Title: Framework for colorectal cancer health needs assessment in Post-Soviet countries

Abstract

Background: Colorectal cancer (CRC) is the third leading cause for cancer worldwide. Prevalence of CRC is increasing in post -Soviet countries (PSC). European guidelines encourage member countries to allocate resources for primary prevention of CRC through screening. Though, cost-effective screening is becoming a priority. Methods: A framework for health priority determination to prioritize CRC screening was developed. Public health websites were accessed to abstract epidemiologic data for PSCs. The framework included prioritization by absolute risk (incidence, prevalence), relative risk (CRC ranking for national cancer deaths) and population attributable risk for the disease. Risk indicators were identified for PSC. Further detailed risk assessment by Z scoring was completed to assess CRC disease burden. Statistical analysis was performed for correlation. Variables included in risk assessment were population, life expectancy, gross national income per capita, percent GDP spent on health expenditure, total expenditure on health per capita, age standardized mortality to incidence ratio, cancer ranking by incidence and smoking prevalence. Results: Ideal risk assessment can assess the disparities related to CRC burden. The risk assessment showed difference in CRC burden amongst the PSC. Armenia, Belarus, Georgia and Kyrgyzstan have high burden with risk scores ranging from 2-5. Though Latvia and Lithuania have some CRC burden, the risk score is mitigated by expenditure on health and improved mortality to incidence ratio because of CRC screening. On the other hand, Tajikistan with some risk factors had most of its score decreased by the CRC mortality ranking of 22nd indicating a very low CRC burden. Conclusion: Risk assessment score could be an arbitrary measure to evaluate inter regional variability in CRC burden.Identifying high CRC burden countries to prioritize screening is important. Uniform and comparable CRC risk indicators for the region is needed. Health need assessment and priority setting is important for better distribution of resources.