Scoping Review of Colorectal Cancer Research in Libya: Gaps and Opportunities in Peer-Reviewed Publications

Abstract

Introduction

This scoping review systematically mapped the landscape of peer-reviewed publications on colorectal cancer (CRC) research in Libya to identify prevailing trends and knowledge gaps that can inform national cancer control strategies.

Methods

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines, a comprehensive search of open-access databases was conducted.

Results

Findings from 42 eligible studies published between 1993 and 2024 revealed a fragmented research landscape with significant methodological and geographic disparities. Most of the studies were retrospective, hospital-based, and concentrated in northern urban centers such as Benghazi, Misrata, and Tripoli, leaving southern and peripheral regions underrepresented. Thematic analysis revealed an over-reliance on descriptive epidemiology, with minimal reporting on tumor characteristics, molecular profiling, or treatment outcomes. The research ecosystem also faces structural challenges, including dispersed authorship and inconsistent reporting of ethical and funding information, with the limited visibility of local journals further impeding their global reach.

Conclusion

These findings indicate that peer-reviewed publications on CRC research in Libya are in a nascent developmental phase, facing structural and spatial challenges. Strengthening the research ecosystem will require an active centralized cancer registry, investment in molecular diagnostic infrastructure, and the adoption of inclusive, prospective, and community-based study designs. Addressing these systemic gaps is crucial for generating actionable and representative evidence to improve cancer outcomes nationwide.

Plain Language Summary

Colorectal cancer (CRC) is a major health concern in Libya, but research on the disease is limited and unevenly distributed. In countries with fewer resources, like Libya, understanding how research is conducted and where the gaps are is essential for improving cancer care and outcomes. This study aimed to map out existing CRC research in Libya and identify areas that need more attention. Forty-two published studies on CRC in Libya from 1993 to 2024 were reviewed. The review examined covered topics, study designs, and geographical locations. Furthermore, the studies were assessed for the inclusion of key details such as cancer stage, tumor type, ethical approval, and funding sources. Most studies were based in hospitals and used patient records. Research was concentrated in northern big cities, while southern and rural regions were largely excluded. Many studies focused on basic patient statistics, with few exploring treatment outcomes, genetic factors, or prevention strategies. Limited studies reported the tumor details such as stage and anatomical location, and only a small number of studies reported ethical approval or funding. Most were published in journals with limited international reach. This review highlights the need for stronger, more inclusive cancer research in Libya. To improve CRC outcomes, future studies should include diverse populations, use modern research tools, and focus on practical solutions. Building a national cancer registry, investing in laboratory infrastructure, and supporting ethical, well-funded research are key steps forward. Importantly, researchers and policymakers must also consider cultural beliefs, health-seeking behaviors, and local system constraints when designing studies and implementing interventions. Tailoring solutions to the local unique social and healthcare context will help ensure effectiveness, sustainability, and equity across all regions of the country.

Introduction

CRC is a prevalent malignancy and a leading cause of cancer-related mortality globally.^1,2 Once considered a disease of high-income countries (HICs), CRC incidence and mortality are rising rapidly in low- and middle-income countries (LMICs) due to demographic transitions and Westernized lifestyles.^1,3 This shift has created a distinct epidemiological profile in LMICs, where patients present at a younger age with a higher proportion of early-onset CRC and are often diagnosed at late stages.^4,5 This late diagnosis is largely due to underdeveloped screening programs, strained healthcare systems, and limited public awareness.^6,7 These challenges are particularly severe in conflict-affected regions such as Libya, where prolonged instability further compounds existing healthcare limitations. ⁸

Libya, a North African country, reflects these broader LMIC trends. CRC is the second most common cancer and the second leading cause of cancer-related mortality among men and women. ⁹ The age-standardized incidence and mortality rates are among the highest in North Africa, ¹⁰ and the cumulative risk of developing CRC before age 75 is estimated at 1.6%. ⁹ Notably, Libya exhibits a gender pattern reversal, with a higher CRC incidence reported among females, where it is typically more common in males. ¹¹

