Cancer screening utilization among insured beneficiaries in Saudi Arabia, 2023–2024: a national analysis of trends, calendar variation, and distribution across breast, cervical, and colorectal screening programs

Abstract

Background 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. Methods We analyzed six publicly available Council of Health Insurance datasets reporting monthly breast, cervical, and colorectal cancer screening counts among insured beneficiaries during 2023–2024 (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–December 2024 step-change term. Sensitivity analyses evaluated three alternative Ramadan exposure definitions. Results 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 1.5–4.5), cervical (+2.7%; 95% CI 1.6–3.8), and CRC screening (+4.6%; 95% CI 3.3–5.9) (all p < 0.001). April screening counts were 32.4%–41.6% below model-predicted values across all programs, consistent with a Ramadan–Eid-associated reduction in elective screening activity and robust across all sensitivity analyses. A significant CRC-specific step change was identified during October–December 2024 (+46.6%; 95% CI 13.1–89.9; p = 0.006), 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. Conclusions Insurance-linked cancer screening utilization increased substantially across all three screening programs between 2023 and 2024. A reproducible Ramadan–Eid-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.