S602 Colorectal Cancer Screening in India: A Neglected Priority

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% men and 12.7% women 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. A prospective multicentre study on 266 CRC patients revealed catastrophic out of pocket expenditure for treatment. Median total cost of CRC treatment was $5,340 USD of which the biggest contributor was out-of-pocket expenditure (OOPE) with a median of $4,328 USD. 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. Conclusion: Despite being fourth and fifth most common cancer in Indian men and women 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).