Despite the growing burden of CRC, Libya’s research output is markedly limited. A bibliometric analysis of cancer research across 22 Arab countries from 2005 to 2019 found that Libya contributed only 131 cancer-related publications (less than 0.5% of the region’s total output), placing it among the lowest contributors to cancer research. While CRC has garnered increasing attention regionally, with 1169 publications identified, Libya’s contribution to this body of work was minimal according to this bibliometric analysis by Machaalani et al. in 2022. ¹² More recently, a 16-year bibliometric analysis (2007-2023) published by Abbas et al. further underscored this gap: the analysis revealed that Libya had no recorded scientific production on CRC screening despite elevated national incidence and mortality rates. In contrast, high-income countries, such as Saudi Arabia and Qatar, demonstrated substantial and growing CRC research publications, which were more closely aligned with their disease burden. This disparity highlights the urgent need for context-specific evidence to inform CRC prevention, early detection, and control strategies in Libya. ¹³

Research output from LMICs, such as Libya, encounters barriers such as limited funding and infrastructure, and difficulties in disseminating findings in international journals due to complex submission processes and high article processing charges (APC). ¹⁴ These systemic issues create a vicious cycle in which a lack of resources hinders research, which in turn limits the evidence needed to secure funding and improve public health outcomes. Furthermore, locally published studies are often internationally inaccessible because of language barriers and inconsistent reporting standards. Consequently, the overall evidence base on CRC in Libya remains fragmented, impeding local policy-making and global understanding of the disease. Despite the rising burden of CRC in Libya, no prior review has systematically mapped the scope, quality, and accessibility of published research, which limits the ability to plan for evidence-based cancer control strategies. This is particularly urgent in post-conflict settings, where infrastructure and policy reforms are underway, and foundational evidence is needed to guide the development of resilient cancer systems.

This scoping review addresses the following question: What are the methodological patterns, thematic gaps, and structural barriers in peer-reviewed publications on CRC in Libya? Given this fragmented literature, a scoping review is well-suited to systematically map the peer-reviewed publications on CRC in Libya. Following the methodological framework proposed by Arksey and O’Malley ¹⁵ and further refined by the Joanna Briggs Institute ¹⁶ , this approach allows for a comprehensive overview of the current research landscape, which is essential for identifying critical gaps. Given the exploratory nature of the research question and the heterogeneity of study designs, a scoping review is the most appropriate method for capturing the breadth of evidence and identifying gaps in peer-reviewed publications on CRC in Libya.

This review aims to capture both locally and internationally published literature to identify gaps, thematic trends, and opportunities for future research. To our knowledge, this is the first comprehensive synthesis of peer-reviewed CRC research published in Libya.

The review seeks to:

• • Identify the volume and characteristics of peer-reviewed publications on CRC in Libya.

• • Analyze methodological trends and research design.

• • Explore barriers influencing the production and dissemination of peer-reviewed publications on CRC.

By addressing these objectives, this review will provide a comprehensive overview of the current state of peer-reviewed publications on CRC research in Libya, highlight critical gaps, and inform strategies to strengthen research capacity and improve patient outcomes in Libya and comparable LMIC settings. Ultimately, this study contributes to the foundational evidence needed to build resilient cancer control systems in limited-resource and post-conflict environments, as emphasized in recent global health dialogues.

Methods

This scoping review followed the PRISMA-ScR guidelines, ¹⁷ ensuring a comprehensive, transparent, and reproducible mapping of peer-reviewed publications on CRC in Libya, aligned with current best practices. The method utilized for evidence synthesis was a descriptive mixed-methods approach tailored to map the scope of CRC literature. This involved a quantitative analysis to summarize article characteristics (e.g., geographic location, publication trends, thematic focus) and a qualitative narrative synthesis to describe and interpret key findings, research gaps, and authorship patterns. This approach allowed for comprehensive mapping of the volume and nature of peer-reviewed published CRC research in Libya.

Protocol and Registration

A protocol outlining the objectives, eligibility criteria, and analytic methods was developed before the review. Although not formally registered, it adhered to the PRISMA-ScR recommendations and guided study implementation and reviewer calibration.

Eligibility Criteria

Studies were included based on the following criteria.

• • Population and Context: Focused on CRC in Libya, involving Libyan participants or biological samples (e.g., tissue, biopsies) from Libyan patients, regardless of the author’s nationality or affiliation.

• • Conceptual Scope: Covered any CRC-related topic, prevention, screening, awareness, policy, epidemiology, diagnosis, treatment, or outcomes. Sub-sites such as the colon, rectum, and sigmoid cancers were included.

• • Study Design: Peer-reviewed empirical studies using quantitative, qualitative, or mixed methods, as well as narrative reviews and clinical case reports.

