{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T06:17:57Z","timestamp":1787897877343,"version":"build-2784847793"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Breast, cervical, and colorectal cancer (CRC) screening uptake in Saudi Arabia has been reported as consistently low, but no national longitudinal description of insurance-linked screening utilization has been published. This study examined temporal trends, calendar variation, and demographic distribution of cancer screening among privately insured beneficiaries in Saudi Arabia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed six publicly available Council of Health Insurance datasets reporting monthly breast, cervical, and colorectal cancer screening counts among insured beneficiaries during 2023\u20132024 (24 monthly observations per cancer type). Because the datasets contain aggregate counts without enrollment or eligibility denominators, only absolute utilization counts could be analyzed. Two log-linear regression models were fitted to each monthly series: an unadjusted time-trend model and a primary adjusted model incorporating Ramadan and an October\u2013December 2024 step-change term. Sensitivity analyses evaluated three alternative Ramadan exposure definitions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Total screening counts increased by 56.3%, from 102,048 in 2023 to 159,496 in 2024. In the adjusted model, statistically significant upward monthly trends were observed for breast (+3.0%; 95% CI 1.5\u20134.5), cervical (+2.7%; 95% CI 1.6\u20133.8), and CRC screening (+4.6%; 95% CI 3.3\u20135.9) (all\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001). April screening counts were 32.4%\u201341.6% below model-predicted values across all programs, consistent with a Ramadan\u2013Eid-associated reduction in elective screening activity and robust across all sensitivity analyses. A significant CRC-specific step change was identified during October\u2013December 2024 (+46.6%; 95% CI 13.1\u201389.9;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.006), whereas no comparable effect was observed for breast or cervical screening. CRC screening consistently showed male predominance, with male-to-female count ratios of 1.53 in 2023 and 1.57 in 2024.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Insurance-linked cancer screening utilization increased substantially across all three screening programs between 2023 and 2024.\u00a0A reproducible Ramadan\u2013Eid-associated decline and a CRC-specific late-2024 increase were identified, providing insights relevant to screening program planning and evaluation. Because eligible-population denominators were unavailable, these findings describe utilization counts rather than screening participation or coverage and highlight the need for denominator linkage to enable future assessment of coverage and equity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1837321","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:36:02Z","timestamp":1787895362000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cancer screening utilization among insured beneficiaries in Saudi Arabia, 2023\u20132024: a national analysis of trends, calendar variation, and distribution across breast, cervical, and colorectal screening programs"],"prefix":"10.3389","volume":"16","author":[{"given":"Abdurahman","family":"Alloghbi","sequence":"first","affiliation":[{"name":"Department of Oncology, College of Medicine, King Khalid University","place":["Abha, Saudi Arabia"]},{"name":"Department of Oncology, Saudi German Hospital","place":["Khamis Mushait, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.36401\/JQSH-21-15","article-title":"Breast cancer stage migration in Saudi Arabia: Examining the influence of screening","volume":"5","author":"Abusanad","year":"2022","journal-title":"Glob J Qual Saf Healthc"},{"key":"B2","doi-asserted-by":"publisher","first-page":"13","DOI":"10.31557\/APJCP.2023.24.1.13","article-title":"Colorectal cancer in Saudi Arabia: The way forward","volume":"24","author":"Elwali","year":"2023","journal-title":"Asian Pac J Cancer Prev"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.4103\/sjg.sjg_28_26","article-title":"A preventable surge: Confronting the rising burden of colorectal cancer in Saudi Arabia through enhanced screening","volume":"32","author":"Almohammadi","year":"2026","journal-title":"Saudi J Gastroenterol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2014.00065","article-title":"HPV infection in cervical and other cancers in Saudi Arabia: Implication for prevention and vaccination","volume":"4","author":"Alsbeih","year":"2014","journal-title":"Front Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1097\/CEJ.0000000000000466","article-title":"Uptake of breast and cervical cancer screening in four gulf cooperation council countries","volume":"28","author":"So","year":"2019","journal-title":"Eur J Cancer Prev"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol32050243","article-title":"Predictors of colon cancer screening among the saudi population at primary healthcare settings in riyadh","volume":"32","author":"Alharthy","year":"2025","journal-title":"Curr Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.15537\/smj.2026.47.1.20250597","article-title":"Colorectal cancer screening in Saudi Arabia: Current challenges and future directions","volume":"47","author":"Aljabri","year":"2026","journal-title":"Saudi Med J"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.24065","article-title":"Cervical cancer screening uptake and predictors among women in jeddah, Saudi Arabia","volume":"14","author":"Alsalmi","year":"2022","journal-title":"Cureus"},{"key":"B9","doi-asserted-by":"publisher","first-page":"189","DOI":"10.5144\/0256-4947.2015.189","article-title":"National Guidelines for Colorectal Cancer Screening in Saudi Arabia with strength of recommendations and quality of evidence","volume":"35","author":"Alsanea","year":"2015","journal-title":"Annals of Saudi Medicine"},{"key":"B10","unstructured":"Colorectal cancer screening practices and attitudes among primary healthcare physicians in Saudi Arabia\n          \n          \n            \n              Banamah\n              O\n            \n          \n          \n          2017"},{"key":"B11","unstructured":"Health Sector Transformation Program"},{"key":"B12","unstructured":"Health Sector Transformation Program Overview"},{"key":"B13","unstructured":"Updated essential benefit package (effective 1 October 2022)"},{"key":"B14","unstructured":"Health insurance companies are obliged to cover breast cancer treatment\n          \n          \n          \n          2019"},{"key":"B15","doi-asserted-by":"publisher","first-page":"2544","DOI":"10.3390\/healthcare12242544","article-title":"Healthcare Financing in Saudi Arabia: A Comprehensive Review","volume":"12","author":"Nair","year":"2024","journal-title":"Healthcare"},{"key":"B16","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/j.jiph.2019.06.001","article-title":"National screening programs in Saudi Arabia: Overview, outcomes, and effectiveness","volume":"4","author":"Gosadi","year":"2016","journal-title":"Int J Acad Sci Res"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.26719\/2015.21.2.111","article-title":"Breast cancer screening programme: Experience from eastern province, Saudi Arabia","volume":"21","author":"Al Mulhim","year":"2015","journal-title":"East Mediterr Health J"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1260","DOI":"10.15537\/smj.2022.43.11.20220269","article-title":"Evaluation of participation and performance indicators in a breast cancer screening program in Saudi Arabia","volume":"43","author":"Alatawi","year":"2022","journal-title":"Saudi Med J"},{"key":"B19","doi-asserted-by":"publisher","first-page":"100250","DOI":"10.1016\/j.jcpo.2020.100250","article-title":"Moving cancer prevention and care forward in Saudi Arabia","volume":"26","author":"Alessy","year":"2020","journal-title":"J Cancer Policy"},{"key":"B20","doi-asserted-by":"publisher","first-page":"258","DOI":"10.5144\/0256-4947.2016.258","article-title":"Emergency department attendance patterns during Ramadan","volume":"36","author":"Butt","year":"2016","journal-title":"Annals of Saudi Medicine"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1837321\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:36:05Z","timestamp":1787895365000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1837321\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":20,"alternative-id":["10.3389\/fonc.2026.1837321"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1837321","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]},"article-number":"1837321"}}