Mapping the epidemiology of neoplastic and pre-neoplastic colorectal lesions: an initial step toward constructing a prevention strategy.

Colorectal cancer (CRC) is considered a preventable disease through early detection and avoidance of modifiable risk factors. It takes decades for a colorectal pre-neoplastic lesion to progress to neoplastic lesions. Therefore, the removal of such lesions earlier has been found to reduce the incidence and mortality of the disease significantly. Unfortunately, in Oman, the incidence and mortality of CRC are increasing significantly, especially among young patients. CRC in Oman presents at an advanced stage with a higher pathologic grade and a greater risk of recurrence and metastatic disease. Accumulatively, this led to an unfavorable prognosis and premature death. The cost of cancer care, in general, is expensive considering both the direct and the indirect expenses, adding to it the years of potential life lost due to premature cancer-related mortality. The low survival rate of CRC patients in general and in patients below 50 years and the advanced stage at presentation contribute to the loss of the productivity years of these patients and the extra economic burden. The indirect cost of loss of productivity years and absenteeism has been estimated to be six times more than the direct cost of diagnosis, management, and follow-up. It is estimated that 72% of all deaths in Oman are non-communicable disease (NCD) related, and cancer is among them. In Oman, the current cancer care system largely relies on the diagnosis and treatment of cancer patients. This has been found to be a costly and overwhelming approach considering the rapid increase in cancer cases and the expensive treatment offered. Therefore, the Ministry of Health in Oman is working in collaboration with WHO toward strengthening the other aspects of the cancer continuum framework, such as primary and secondary prevention and early detection. They have launched the national policy and multi-sectoral plan to reduce the incidence of NCD-related premature death by 25% before 2025 through public awareness campaigns and the implementation of suitable prevention and screening strategies. The first and most crucial step in constructing a preventive program is to evaluate and study the magnitude of the disease, its geographical distribution, and associated risk factors. Therefore, in this study which is the first of its kind in the country, we aim to extensively study the baseline trend of pre-neoplastic and neoplastic colorectal lesions in Oman and stratify it according to age and geographical mapping. Furthermore, we aim to evaluate the association of the disease with sets of modifiable risk factors. We aim to decipher the trend of pre-neoplastic colorectal lesions in the Omani population and highlight the age at which there is a noticeable increase in the number of cases. If deemed appropriate, a CRC screening program should be initiated. The results of this project will be the beginning of a process that will ultimately be translated into a well-structured preventive program, both primary and secondary, where specialized professional bodies will actively be involved and contribute their expertise to construct such programs systematically.