• • Language: Published in English or Arabic.

• • Accessibility: Full texts available through public or institutional sources; abstracts without full access were excluded.

• • Publication Status: Published in peer-reviewed journals with accessible metadata.

Exclusion Criteria:

Studies were excluded based on the following criteria:

• • Did not involve Libyan human subjects or biological samples.

• • Focused on non-CRC malignancies or lacked contextual relevance to Libya.

• • Editorials, commentaries, conference abstracts without full articles, or grey literature (e.g., theses, institutional reports).

This framework ensures the inclusion of verifiable, context-specific research on CRC epidemiology and healthcare in Libya while maintaining methodological integrity.

Information Sources

A structured literature search was conducted using PubMed, Google Scholar, and African Journal Online (AJOL). PubMed and Google Scholar were chosen for their broad open-access biomedical indexing. AJOL was included to cover African-published journals, specifically Libyan-affiliated journals relevant to the review. This combination of databases ensures comprehensive and accessible coverage, particularly for researchers in LMICs with subscription restrictions. This approach emphasizes reproducibility in resource-constrained settings, aligning with evidence mapping in LMICs.

Additionally, a manual search was performed on unindexed Libyan scientific journals and reference lists of the included studies to identify missed records. The search was restricted to English and Arabic publications and was not restricted by publication status. It was applied using the maximum historical range possible, from January 1, 1900, to 2024. This broad timeframe was selected to ensure the capture of all published evidence on CRC research in the Libyan context since the inception of the major indexing databases. No contact was made with the study authors for extra data, and no automation tools were used for screening or deduplication.

Search Strategy

Tailored search strategies were implemented in each database to comprehensively identify peer-reviewed studies on CRC in Libya. The specific search queries and filters used for each electronic database are listed in Table 1.

Table 1.

Search Strategies for Electronic Databases

Database	Search strategy
PubMed	A Boolean search string targeting titles and abstracts, filtered for human studies in English or Arabic: ((colon[Title/Abstract]) OR (rectum[Title/Abstract]) OR (sigmoid[Title/Abstract]) OR (rectal[Title/Abstract]) OR (colonic[Title/Abstract]) OR (colorectal[Title/Abstract])) AND ((cancer[Title/Abstract]) OR (tumor[Title/Abstract]) OR (malignancy[Title/Abstract]) OR (malignant[Title/Abstract]) OR (neoplasm[Title/Abstract])) AND ((Libya[Title/Abstract]) OR (Libyan[Title/Abstract]) OR (Libyans[Title/Abstract]) OR (Tripoli[Title/Abstract]) OR (Benghazi[Title/Abstract]) OR (Misrata[Title/Abstract]) OR (Sabha[Title/Abstract]) OR (Sabratah[Title/Abstract]) OR (Tajora[Title/Abstract]) OR (Sirte[Title/Abstract])) AND ((Humans[MeSH Terms]) OR (Humans[All Fields])) AND ((English[Language]) OR (Arabic[Language]))
Google scholar	The search was conducted in 2025, using the platform’s custom date range filter set from 1900 to 2024. The following Boolean string was entered in the main search bar: (“colon” OR “rectum” OR “sigmoid” OR “colonic” OR “rectal” OR “colorectal” AND “cancer” OR “malignancy” OR “malignant” OR “tumor” OR “neoplasm” AND “Libya”)
	The first 100 results sorted by relevance were selected for screening. No language or subject filters were applied
AJOL	A two-step manual search strategy was employed. First, the platform’s “country” filter was applied to identify journals published in Libya. Five health-related journals were selected based on scope and relevance
	- AlQalam journal of medical and applied sciences
	- Libyan journal of medicine
	- Libyan medical journal
	- Mediterranean journal of pharmacy and pharmaceutical sciences
	- Wadi Alshatti university journal of pure and applied sciences
	Second, each journal was manually searched across all available issues using the following individual keywords: “cancer”, “malignancy”, “colorectal”, and “colon”. Boolean operators and advanced search syntax were not supported by this platform. The search was conducted on the 23rd of December 2024, and all retrieved records were exported for screening

To supplement the electronic database searches and enhance the coverage of locally published research, a manual hand search was conducted in January 2025. This involved screening all available issues of 2 key Libyan health journals, the Libyan Journal of Medical Sciences and the Libyan Journal of Public Health Practices, which are not indexed in the major bibliographic databases. Relevant keywords (“cancer”, “malignancy”, “colorectal”, “colon”) were applied across titles and abstracts. Additionally, backward citation tracking was performed by reviewing the reference lists of the included articles to identify earlier studies that might have been missed in the initial searches. Records identified through these processes were exported and screened alongside the database results.

