title: National Guidelines for Colorectal Cancer Screening in Saudi Arabia with strength of recommendations and quality of evidence.
abstract: BACKGROUND
  Colorectal cancer is the most common cancer among Saudi men and the third commonest among Saudi women. Given the predominance of colorectal cancer compared with other cancers in Saudi Arabia, context-specific guidelines are needed for screening.
  
  
  METHODS
  Experts from the Saudi Society of Colon and Rectal Surgery, Saudi Gastroenterology Association, Saudi Oncology Society, Saudi Chapter of Enterostomal Therapy, Family Medicine and Department of Public Health at the Saudi Arabian Ministry of Health and a patient advocate was assembled by the Saudi Centre for Evidence-Based Healthcare, a subsidiary of the Saudi Arabian Ministry of Health. The panel collaborated with a methodological team from McMaster University, Canada to develop national guidelines for colorectal cancer screening. After identifying key questions, the panel conducted a systematic review of all reports on the utility of screening, the cost of screening for colorectal cancer in Saudi Arabia and on the values and preferences of Saudi patients. Meta- analyses, when appropriate, were performed to generate pooled estimates of effect. Using the GRADE approach, the panel used the evidence-to-decision (EtD) framework to assess all domains important in determining the strength and direction of the recommendations (benefits and harms, values and preferences, resource implications, equity, acceptability, and feasibility). Judgments related to the EtD domains were resolved through consensus or voting, if consensus was not reached. The final recommendations were developed during a two-day meeting held in Riyadh, Saudi Arabia in March 2015. Conflicts of interests among the panel members were handled according to the World Health Organization rules.
  
  
  CONCLUSIONS
  There is lack of national data on the incidence of adenomatous polyps or the age groups in which the incidence surges. There were no national clinical trials assessing the effectiveness of the different modalities of screening for colorectal cancer and their impact on mortality.
  
  
  CONCLUSIONS
  The panel recommends screening for colorectal cancer in Saudi Arabia in asymptomatic Saudi patients at average risk of colorectal cancer. An infrastructure should be built to achieve that goal.
authors.affiliation: Nasser Alsanea, MBBCh, President, Saudi Society of Colon & Rectal Surgery,, Head Section, Colon & Rectal Surgery,, King Faisal Specialist Hospital & Research Centre-Riyadh, (MBC-40), PO Box 3354, Riyadh 11211,, Saudi Arabia, T: 966-1-442 7754, F: 966-1-442.7772, nsanea@kfshrc.edu.sa.
authors.forename: Nasser
authors.initials: N
authors.lastname: Alsanea
authors.forename: Majid A
authors.initials: MA
authors.lastname: Almadi
authors.forename: Alaa S
authors.initials: AS
authors.lastname: Abduljabbar
authors.forename: Samar
authors.initials: S
authors.lastname: Alhomoud
authors.forename: Taghreed A
authors.initials: TA
authors.lastname: Alshaban
authors.forename: Abdullah
authors.initials: A
authors.lastname: Alsuhaibani
authors.forename: Ahmad
authors.initials: A
authors.lastname: Alzahrani
authors.forename: Faisal
authors.initials: F
authors.lastname: Batwa
authors.forename: Abdul-Hameed
authors.initials: AH
authors.lastname: Hassan
authors.forename: Denise
authors.initials: D
authors.lastname: Hibbert
authors.forename: Randa
authors.initials: R
authors.lastname: Nooh
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alothman
authors.forename: Bram
authors.initials: B
authors.lastname: Rochwerg
authors.forename: Waleed
authors.initials: W
authors.lastname: Alhazzani
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Morgan
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003299:Cooperative Behavior; D055088:Early Detection of Cancer / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D012307:Risk Factors; D012529:Saudi Arabia