Abstract
Background: Colorectal cancer (CRC) is an emerging public health concern in sub-Saharan Africa, where late-stage presentation contributes to poor outcomes. According to GLOBOCAN 2020 data, colorectal cancer (CRC) accounted for more than 1.9 million new cancer cases and more than 930,000 cancer-related deaths worldwide. It is currently second only to lung carcinoma in cancer mortality. The incidence of colorectal cancer has increased markedly over the years, with a recent overall annual crude incidence of 4.62 per 100,000 populations and an age-specific standardized rate of 7.93 per 100.000 population in Low and middle income countries (LMIC’s) including Ghana. Early detection through structured screening programmes remains limited in LMIC’s. We report on the implementation of a two-step CRC screening programme at a major teaching hospital, combining fecal immunochemical testing (FIT) with diagnostic colonoscopy.
Methods: The study employed a 2-stage colorectal cancer screening guideline from the American College of Gastroenterology. Adults aged 45 years and above presenting for CRC screening were enrolled. Step one involved FIT, with positive cases referred for colonoscopy. Data collected included age, gender, time to submission, bowel preparation adequacy (BPPS score), cecal intubation, endoscopic findings, and histopathology results. Data were analysed using Stata 18, and descriptive statistics were applied to assess feasibility and diagnostic yield. Results were presented in frequencies and percentages.
Results: Of 244 patients recruited, 167 samples were submitted for screening (average age 51.2 years; 54% male). FIT was positive in 38 cases (22.7%). Colonoscopy was performed on all FIT-positive patients, with cecal intubation achieved in 96% and an average BPPS score of 7, indicating generally adequate bowel preparation. Endoscopic findings included internal haemorrhoids (42%), diverticular disease (6%), colitis (3%), and polyps (9%). Histopathology confirmed neoplastic lesions in 5 patients (4.2%), including tubular adenomas and regenerative polyps. Notably, premalignant lesions were found in asymptomatic individuals, highlighting the program's preventive potential.
Conclusion: Implementation of a two-step CRC screening programme in a Ghanaian teaching hospital proved feasible, with high colonoscopy completion rates and clinically relevant findings. Prominently, cases identified have been enrolled into Komfo Anokye Teaching Hospital's (KATH) Colorectal Cancer Clinic for treatment and follow-up. However, the detection of premalignant lesions highlights the value of structured screening in resource-limited settings. Strengthening awareness, ensuring timely follow-up, and integrating histopathology are critical for sustainability and an initiative would strengthen local capacity in CRC screening, endoscopy, and pathological services, promoting sustainable cancer prevention in a low-resource setting. Our experience demonstrates the potential of two-step screening pathways to advance cancer prevention in sub-Saharan Africa.