Colorectal cancer incidence and clinicopathological patterns in Saudi Arabia, 2013–2023: A national registry analysis with exploratory estimation of attributable risk factor burden
Ahmed A. AlmohammadiABSTRACT
Background:
Colorectal cancer (CRC) is the most commonly diagnosed cancer among Saudi males and a leading cause of cancer mortality in Saudi Arabia. Systematic characterization of its incidence and clinicopathological patterns is needed to inform national screening and prevention priorities.
Objectives:
The primary objective was to describe age-standardized incidence rate (ASIR) trends and clinicopathological characteristics of CRC in Saudi Arabia from 2013 to 2023. As secondary, hypothesis-generating objectives, this study exploratorily estimated population attributable fractions (PAFs) of six established risk factors and benchmarked Saudi ASIR against regional and global comparators.
Materials and Methods:
This secondary epidemiological analysis used national data from the Saudi Cancer Registry (2013–2023; 2023 data preliminary), GLOBOCAN 2020, and the Saudi Health Interview Survey (SHIS 2018). ASIRs per 100,000 were calculated using the World Standard Population. Individual PAFs for six established risk factors were estimated using Levin’s formula and are presented as exploratory ecological approximations.
Results:
Combined CRC ASIR increased from 9.2 per 100,000 in 2013 to 12.1 per 100,000 in 2023 (2023 preliminary; a 31.5% relative difference), a descriptive observation not derived from formal statistical trend testing. Males maintained higher rates than females (14.2 vs. 9.9 per 100,000 in 2023). The incidence increased sharply with age, peaking at 71.2 per 100,000 in adults aged ≥70 years. Colon cancer accounted for 62.3% of cases and rectal cancer for 31.4%. Among the approximately 78% of cases with complete tumor-node-metastasis staging documentation (22% missing), advanced disease (Stages III–IV) predominated, comprising 64.8% of staged cases. In exploratory PAF analysis, physical inactivity yielded the highest individual estimate (12.7%), followed by obesity (9.9%), high red/processed meat intake (9.5%), and low fruit/vegetable intake (9.2%); family history, a nonmodifiable factor, carried an estimated PAF of 10.6%. SHIS 2018 survey data indicated self-reported CRC screening uptake (colonoscopy/FOBT) below 12% among adults aged ≥45 years.
Conclusions:
CRC incidence in Saudi Arabia is rising descriptively, accompanied by a heavy burden of late-stage diagnoses and low self-reported screening uptake. Exploratory ecological PAF estimates suggest that modifiable lifestyle and dietary factors may account for meaningful fractions of this burden, though these approximations warrant cautious interpretation given their ecological, non-individual-level derivation. These findings support further investigation of organized screening and prevention strategies aligned with Saudi Vision 2030 health transformation goals.