Assessing Adherence and Identifying Barriers to Colorectal Cancer Screening in the Adult General Populations of Saudi Arabia: A Nationwide Cross-Sectional Study

Background: Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality worldwide. Despite its preventability through early screening, uptake remains suboptimal in many countries, including Saudi Arabia. This study aimed to assess adherence to CRC screening guidelines and identify barriers among the adult population in Saudi Arabia. Methods: A nationwide cross-sectional study was conducted using a self-administered online questionnaire targeting individuals aged ≥ 40 years across all Saudi regions. Data on demographic characteristics, knowledge, attitudes, screening practices, and perceived barriers were analyzed using SPSS v26, with significance set at p < 0.05. Results: Of the 573 eligible participants, only 12.7% had undergone colonoscopy and 19.5% reported having completed a fecal occult blood test (FOBT). The most frequently cited barriers were the absence of symptoms (49.9%), fear of the procedure (36.6%), and lack of knowledge (35.3%). Notably, 84.5% indicated they would undergo screening if recommended by a physician. Regional disparities were evident, with participants from the Southern region significantly more likely to undergo FOBT (OR = 8.97, p < 0.001). Awareness was generally low, with over half of the participants rating their CRC screening knowledge as 1 out of 10. Conclusions: This study revealed a concerningly low rate of colorectal cancer screening among adults in Saudi Arabia. Efforts to increase screening rates should prioritize raising awareness, correcting misconceptions, and encouraging non-invasive screening methods. Establishing a nationwide screening initiative could help close existing gaps and support earlier detection of colorectal cancer.