Selection of Sources of Evidence

All citations retrieved through database and manual hand searches were consolidated into a Microsoft Excel spreadsheet. Duplicate records were identified and removed, and the resulting master sheet was used to coordinate the reviewer assignments and track the decision outcomes throughout the screening process.

To ensure consistency among the reviewers, we conducted a calibration exercise before beginning the review. All 5 reviewers independently screened the same ten titles and abstracts. The results were then discussed, and any inconsistencies were resolved to refine our understanding of the eligibility criteria. This process helped standardize the screening forms and clarify how the exclusion criteria were applied. The study selection followed a two-stage, team-based protocol.

Initial Screening (Title and Abstract Review)

A team of 5 reviewers independently screened the titles and abstracts in pairs. Decisions on inclusion and exclusion were documented in a shared Google Sheet. Any conflicts were resolved by a third reviewer, and the final decision was determined by majority rule.

Full-Text Eligibility Assessment

Following the initial screening, 2 reviewers independently assessed the full texts of all potentially eligible articles. A structured Google Form developed from the study’s inclusion criteria was used. To ensure consistency, all reviewers were trained to use the form and completed a calibration exercise with a sample of 10 articles. The principal investigator provided continuous support throughout the process. For each exclusion, reviewers were required to select a reason from a predefined list: “Not conducted in Libya or study subjects are not Libyan,” “Not related to CRC,” “Not a research article,” “Not in English or Arabic,” and “Inaccessible in full text.” A third reviewer resolved any discrepancies, with the majority decision being the final decision.

This rigorous two-stage protocol ensured methodological consistency, minimized bias, and improved inter-rater reliability. A PRISMA-ScR flow diagram in the results section details the screening results.

Data Charting Process

A standardized Google Form was developed to collect information to be extracted from each study. This form was pilot-tested using a sample of the included studies to ensure a shared understanding of each field and to improve consistency across reviewers. It also served as an informal inter-rater reliability measure, aligning the interpretation of the charting criteria before full data extraction.

Each article was independently charted by 2 reviewers, with categorical and free-text responses captured based on the review objectives. No attempts were made to contact the study authors for clarification or for additional data. Once charting was complete, the lead reviewer conducted a final verification of all extracted entries to ensure each entry’s accuracy and coherence prior to synthesis. Discrepancies were adjudicated by a third reviewer, and a majority decision process was used to ensure procedural consistency and minimize bias. This process reflects a commitment to a reproducible scoping review methodology in settings constrained by limited access to centralized research metadata.

Data Items

A data charting form was developed using Google Forms to ensure a structured and consistent approach. The extracted variables were aligned with the study objectives and included the following domains:

• • Article and Study Characteristics: Title, DOI or access link, publication year, study design, sample size, stated aim, setting (e.g., hospital, municipal), timeframe, geographic coverage, and classification as locally led or collaborative.

• • Population Details: Sex and age.

• • Cancer-Related Attributes: Anatomic site, cancer type, stage at diagnosis, and degree of differentiation (where reported).

• • Authorship and Institutional Affiliation: First author’s name and gender, institutional affiliation, and city.

• • Ethics and Funding Transparency: Presence of ethics approval, name of the approving body (if available), funding disclosure, and declared funding sources.

• • Journal Metrics: Journal name, impact factor (where known), and quartile ranking (Q1–Q4, if available).

• • Thematic Focus: Primary study outcomes, such as screening, treatment, prevention, awareness, and epidemiological characterization. Multiple thematic codes were assigned to the data when applicable.

Missing data were documented as “Not stated,” and no imputation or assumptions were made. The collected data were managed and synthesized using Microsoft Excel software. Due to heterogeneity in age reporting (e.g., mean, median, grouped ranges), participant ages were not treated as quantitative variables but were broadly classified as adult populations.

Critical Appraisal of Individual Sources of Evidence

Consistent with the scoping review methodology, we did not perform a formal critical appraisal or risk of bias assessment of the included studies. This aligns with the guidance from PRISMA-ScR, which prioritizes mapping the breadth and thematic landscape of the available evidence over evaluating the quality of individual studies. Our intent was to provide an overview of research activity and its structural attributes, not to determine the effectiveness or validity of specific findings.

