Background. In Egypt more than one-third of colorectal cancer (CRC) cases occur in individuals aged 40 years and younger, and are diagnosed at advanced stages; currently, CRC screening is not done as a routine part of preventive care. To lay the foundation for the development of a CRC multilevel screening program in Egypt, this qualitative study aimed to explore the perspectives of Egyptian physicians. Materials and Methods. The PRECEDE-PROCEED model, which focuses on predisposing (intrapersonal), reinforcing (interpersonal), and enabling (structural) factors inherent in health behaviors, served as our theoretical framework. Primary health care physicians, oncologists, and gastroenterologists practicing in Alexandria, Egypt, participated in 1 one-hour semistructured interview. Interviews were audio recorded, transcribed, translated into English, and analyzed by thematic analysis. Results. Seventeen physicians participated (n = 8 specialists and n = 9 primary care physicians). Barriers to CRC screening included socioeconomic status, a lack of emphasis on prevention, fear, and cost (predisposing); a belief that only high risk patients should be screened and a lack of confidence in providers to perform and interpret screening tests appropriately (reinforcing); and cost, lack of availability of the tests, and inadequate training for laboratory technicians and providers (enabling). Potential facilitators included implementing a media campaign emphasizing early detection, curability and prevention (predisposing); educating physicians and eliciting physician engagement (reinforcing); and decreasing costs, making screening tests widely available, and providing well-trained providers (enabling). Conclusion. A CRC screening program is needed in Egypt, and to be successful it would likely need to address barriers at multiple levels. The Oncologist 2020;25:e1525-e1531 Implications for Practice: In Egypt, colorectal screening is not a routine part of preventive care, and colorectal cancer is often diagnosed at an advanced stage in individuals aged 40 years or younger. Screening can prevent and detect colorectal cancer in its early stages, but before designing any screening program, understanding the context is important as cultural beliefs may impact the acceptability of screening methods. By exploring the perspectives of Egyptian physicians, this study found important insights into how screening program components should be considered in the Egyptian culture and lays the foundation for the development of a multilevel colorectal screening program in Egypt.

Background: Colorectal cancer (CRC) incidence and mortality rates are increasing in Egypt. Because no national screening guidelines exist, developing an effective evidence-based screening intervention could lower rates by early detection of pre-cancerous and cancerous lesions and polyps. This paper describes the development of a CRC screening intervention in Alexandria, Egypt using Intervention Mapping (IM). Materials and Methods: Between September 2019 and March 2020, the successive steps of the IM process were completed. Beginning with the needs assessment, we conducted a literature review, held focus groups with residents of Alexandria, and conducted interviews with local gastroenterologists and oncologists. Program objectives and target audience were determined before designing the program components and implementation plan. Using the PRECEDE-PROCEED theoretical model, predisposing, reinforcing, and enabling screening barriers were assessed. Finally, we developed a Standard Operating Procedures manual detailing aspects of the intervention and evaluation to serve as a model for an expanded screening program. Results: The needs assessment, e.g., literature review, seven focus groups (N=61 participants) and interviews (N=17 participants), indicated that barriers among residents included CRC knowledge deficits, fear/anxiety regarding testing, high cost, and lack of accessibility. Physicians believed CRC testing should only be performed for high risk individuals. Findings from each step of the process informed successive steps. Our final intervention consisted of training components for medical students (Health Champions) who would deliver the intervention to patients in primary care waiting rooms, providing short descriptions of CRC risks and screening, educational brochures, and distributing vouchers for no-cost guaiac fecal occult blood test kits. Health Champions would then follow up with the patients, providing results and referrals for no-cost colonoscopy testing for those with abnormal results. Conclusion: Utilizing the IM steps successfully led to development of a theory-based CRC screening intervention for Egypt. Next steps include the implementation of a feasibility pilot intervention.

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PURPOSE Colorectal cancer (CRC) screening is not routinely performed in Egypt, and more than one third of CRC cases occur in individuals age 40 and younger, with overall survival estimated at only 2 years, presumably because of late diagnoses. To lay the foundation for the development of a CRC multilevel screening program in Egypt to promote CRC prevention and early detection, this qualitative study aimed to explore the potential barriers to and facilitators of screening from the perspectives of physicians and residents in Alexandria. METHODS We conducted one-on-one, 1-hour, semistructured interviews with primary health care physicians and specialists—oncologists and gastroenterologists—practicing in Alexandria, Egypt. Focus groups of residents, stratified by social class and gender, were also held. Interviews and focus groups were conducted in Arabic by trained interviewers/moderator, and were audio recorded, transcribed, translated into English, and analyzed using thematic analysis. RESULTS Seventeen physicians participated—8 specialists and 9 primary care physicians—and 7 focus groups—7 to 8 participants each—were held. According to both interview and focus group participants, individual-level barriers to CRC screening included socioeconomic status, a lack of emphasis on prevention in the culture, fear, and cost. Provider-level barriers as mentioned by physicians included a belief that only high-risk patients should be screened and a lack of confidence in providers to perform and interpret screening tests appropriately. Structural-level barriers, discussed by physicians and focus group participants, included cost and a lack of testing availability. Potential facilitators of screening mentioned by physicians included implementing a media campaign emphasizing early detection and curability. Focus group participants focused on making screening tests free or low cost, obligatory, and convenient. CONCLUSION On the basis of the perceptions of physicians and residents of Alexandria, Egypt, multiple barriers to and facilitators of CRC screening exist. Addressing these would be important in designing a successful screening program.

Purpose: Colorectal cancer (CRC) incidence and mortality rates continue to climb in Egypt and other low- and middle-income countries, where few screening intervention programs exist. In Egypt, CRC screening is not a routine part of preventive care and most CRC diagnoses happen with advanced disease and poor prognosis. This pilot study aims to develop, implement, and examine the feasibility of a culturally relevant intervention to promote CRC screening among healthy adults in Alexandria, Egypt. Methods: This feasibility study was conducted in two clinics in Alexandria, Egypt in December 2019-March 2020. Participants were individuals age 50 and above who were visiting the clinics. Medical students were trained to recruit patients, increase awareness on the importance of CRC screening, and provide a voucher and instructions for returning a guaiac fecal occult blood test (gFOBT) kit. Students followed up with phone call reminders to return the kit, report results, and encourage participants with abnormal results to receive further no-cost testing. Our outcome measure was the number of total participants returning the gFOBT kit. We hypothesized that 20% of patients who received the intervention would return the kits, assuming a null screening rate of 2% and target screening rate after the intervention of 20%. A sample size of 120 would achieve 99% power to detect a difference of 18% at a 1% significance level. Results: Of the 117 patients who were recruited, 44 patients (37.6%) returned a kit, with 95% exact confidence interval of (28.8, 47.0). Of the 44 patients who returned a kit, five (11.4%) had a positive FOBT test, with 95% exact confidence interval of (3.8, 24.6). Of these five patients, three (60%) followed up with colonoscopy. Conclusion: This feasibility study provides promising findings to lay the foundation for a larger pragmatic trial that would address barriers to CRC screening in Egypt Citation Format: Lori Brand Bateman, Ahmed Nawwar, Somaia Khamess, Mona N. Fouad, Waleed Arafat, Salah-Eldin Abdelmoneim, Sejong Bae, Katie Falkner, Laura Q. Rogers, Isabel Scarinci. Examining a Culturally Relevant Intervention to Promote Colorectal Cancer Screening in Egypt [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 59.