By Dr Nafisah AlFaris, Director of the Oncology Centre at Johns Hopkins Aramco Healthcare
In oncology, I often think about patients who knew about screening but did not get the chance to act in time. They understood that a mammogram or a colonoscopy could find cancer early. They meant to make the appointment at some point, but by the time they actually arrived at the clinic, the disease had progressed to a later stage.
To me, the gap between knowing about screening and getting it done is one of the biggest challenges in cancer care in Saudi Arabia today. Yet it is not always the challenge we talk about most.
The awareness-action gap
For years, the guiding assumption in cancer control has been that awareness is the bottleneck, and that if people simply understood the value of early detection, they would act on it. We have invested heavily in that belief, and in one sense it has worked. Research suggests that awareness of tests for various cancers and tumours in the Kingdom is high. Most people know these programmes exist and understand that catching cancer early improves the odds.
And yet participation remains low. To me, that is the uncomfortable truth beyond our progress. We have largely won the argument and mistaken winning the argument for winning the outcome.
If awareness is no longer the barrier, we have to be honest about what it is. It is rarely one big reason. It may be a woman who cannot take time away from work. It may be fear of finding a tumour. It may be an older patient who lives far from the nearest specialist. These are not simply personal choices; they are barriers that the healthcare system needs to help patients overcome.
Beyond personal choice: The barriers we overlook
In some communities, another, quieter barrier may also be at play: a belief that illness and its timing are ultimately a matter of fate, leaving little room for individual action to alter the outcome. Engaging with this perspective thoughtfully and respectfully, rather than dismissing it, may be essential to reinforcing that seeking screening is not a challenge to faith, but an act of stewardship over one’s health.
This is why population health is about more than awareness campaigns. It is what helps patients move from knowing they need screening to making the appointment, completing the test, and getting the right follow-up if a result is abnormal. It can be as simple as a nurse calling to check in, answer questions, or encourage a patient to complete a test. It is the support patients need at each step of the journey. When the healthcare system works alongside patients in this way, awareness can lead to action – and action can lead to earlier care and better outcomes.
In my experience, awareness alone is not enough. Patients are more likely to attend screening when the next step is simple: a timely reminder, help booking an appointment, and someone they can call with questions.
Making screening fit into ordinary life
We also need to make screening easier to fit into ordinary life. Convenient appointments, extended hours, and screening offered closer to where people work, live and gather can remove barriers that are easy to underestimate. For some patients, the challenge is transport. For others, it is navigating referrals, preparing for a test, or finding time around work and family. Helping arrange appointments and transport, rather than simply advising patients to make them, can make the difference between good intentions and a completed check-up.
Trust matters just as much. Many patients are more likely to act when encouragement comes from someone they know and feel comfortable with: their primary care team, a nurse, or a trusted member of their community. For communities with different languages, traditions or concerns about cancer, conversations must be respectful, culturally sensitive, and delivered in language that people can understand. We cannot treat reluctance as indifference. Often, it is fear, uncertainty, or a past experience that has made the system feel difficult to approach.
Most importantly, we should not expect one intervention to solve every barrier. The strongest approach brings these elements together: a trusted recommendation, a timely reminder, help with the logistics, and a clear path from screening to follow-up if something is found. This is how we make earlier screening not merely something patients know they should do, but something they are actually able to do.
Redefining success: Beyond awareness and survivorship
If that is the goal, then we must also change what we count as success. For a long time, we have judged cancer programme efficacy by two numbers: awareness and survivorship. Both matter. Awareness tells us who heard the message, not who acted on it. Survivorship tells us what happened after diagnosis, not whether the diagnosis came early enough to change the story.
We need to know how many eligible people were screened, not just informed; at what stage cancers were caught; how quickly a patient moved from an abnormal result to a confirmed diagnosis, and from diagnosis to treatment; and whether those figures hold for a patient in a border region as well as for one in a major city. When we measure the gap instead of the message, we finally begin managing the thing that determines outcomes.
The Oncology Centre of Excellence: A model for continuity
This is the rationale behind the Oncology Centre of Excellence at Johns Hopkins Aramco Healthcare in Dhahran, Kingdom of Saudi Arabia. Rooted in a model similar to Johns Hopkins’ Sidney Kimmel Comprehensive Cancer Centre, it emphasises multidisciplinary care and continuity throughout the patient journey. At its core, the Centre is focused on closing the gaps that stand between awareness and better outcomes. Taking its cue from Johns Hopkins Medicine’s model of coordinated, multidisciplinary care, its focus extends beyond treatment to the entire patient journey, particularly the critical period before diagnosis, where timely screening, follow-up and navigation can make the greatest difference.
A centre of excellence is not just about bringing advanced treatment together in one place. It is also about making sure patients are supported at every step, from screening through diagnosis and treatment, without delays or missed handoffs. It is the surgeon, medical oncologist, radiologist, pathologist, nurse and care navigator working from one shared plan rather than a scattered set of referrals. It is the partnership between primary care and the oncology team that bridges population health and specialist care. This seamless handoff keeps the patient at the centre of the journey, ensuring continuity from screening and early detection to diagnosis and treatment. Excellence in cancer care is not only what we can do for a patient once the disease is advanced; it is how reliably we reach them before it is.
None of this diminishes the progress Saudi Arabia has already made; it builds on it. Vision 2030 and the Health Sector Transformation Programme have moved the system decisively towards prevention, and the national screening programmes are a genuine achievement. National projections put cancer cases in the Kingdom at close to 40,000 by 2030 – a figure that makes the case for early, coordinated care more pressing, not less. The task now is to finish the job: to convert the awareness we have worked so hard to create into participation, earlier diagnosis, and changed lives.
The next chapter of cancer care in the Kingdom will not be defined by how well we can explain the value of early detection. It will be defined by how many people we can bring through the door in time, and by whether, when they arrive, the system is ready to carry them the rest of the way.
