170 | Noncommunicable Diseases in Saudi Arabia
following eight conditions is addressed: colorectal, breast, and lung cancers; childhood obesity; gestational diabetes and abnormal blood glucose; high blood pressure; and lipid disorders. Both supply-side interventions (which focus on scaling up, financing, and incentivizing screening) and demand-side interventions (which focus on increasing demand for and use of screening programs among the population) are considered. The chapter only covers cancers that are strongly linked to behavioral factors for which effective screening exists. Dietary risks, high body mass index (BMI), tobacco use, high blood glucose levels, and inadequate physical activity all contribute to the burden of colorectal cancer in Saudi Arabia (IHME 2020). Tobacco use, high blood glucose, and inadequate physical activity are among the main risk factors for breast cancer. Morbidity and mortality from lung cancer are partially attributable to tobacco use, dietary risks, and high blood glucose and partially to air pollution and occupational and environmental risks. Smoking also increases the risk of cervical cancer, and there are cost-effective interventions to screen for cervical cancer; however, this disease is excluded from the analysis because of its communicable nature. Various screening policies and approaches are available for the eight selected conditions. Primary and secondary prevention of risk factors, including screening, are key components of a successful strategy for mitigating chronic disease. Screening policies differ across several dimensions, such as targeted population (breast cancer screening for high-risk women only or for all women), frequency of screening (breast cancer screening every three years versus every two years), type of screening (colonoscopy versus flexible sigmoidoscopy versus fecal immunochemical tests for colorectal cancer), treatment of persons who test positive for a condition (lifestyle interventions versus metformin for glucose abnormalities), where such screenings should take place (health facilities versus malls or mosques for screening glucose abnormalities), and who should be responsible for administering the tests (blood pressure measurement by a health professional versus self-measured blood pressure). The remainder of this chapter is organized as follows. After providing an overview of current screening programs in Saudi Arabia, the chapter assesses the effectiveness and cost-effectiveness of screening programs and the effectiveness and cost-effectiveness of interventions to increase screening uptake. It then discusses gaps in the literature and offers policy recommendations for Saudi Arabia to consider. A final section concludes.
SCREENING IN SAUDI ARABIA Screening uptake Where data exist, evidence suggests that screening rates are lower in Saudi Arabia than in other countries. This is true for colorectal and breast cancer screening, where data on uptake are available from nationally representative surveys. Table 8.1 compares cancer screening uptake in Saudi Arabia and the United States. Uptake rates of screening for childhood obesity, gestational diabetes, high blood sugar, high blood pressure, and lipid disorder in Saudi Arabia are unknown. Many Saudi Arabians with high blood glucose, high blood pressure, or abnormal blood lipids do not know they have the condition. In 2013, 15.2 percent of
