Why Nigeria is facing difficulties in colorectal cancer screening – Dr. Peter Kingham 

Dr Kingham, who spoke at a recent lecture on colorectal cancer organized on Thursday by Medserve in partnership with MSK and ARGO held in Lagos, highlighted that most screening guidelines are based on data from high-income countries, making them difficult to apply in Nigeria and other low- and middle-income nations.

He emphasized the need for locally relevant research to develop effective screening strategies tailored to Nigeria’s healthcare realities.

“Nigeria and other low- and middle-income countries (LMICs) struggle with effective colorectal cancer screening due to the lack of locally relevant data and resources. 

“Most screening guidelines are based on data from high-income countries, and it’s difficult to apply those in a completely different setting. 

“There are so many models predicting who is at high risk, who has a polyp, how often they should be screened, but these are all based on populations outside Nigeria. There’s no context-specific data to guide screening recommendations here,” Dr. Kingham explained. 

Colorectal cancer is a type of cancer that starts in the colon (large intestine) or rectum (the last part of the digestive tract). It usually begins as small growths called polyps, which can turn cancerous over time.

Dr. Kingham pointed out that the wide range of screening options—including stool tests, DNA-based tests, blood tests, colonoscopy, and CT colonography- makes it difficult to determine the best approach for Nigeria.

“It gets confusing. What’s the best method to use? What will work in a resource-limited setting where colonoscopy is not easily accessible, and most people pay out-of-pocket for healthcare?” he said. 

A recent screening study conducted in Nigeria during the COVID-19 pandemic revealed major limitations in using stool-based FIT (Fecal Immunochemical Test) for colorectal cancer detection.

“The study screened over 2,000 asymptomatic Nigerians aged 45-75 across three cities. About 21% of participants tested positive—a rate significantly higher than in high-income countries,” Dr. Kingham noted. 

However, further tests showed that many positives were false alarms, often caused by internal hemorrhoids or diverticulosis rather than cancer. The positive predictive value (PPV) for invasive cancer was only 1.1%, and for advanced adenomas, it was 7%—both much lower than in wealthier countries.

“The high false positive rate makes FIT at 50 micrograms per milliliter very difficult to recommend for widespread screening in Nigeria,” Dr. Kingham said. “Colonoscopy access is already limited, and most people have to pay out of pocket, so sending too many people for unnecessary procedures is a big issue.” 

The study also raised the possibility that colorectal cancer develops differently in Nigerians compared to Western populations.

“It may be that the traditional pathway from normal cells to cancer is different here, or that the overall incidence is still not high enough to justify mass screening for asymptomatic people,” Dr. Kingham suggested. 

With mass screening proving difficult, researchers are now focusing on identifying high-risk individuals, such as those with symptoms or a family history of colorectal cancer.

With mass screening proving difficult, researchers are now focusing on identifying high-risk individuals, such as those with symptoms or a family history of colorectal cancer.

“Instead of screening the entire population, we need to prioritize symptomatic patients and those with strong risk factors,” Dr. Kingham said. 

He emphasized that more local research is urgently needed to develop effective and affordable colorectal cancer screening strategies tailored to Nigeria’s healthcare realities.

Professor Olusegun Isaac Alatise, a Professor of Surgery at Obafemi Awolowo University (OAU) and Consultant General at OAU Teaching Hospital, noted that Nigeria also faces a gap in specialized cancer treatment teams, making it difficult to provide comprehensive care for colorectal cancer patients.

According to him, a number of people are being trained in Nigeria, but the majority are not staying back.

“For an adequate colorectal cancer team, you need trained surgeons, medical oncologists, clinical oncologists, radiation oncologists, nurses, physiotherapists, psycho-oncologists, pharma-oncology pharmacists, and more. But how many of them are actually staying back?” he questioned. 

Professor Alatise further stressed that one major challenge is that Nigeria lacks enough specialists to form dedicated multidisciplinary teams (MDTs) for different cancers.

“Abroad, every disease entity has its own specific MDT,” he explained. “If you are treating colorectal cancer, you focus only on colorectal cancer. If you are treating breast cancer, you focus on breast cancer. But in Nigeria, almost all oncologists treat colorectal cancer, breast cancer, and even pediatric cancers. We become a jack of all, the master of all. This affects how effective we can be.” 

Due to this shortage, many hospitals in Nigeria struggle to provide essential cancer services. “There are teaching hospitals without a single clinical oncologist. Some hospitals have to rely on specialists from outside the country,” he noted.