Cancer is a life-threatening condition characterized by the spread of unknown cells to different parts of the human body. These abnormal cells can invade and damage healthy tissues, leading to severe consequences. Colon cancer, in particular, is a type of cancer that starts in the inner lining of the colon, with cancerous cells multiplying uncontrollably and forming a mass that alters the stomach's scene. This type of cancer can affect all layers of the intestinal system, adjacent organs of the stomach entrance, and other sections of the body.

Certain natural and inherited factors can increase the chances of developing colon cancer, such as low socioeconomic position, a sedentary lifestyle, poor dietary habits, smoking, obesity, and inflammatory bowel disease. However, adopting healthier lifestyle habits, specifically dietary and environmental modifications, can help mitigate the risk. Certain inherited risk factors cannot be altered, though. Individuals with a family history of colon cancer are more likely to develop the condition two to five times than those without this history.

Colon cancer is a significant clinical problem globally, as it is the world's third most destructive and second most lethal malignancy. In 2020, it accounted for around 9.4% of all cancer-related fatalities. Unfortunately, the incidence of colon cancer is predicted to more than double by 2035, with undeveloped nations suffering most of the increase due to the rising incidence of diagnosed cases in the older population group.

Colorectal cancer is the most prevalent cancer in developed countries, with an estimated 570,000 new cases per year. Nonetheless, previous studies suggest that it was a rare disease among Africans, accounting for only between 3% and 6% of all dangerous developments in most African investigations. The African diet, consisting of basic carbohydrates, organic fruits, high-fiber food sources, and plant-based proteins, helps lower the risk of colon cancer. However, urbanization has led Africans to adopt unhealthy lifestyles, such as consuming refined carbohydrates, high-fat meals, and processed red meat, everything linked to colon cancer and other long-term issues.

Lifestyle changes have contributed to the continuing incidence of colon cancer on the continent, although Africa has a much lower rate of colon cancer globally, given the changing dining culture and the growth of drive-through restaurants. Health reports show that many Africans, including those under 40 years, have been diagnosed with rectal cancer. Research also indicates that males are more likely to have it between the ages of 51 and 60, while women are more affected by the condition between the ages of 41 and 50. This disturbing trend underscores the urgent need to raise awareness and educate the public on the dangers of an unhealthy lifestyle.

Population-based screening refers to identifying instances of lethargic illnesses among low-risk groups to facilitate early intervention, thereby reducing risks to people and organizations (Wilson and Jungner, 1968). While colorectal cancer is not the most advanced type of epidemic, it is essential to recognize that non-communicable diseases, like cancer, cause a substantial number of deaths (Bollyky, 2020). This is becoming increasingly evident even in the most devastated parts of the world, such as West Africa. Every March, World Colorectal Cancer Day coincides with National Colorectal Cancer Month, providing an opportunity to create awareness and promote treatment for the disease. However, there is a need for greater efforts and attention to raising awareness about colorectal cancer in West Africa.

Colorectal cancer is an emerging disease in West Africa, in need of immediate attention to prevent a rise in incidence and mortality rates. Experts forecast a 70% increase in new cancer cases by 2030, attributed to demographic and lifestyle trends (Siegel et al., 2020; Hamdi et al., 2021; Sung et al., 2021). This ongoing issue coincides with the discovery of other overpowering diseases, such as HIV/AIDS, Ebola, COVID, and other tropical illnesses. Despite cancer death rates surpassing those of AIDS, tuberculosis, and tropical fever combined, there is still no accountability for cancer control in West Africa. Colon cancer receives relatively little attention compared to other forms of cancer, like breast cancer, cervical cancer, and prostate cancer, which may stem from a lack of public awareness. A study conducted by Hee-Soon Juon et al. reveals that a lack of knowledge regarding CRC and screening leads to poor early detection outcomes (Juon, Guo, Kim, and Lee, 2019).

It is essential to prioritize training on preventing and treating CRC in individuals over the age of 50. General information dissemination about CRC and its detection strategies amongst the population could help improve awareness of the disease's associated risks, leading to early detection in the early stages. Breast cancer awareness has received a lot of effort and research, which has yielded encouraging results, as many people are diagnosed early before the disease could reach an advanced stage (Adeoti et al., 2016).

