ABSTRACT
@#The downstream effect of the pandemic on global cancer prevention and control efforts is wide-ranging, especially for lower and middle-income countries (LMICs), including Malaysia. This paper explores the performance of the colorectal cancer screening programme in Malaysia for the years 2019 and 2020, This is followed by evidence-based recommendations for building back a better cancer control programme in Malaysia. Malaysia screened a total of 31,529 eligible candidates in 2019 and 42,554 in 2020. A total of 2,668 (8.46%) and 2767 (6.50%) individuals tested positive for the immunochemical faecal occult blood test (iFOBT) in 2019 and 2020 respectively. Of these numbers, only 1454 (54.49%) of those who tested positive underwent colonoscopy in 2019 and this proportion reduced to 1148 (41.48%) in 2020. This analysis also shows a drop in the number of screenings in the second quarter of 2020. This drop coincides with the announcement of Malaysia’s first Movement Control Order. Existing challenges exacerbated by pandemic restrictions have possibly led to a decreased colonoscopy attendance rate in 2020. To build back a better cancer control programme, better governance, and political will, coupled with improved financing, sustainable partnerships, improved service delivery, and a robust monitoring and evaluation mechanism is vital.
ABSTRACT
@#Introduction: Colorectal cancer (CRC) is the second most common cancer in Malaysia with 65% detected at stage III and IV. Despite the increasing incidence of cancers including CRC, Malaysia has yet to implement populationbased screening for cancers. The objective of this paper is to review the strategic planning and implementation of the CRC screening program in Malaysia. Methods: A desk review was conducted from August to October in 2018, to examine, review and describe the historical perspective, strategic planning and implementation of the current CRC screening program in Malaysia. Results: The main policy documents related to CRC screening are the National Strategic Plan for Cancer Control Programme 2016-2020, the Clinical Practice Guideline for Management of Colorectal Carcinoma 2017, and the Implementation Guideline for CRC Screening in Malaysia 2014. Several papers have been published on the epidemiology of CRC in Malaysia. Between 2014 and 2018, 127,957 men and women were screened using immunochemical Faecal Occult Blood Test (iFOBT); 9.3% had positive iFOBT results and were referred for colonoscopy. For those who underwent colonoscopy, CRC detection rate was 4.1% and 13.9% for pre-malignant conditions. Barriers were identified along the continuum of screening process, including patient, provider, and system factors. Conclusion: Although population-level organised screening programmes are preferable to opportunistic screening, the CRC programme in Malaysia was tailored to meet the needs of the population based on available existing resources. A well-mapped budget for the entire screening programme continuum, a strong partnership between stakeholders and an opportunistic screening strategy is crucial to address the rising incidence of CRC