Synthesis of Results

The extracted data were compiled in Microsoft Excel and imported into the SPSS (version 26) for statistical analysis. Categorical variables were summarized using descriptive statistics, including frequency counts and proportions, to map the distribution, scope, and characteristics of the included studies.

The synthesized findings were organized across the following analytical domains:

• • Study Design and Data Source: Classification of methodological approaches (e.g., observational, case series) and data origins (primary vs secondary).

• • Geographic Distribution: Regional mapping based on institutional locations and the participant recruitment sites in Libya.

• • Thematic Categorization: Grouping of studies under 5 dominant CRC focus areas:

  • ◦ Clinical Characteristics and Diagnosis
  • ◦ Epidemiology and Incidence
  • ◦ Molecular and Genetic Studies
  • ◦ Treatment and Outcomes
  • ◦ Risk Factors & Etiology

• • Tumor Characteristics: Documentation of histological types, anatomical sites, staging, and differentiation (when reported).

• • Authorship and Collaboration Patterns: Classification of studies as locally led vs internationally co-authored and analysis of the first author’s institutional affiliation.

• • Gender Determination and Classification: The first author’s gender was determined based on native knowledge and cultural expertise of common Libyan naming conventions. Due to the distinctive nature of these names, sex (Male or Female) was assigned based on the publication name. Authors with unfamiliar names and those not easily recognizable as Libyan and whose gender was unclear were classified as Unknown. This ensures accurate local classification while flagging ambiguous cases.

• • Ethical Oversight and Funding Transparency: Presence of documented ethics approval and funding disclosures, including named approving bodies and sponsors.

• • Journal Quality Indicators: Impact factor and quartile ranking (Q1–Q4), when available.

To maintain data integrity, studies reporting overlapping cohorts were carefully reviewed and not counted twice.

Age variables were treated descriptively because of heterogeneity in the reporting format. Mean, standard deviation, and range data were preserved when available. For studies presenting age categories (e.g., “<40 years” or “>60 years”), participants were conservatively classified as adults in accordance with broader eligibility criteria.

The results were synthesized using tables and narrative interpretation to illuminate key patterns, gaps, and structural characteristics in Libya’s peer-reviewed publications on CRC in Libya.

Ethical Considerations

This scoping review did not require ethical approval because it involved the synthesis of data from publicly available sources and did not include human participants, identifiable personal data, or biological materials. In accordance with international guidelines for research ethics, such studies are exempt from Institutional Review Board oversight.

Results

Study Selection

The initial search and selection processes followed the PRISMA-ScR guidelines, as illustrated in the flow diagram (Figure 1). A total of 287 records were identified across 4 sources: PubMed (n = 93), Google Scholar (n = first 100), AJOL (n = 83), and hand searching (n = 11). After removing 39 duplicate records, 248 unique citations were screened by title and abstract, resulting in the exclusion of 129 records. These exclusions were primarily due to a lack of relevance to the Libyan context or a focus on cancer types outside the scope of this review. Full-text retrieval was attempted for 119 articles, of which 7 were not available. Of the 112 full-text articles, 70 were excluded for the following reasons: not conducted in Libya or used non-Libyan subjects (n = 38), not CRC-focused (n = 24), not original research (n = 7), and a suspected text duplication (n = 1). Ultimately, 42 studies met the inclusion criteria and were retained for analysis.

Figure 1.

PRISMA-ScR Flow Diagram of Study Selection for Peer-Reviewed Publication on CRC Research in Libya

*AJOJ is the African Journals Online the indexing platform of quality African-Published scholarly journals, Source: Page MJ et al. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. This work is licensed under CC BY 4.0. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/

Characteristics of Sources of Evidence

Methodological Features of Included Studies

The 42 included studies were published between 1993 and 2024, with data collection beginning in 1981. The majority employed retrospective designs: 16 (38.1%) were classified as retrospective analytical and 15 (35.7%) as retrospective descriptive. Case-control studies and case reports each accounted for 3 studies (7.1%), while reviews were less common (n = 4). One study lacked sufficient information to determine its design. ¹⁸ Hospital-based settings dominated the included studies, accounting for 85.7% (n = 36), with only one study using municipal data and a few relying on global databases such as GLOBOCAN 2020 and the Global Burden of Disease. Overall, 69% of the studies (n = 29) relied on secondary data sources, primarily medical records and institutional archives (n = 22). Primary data collection was reported in 13 studies (31%), including 3 case reports, and was most often based on human subjects (n = 7) or tissue samples (n = 5), with one study combining both types of data. Table 2 summarizes the characteristics of the 42 studies included in this scoping review, focusing on the study design, setting, and data source.