Colorectal cancer affects both young and older people alike, and most instances are discovered after the disease has progressed. Patients often report noticing some of the early symptoms, which they attribute to "Jedi," a vague collection of symptoms, including anal swelling, constipation, anal itching, mucoid/rheumy stools, lower back pain, loss of libido, and so on. The similarity of risk factors and awareness of colorectal cancer among vulnerable groups is enticing for an interventional awareness campaign, and this is the foundation for this review. Although significant breakthroughs have been made in identifying and treating colorectal cancer, there are still unsolved challenges surrounding public awareness of the illness. Improving knowledge and awareness of early adverse events and screening approaches should be an intrinsic component of this process to make further progress. This review aims to critically examine evidence on colorectal cancer awareness among adults in West Africa.

Goal

This review seeks to establish the evidence-based awareness of colorectal cancer among adults in West Africa through a systematic analysis of literature published between 2000 and 2021. The reviewed literature comprises studies that examine awareness programs for colorectal cancer, incidence levels, access, affordability of treatment options, as well as awareness of symptoms associated with colorectal cancer.

Research Questions

1. What is the level of awareness of colorectal cancer in West Africa?

2. How effective are existing awareness initiatives for colorectal cancer in promoting early detection in West Africa?

The Meaning of Outcomes

Colorectal Cancer

In the field of oncological pathology, colorectal cancer stands as the third most common type of cancer (Douaiher et al., 2017). This disease currently constitutes the most significant threat to the gastrointestinal tract, accounting for 13% of all cancerous growths. It is expected that this condition will become the leading cause of cancer-related deaths worldwide, affecting both men and women equally (Bray and colleagues, 2018). Colorectal cancer is prevalent in individuals aged 65 to 74 years, and women have a higher incidence rate than men (Murphy et al., 2019). On the other hand, Irabor (2017) defines colorectal cancer as a condition whereby the cells in the colon or rectum undergo rapid and irregular multiplication. Other terms that refer to colon cancer include "strong casing" or "strong casing," and the rectum acts as a connector between the digestive organ and the buttocks.

Colorectal Cancer Development

Colorectal cancer is a hereditary condition, but a variety of environmental factors can also contribute to its progression. Multiple colorectal cancer cells display various somaclonal alterations resulting from different qualities of expression profile. As a result, CRC is thought to incorporate one of the most extensive sets of mutations of any condition. Based on the number of somaclonal mutations, CRC can be classified as hypermutated (more than 12 mutations per 106 bases) or non-hypermutated (less than 8.24 mutations per 106 bases) (Cancer Genome Atlas Network, 2012). In addition, an innovative classification structure for CRC was developed by combining data on quality expression profiles with growth genotypes, leading to a revision and adjustment of these classifications (Cancer Genome Atlas Network, 2012).

Colorectal cancer occurs due to a series of hereditary or epigenetic alterations that cause epithelial cells to proliferate (Testa, Pelosi, and Castelli, 2018). These rapidly proliferating cells form a benign adenoma that can progress into cancer and metastasis through various mechanisms, including microsatellite instability (MSI), chromosomal instability (CIN), and serrated neoplasia (Malki et al., 2020). The adenoma-carcinoma sequence is used to describe cancer progression.

The traditional pathway is responsible for the majority of irregular CRC cases. Cancer begins as a small adenoma that grows into a giant adenoma and eventually becomes cancerous. There is a connection between this signaling system and the development of the chromosomal instability (CIN)-positive subtype (CIN-positive). According to the National Cancer Institute, this approach accounts for 10–15% of all inconsistent CRC (Keum and Giovannucci, 2019). It involves the progression of normal cells into hyperplastic polyps, sessile serrated adenomas, and long-term malignancy. This pathway is often associated with the creation of the CpG island methylator aggregate (CIMP) high subtype, which is linked to inflammation. Chronic inflammation leads to indeterminate dysplasia, resulting in second-grade dysplasia, high-grade dysplasia, and finally, cancer (Keum and Giovannucci, 2019). Inflammatory bowel disease and the persistent use of preventive colectomy account for less than 2% of all CRC cases worldwide. Although harmless pruritus ulcers are present in all pathways and can be eliminated, they are most visible in the adenoma-carcinoma and serrated pathways (Keum and Giovannucci, 2019). As they develop into cancer slowly, there is a window of opportunity for voluntary colon cancer treatment.

Revised:

The illustration in Figure 1 showcases the different phases and transformation of colorectal cancer (CRC). The growth of CRC carcinogenesis is categorized into four stages: initiation, progression, dissemination, and metastasis. Metastasis usually transpires in the liver and is followed by the lungs and bones, but foretelling the span of each phase can be complicated. Nevertheless, CRC is likely to persist for multiple years. The diagram was produced via BioRender.com (accessed on August 13, 2022).