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Abstract

Background: Accurate estimation of colorectal cancer (CRC) cases in South Africa is pivotal to policy and service delivery planning and disease control. It is estimated that CRC will increase up to 8,000 per 100,000 populations by 2030 in the country. Noting the lack of population based CRC registry, the burden may be under estimated. There is scarce knowledge on perceptions of researchers and service providers of CRC on burden, screening interventions, key challenges facing in South Africa and recommendations on CRC control. The study aims to explore perspectives on CRC burden screening and outline recommendations for CRC control.
Methods: A descriptive and explorative qualitative study was conducted using a semi-structured interview guide through telephonic or virtual interviews with 15 participants from multi-disciplinary backgrounds from three big metropolitan cities of South Africa. Data were analyzed using a thematic framework.
Results: CRC was perceived as one of the critical cancers in South Africa although due to a National surveillance system the CRC burden it is not accurately reported. Older Caucasians with a family medical history and young black men were mentioned, as high risk groups. The participants confirmed that South Africa does not need a CRC national screening programme, but, expressed a need for a coordinated targeted programme to better align the public and private health sector screening practices.
Monitoring CRC screening guidelines compliance; barriers in screening access, lack of awareness, distance to screening facilities, lack of demand generation by service providers, lack of medical insurance, equipment failure and scarcity, unpleasant and invasive procedure and poor health seeking behaviour were some of the challenges cited by participants. The participants recommended improvement in targeted screening based on evidence; promotion of screening campaigns, risk assessment to be conducted for early referral, expansion of screening facilities to reduce inequalities and provider capacity building to strengthen competencies and skills.
Conclusion: The findings highlight multiple perspectives on CRC burden and screening in South Africa. Policy makers and programme managers should be aware of these perceptions to improve quality of care; explore alternative testing methods, demand creation approaches to improve CRC awareness and reduce the inequities in screening access.

Keywords: Colorectal cancer; Burden of colorectal cancer; Screening; Colonoscopy; Qualitative study; Cancer; South Africa