research should also continue to focus on strategies to improve screening uptake by integrating behavioural interventions with sociocultural, and health systems level considerations,” the investigators said. “These efforts should go in tandem with analyses on cost effectiveness and implementation science.”
Patient education
Previous studies examining the efficacy of patient education, such as digital aids, mailed informative brochures, physician-led education, and electronic messages, have shown that such interventions could increase CRC screening rates, especially those involving personal outreach phone calls after screening test distributions. [JAMA Intern Med 2013;173:122-129; Ann Behav Med 2011;42:294-303]
“Educational tools should also include information on the absolute risk for CRC, the absolute benefit of the screening test to reduce that risk, and the absolute risk of harms from screening, to allow individuals to make informed choices,” the investigators said. “Involving patients in the decision-making process provides patients with a sense of empowerment over their health.”
Currently, a local primary care team is developing a Decision Aid for CRC screening, which involves input from both patients and physicians. [BMC Med Inf Decis Making 2021;21:86]
Teleconsultation
Another strategy to improve screening is remote consultation. Telemedicine, virtual consultation, and digital healthcare technologies saw a rapid increase during the COVID-19 pandemic. Teleconsultations not only saved time and reduced costs but also prevented unnecessary physical contact, which then added convenience. [J Med Internet Res 2020;22:e22280; Fam Pract 2022;39:168-182]
“However, integrating telemedicine into clinical practice presents new barriers, including funding, reimbursement, infrastructure, and integration into workflow,” the investigators said. “This presents a promising new area of expansion in the future.” [JMIR Med Inform 2020;8:e15380]
Preventable death
“CRC is the third most common cancer and the second leading cause of cancer-related death worldwide, posing a significant global health burden,” according to the investigators, noting an annual incidence of 2 million cases, projected to rise to 3.2 million by 2040. [Gastroenterology 2020;158:447-452; Transl Oncol 2021;14:101174]
If detected early, CRC can be prevented and treated. “There is a window to screen for precursor lesions and early cancers, allowing excision and preventing progression,” the investigators said.
An earlier study found that early detection can prevent nearly one-third to one-half of CRC-specific deaths. [Nat Rev Gastroenterol Hepatol 2022;19:521-531]
However, almost 60 percent of newly diagnosed CRC between 2018 and 2022 were diagnosed in advanced stages (stage 3/4). [https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/scr-ar-2022_web-report6c6e8522-cf39-416f-9390-5fe903065927.pdf?sfvrsn=3712e8bb_1]