P2626 - Colorectal Cancer Screening in India: A Neglected Priority

Ashiya Loomba, MBBS¹, Jasmin Hundal, MD, DipABLM, MS, MPH², Devendra Patel, MD³
1Maharaja Agrasen Medical College, Karnal, Haryana, India; 2Cleveland Clinic Foundation, Cleveland, OH; 3Saint Vincent Hospital, Erie, PA

Introduction: Globally, colorectal cancer (CRC) ranks 3rd most common cancer and 2nd leading cause of cancer related mortality. Despite lower yet up-trending incidence, India ranks 6th in CRC mortality with age adjusted rate of 2.9 as per Global Cancer Observatory (GCO) 2022 data. However, little is known about the CRC screening in India.

Methods: Literature search was carried out to know the current state of CRC screening in India. Cut-off age of 45 years was considered based on the National Comprehensive Cancer Network (NCCN) guidelines. Findings were summarized as possible barriers to CRC screening in India.

Results: As of 2020, 12.5% males and 12.7% females in India are aged 45 years or above and are thus eligible for CRC screening. However, in a survey carried out on a cohort of 1374 eligible candidates, only 7.13% had ever undergone CRC screening.[1] A prospective multicentre study on 266 CRC patients revealed catastrophic out of pocket expenditure for treatment. Median total cost of CRC treatment was 5340 USD of which the biggest contributor was out-of-pocket expenditure (OOPE) with a median of 4328 USD.[2] Statistics published by the Indian Ministry of Health and Family Welfare in 2023 revealed that 52% health financing in India is out of pocket while least proportion i.e. 6.37% is contributed by Govt Health insurance, followed by private bodies contributing 7.72%. India’s OOPE as percent of current health spending is significantly above the average for lower-middle income countries, and amongst the highest in the world. Another significant factor is the lack of awareness. A cross sectional study conducted in Kerala -state with highest literacy rate in India- revealed low level of awareness regarding CRC symptoms and screening.[3]

Discussion: Despite being 4th and 5th most common cancer in Indian males and females respectively, lack of uniform data on CRC screening indicates neglect towards its rising incidence. If the current pattern continues, GCO has anticipated a population adjusted rise of 81.85% incidence and 88.1% CRC mortality by 2045 for India. This calls for the robust implementation of cancer screening programs and strengthening of existing healthcare set-up. (AI was used to refine title of this study)
1) Agrawal et al. (2025), South Asian Journal of Cancer, 229-235.
2) Bose et al. (2022), The Lancet Regional Health- Southeast Asia.
3) Thomas et al. (2023), Cancer Research, Statistics, and Treatment, 13-18.

Disclosures:
Ashiya Loomba indicated no relevant financial relationships.
Jasmin Hundal indicated no relevant financial relationships.
Devendra Patel indicated no relevant financial relationships.

Ashiya Loomba, MBBS¹, Jasmin Hundal, MD, DipABLM, MS, MPH², Devendra Patel, MD³. P2626 - Colorectal Cancer Screening in India: A Neglected Priority, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.