Colorectal Cancer Screening in Ukraine: Factors That Influence It, GMKA Study Shows
The Global Medical Knowledge Alliance research team has published an article in the JCO Global Oncology journal exploring the factors affecting colorectal cancer (CRC) screening in primary care physician practices in Ukraine. These results may help shape tailored screening strategies and guide decision-making in healthcare policy.
Colorectal cancer is a significant problem for the healthcare system in Ukraine due to its high morbidity and mortality rates. This is largely due to late diagnosis and insufficient screening. To improve early detection and reduce mortality, it is important to understand how primary care physicians (PCPs) perceive CRC screening, whether they perform it, and how they implement it.
Researchers surveyed 740 primary care physicians from across Ukraine and found important details about the availability of colorectal cancer screening methods and barriers to their implementation.
The main results of the survey are:
- 46.3% of doctors reported the availability of a fecal occult blood test (FOBT).
- 26.5% said they could refer patients for a colonoscopy.
- 4.5% could organize flexible sigmoidoscopy.
- 2.4% had access to a fecal immunochemical test (FIT) in their practice.
Despite the limited resources, 80% of respondents considered colonoscopy to be an extremely effective screening method, compared to:
- 47% for flexible sigmoidoscopy,
- 29% for FIT,
- 24% for FOBT.
For CRC screening, 75% of PCPs referred patients for colonoscopy, and 71% used FOBT. Only 6% used flexible sigmoidoscopy or FIT, indicating a preference for colonoscopy and FOBT.
The main barriers to CRC screening are:
- Inadequate training of PCPs in educating patients about screening (44%).
- Lack of equipment/supplies for screening (36%).
- Inadequate training of PCPs in performing screening procedures (22%).
- Patients’ fears of pain (46%), lack of awareness (36%), and social biases against screening (29%).
Awareness of the Ministry of Health (MoH) guidelines has had a substantial impact on screening practices.
In 2018, the Ministry of Health of Ukraine (MOH) issued Order 504, which set guidelines for opportunistic cancer screening in the primary care setting. According to MOH Order 504, people at average risk of colon cancer aged 50-75 years should undergo biannual CRC screening with a fecal occult blood test (FOBT) and/or referral to specialized health care facilities for secondary assessment and annually if CRC risk factors are present, including a personal history of adenomatous polyps, inflammatory bowel disease, or a family history of CRC or hereditary CRC syndromes. Physicians who were aware of this order were significantly more likely to use the fecal occult blood test (80%) and refer patients for colonoscopy (84%) compared to those who were not aware of it (32% and 40%, respectively).
Key factors motivating primary care physicians to conduct screening:
- 65.2% pay special attention to the patient’s family history.
- 58.2% mentioned the MoH screening guidelines.
Awareness of official guidelines, access to screening tests and educational materials, and addressing patient fears are crucial for improving CRC screening practices among primary care physicians.
“The study showed how important it is to overcome major barriers and increase education to close the gap between evidence-based public health guidelines and colorectal cancer screening practices,” said Ali Dzhemilev, a resident surgeon at Brigham and Women’s Hospital at Harvard Medical School (Boston, USA) and one of the study’s lead authors. “Our findings emphasize the key role of access to CRC screening tests and awareness of national guidelines, as well as the use of appropriate educational resources, in improving CRC screening in Ukraine.”
The study was supported by GMKA, Mass General Brigham and Women’s Hospital, Harvard Medical School, MD Anderson CC, Academy of Family Medicine of Ukraine, and the National Cancer Institute of Ukraine.
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