Knowledge, attitude, and practice of primary care physicians about colon cancer screening tests and referrals in Saudi Arabia: A systematic review and meta-analysis.

Colorectal cancer is a major public health concern worldwide, and early detection through screening significantly reduces mortality. Primary care physicians (PCPs) play a crucial role in recommending and facilitating colorectal cancer screening. This systematic review and meta-analysis aimed to assess the knowledge, attitudes, and practices of PCPs regarding colorectal cancer screening and referral patterns in Saudi Arabia. A systematic search was conducted in PubMed, Scopus, Web of Science, and Google Scholar following PRISMA guidelines. Studies assessing PCP knowledge, attitudes, or practices toward colorectal cancer screening in Saudi Arabia were included. Ten studies comprising 1648 physicians met the inclusion criteria. The pooled analysis showed that 98% of physicians recognized the effectiveness of colorectal cancer screening. Colonoscopy was perceived as effective by 93% of physicians, fecal occult blood testing by 86%, flexible sigmoidoscopy by 70%, and CT colonography by 56%. Despite generally positive attitudes toward screening, variability in knowledge and referral practices was observed across studies. Barriers such as lack of awareness of screening guidelines, limited resources, and absence of reminder systems were frequently reported. Overall, while PCPs demonstrate good awareness and positive attitudes toward colorectal cancer screening, gaps remain in practical implementation and referral practices. Strengthening physician training and implementing structured national screening programs may improve adherence to screening guidelines.