Mustafa ORUÇ, Melih BAYAZITLI, İbrahim KILINÇ, Erdinç ÇETİNKAYA
Turkish Journal of Surgery - 2026;42(2):181-188
Objective: Colorectal cancer (CRC) screening uptake in Türkiye remains suboptimal, despite the presence of a national screening program. Understanding whether barriers arise primarily from patient-related factors or system-level constraints is essential for effective policy planning. This study aimed to evaluate barriers to CRC screening across the screening pathway using patient, procedural, and provider perspectives. Material and Methods: A descriptive cross-sectional study was conducted between January and June 2025 at a tertiary training and research hospital. Three distinct groups were surveyed: 100 screening-naïve outpatients aged 50-70 years, 100 patients undergoing diagnostic or screening colonoscopy, and 50 general surgeons performing or referring for colonoscopy. Study-specific questionnaires, pilot-tested for clarity but not formally validated, were used to assess screening awareness, attitudes, perceived barriers, and strategies for improvement. The data were analyzed descriptively. Results: Among screening-naïve outpatients, 54% had no prior awareness of CRC screening, and only 28% had received a physician recommendation for screening. Fear of a serious diagnosis (45%) and pain or discomfort (40%) were commonly reported concerns; however, most respondents indicated that these would not deter screening. Among patients undergoing colonoscopy, 77% underwent the procedure for symptoms rather than preventive screening, while post-procedure satisfaction was high. Surgeons predominantly identified system-level barriers, particularly long waiting times (90%) and an insufficient number of trained endoscopists (92%), as major limitations in effective screening delivery. Conclusion: The primary perceived barrier to CRC screening in Türkiye appears to be limited system capacity rather than patient reluctance. Improving screening uptake will likely require coordinated public awareness efforts, structured national reminder systems, and expansion of the number of adequately trained endoscopists, alongside endoscopy infrastructure.
