A Pilot Study of Systematic Colorectal Cancer Screening Using FIT in Primary Care: A Single-Center Study in the Nepalese Population

Introduction: Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth most common cancer in Nepal. The global burden of CRC is increasing in Low- and Middle-income Countries (LMIC), creating a significant public health concern. Therefore, it is high time to implement screening programs that help reduce the rising incidence of CRC. Since there is no published research on systematic CRC Screening (CRCS) programs in Nepal, Gurkha Welfare Trust Nepal (GWTN) aimed to collect and analyze data from a newly introduced screening service and share these with other healthcare professionals in Nepal and globally.

Objectives: The primary goal of this study is to document the uptake of CRCS, measure positive FIT test results, record the outcomes of the positive findings, and evaluate the subjective experiences of medical staff and patient participants.

Material and methods: This is a prospective mixed-method study conducted at the GWTN from October 2024 to December 2024. The study included patients aged 45 to 85 years. The screening method used was a stool sample tested for occult blood via a Fecal Immunochemical Test (FIT). All FIT-positive patients were referred to a tertiary center for colonoscopy, with guidance to follow up within one week of receiving the colonoscopy report. A structured set of questionnaires was administered to 70 randomly selected patients to inquire about their prior knowledge of CRCS, participation, awareness, and overall experience. A different set of structured questionnaires was distributed to the staff to evaluate their subjective experience. All data were initially recorded in Microsoft Excel and later analyzed using the Statistical Package for Social Science (SPSS).

Results: A total of 1,166 patients were counseled for CRCS, of which 1,029 (88.23%) provided a sample. Among these, 105 (10.2%) had FIT-positive results. Of the FIT-positive patients, 90 (85.7%) underwent colonoscopy. 36 (40%) Patients had a normal colonoscopy. Hemorrhoids were observed in 29 (32.2%) patients and terminal ileitis in 3 ( 3.7%) patients. Notably, 24 (26.6%) had colonic polyps and 5 (5.5%) had rectal polyps, findings of clinical significance. Of the 24 colonic polyps, 12 (50%) were tubular adenomas (2 high grade, 10 low grade), 4 (16.6%) had low-grade tubulovillous adenomas, 5 (20.8%) had inflammatory polyps, and 1 (4.1%) had a hyperplastic polyp.

A total of 70 patients were interviewed to explore their awareness and understanding of CRCS. While 32.9% had heard of CRCS previously, only 11.4% were aware of the available screening options, and 20% had previously undergone screening. Despite this, 100% expressed willingness to participate in the future and to recommend it to peers, with nearly all rating their experience as very good.

Fifteen GWTN healthcare staff involved in CRCS were questioned on their subjective experiences. The majority of staff reported having clear guidelines, strong teamwork, and a positive impact from the CRCS program on patient outcomes. Some noted stress levels and administrative burdens, particularly in remote settings. Overall, staff expressed high satisfaction and found the program meaningful.

Conclusions: The CRCS program demonstrated high participation and diagnostic yield, with notable detection of adenomatous polyps and other relevant findings. Feedback from both patients and staff highlighted strong acceptance, satisfaction, and perceived value of the screening initiative.