Table 2.

Summary of Study Designs, Settings, and Data Sources of CRC-Related Publications in Libya Included in this Scoping Review (n = 42)

Characteristic	Category/type	Number of studies	Percentage (%)
Study design	Retrospective analytical	16	38.1
	Retrospective descriptive	15	35.7
	Reviews	4	9.5
	Case-control	3	7.1
	Case reports	3	7.1
	Not clear	1	2.3
Setting	Hospital/clinic-based	36	85.7
	Global datasets: Global burden of disease (n = 2) and GLOBOCAN 2020 (n = 1)	3	7.1
	Municipal-level	1	2.4
	Not specified (Reviews)	2	4.8
Data source	Secondary	29	69
	Primary	13	31

Geographic and Institutional Distribution

Libyan peer-reviewed publications on CRC reveal an uneven geographic landscape, with marked clustering around a few urban centers in the north. Benghazi and nationwide analyses each accounted for 26.2% of the studies (n = 11), followed by 21.4% from Misrata (n = 9), 11.9% from Tripoli (n = 5), and smaller contributions from Tobruk (4.8%, n = 2), Derna, Sabha, Sabratha, and Zlitan, each with one study (2.4%). This distribution highlights persistent regional gaps, particularly in southern Libya, where minimal representation (only Sabha from the south) suggests the under-coverage of certain populations and care contexts.

The institutional affiliations of the first authors mirrored this imbalance. The University of Benghazi led with 8 studies (19%), followed by the National Cancer Institute–Misurata (16.7%, n = 7) and the Libyan International Medical University in Benghazi (7.1%, n = 3). Other contributing institutions included the University of Tripoli (9.5%, 4), University of Misurata (7.1%, 3), and several international collaborators, such as the University of Sharjah (UAE), Hamad General Hospital (Qatar), and institutions in Iran and Ethiopia. This mix of domestic and international affiliations reflects growing cross-border collaboration, although local academic centers remain the primary drivers of peer-reviewed publications on CRC research in Libya.

Thematic Focus and Population Characteristics

The 42 included studies addressed a range of topics in CRC research in Libya. The most frequently represented themes were epidemiology (35.7%, n = 15) and Clinical Characteristics & Diagnosis (33.3%, n = 14). Smaller subsets focused on Treatment and Outcomes (14.3%, n = 6), Risk Factors and Etiology (9.5%, n = 4), and Molecular and Genetic factors (7.1%, n = 3). This distribution reflects a strong emphasis on population-level patterns and clinical presentations, with fewer studies exploring the underlying biological mechanisms or intervention outcomes.

The sample sizes across the included studies ranged from single-patient case reports to a colonoscopy series involving 1858 individuals. Of the 36 studies that reported numerical data, 3 datasets were used twice. Specifically, Bodalal et al used the same sample in 2 publications^10,19; Bensalah et al. did likewise^20,21; and Alragig et al. and Rabie et al. reported on the same sample in separate studies.^22,23 After accounting for these overlaps, the adjusted totals were as follows: data analysis records (n = 6070), human participants (n = 1259), and tissue samples (n = 216).

Most studies (92.9%, n = 39) included both male and female participants. Only 3 studies focused on a single sex: 2 case reports targeted one male each, and one case report targeted one female. The reporting of patient age varied across studies, with inconsistent formats and ranges, making standardized grouping unfeasible. However, most studies focused on adult populations that ranged from below 40 to over 90 years.

The authors, publication year, title, aim, design, data collection period, sample size, sex distribution, and location of the 42 included studies are listed in Table 3.

Table 3.

Summary of the Published 42 Studies on CRC in Libya and Included in this Scoping Review

Category	First author (Publication year)	Title	Aim	Study design	Data collection Period	Sex (Sample size*)	Location
Epidemiology (No. = 15)	S.S. Akhtar 1993 24	Cancer in Libya —A retrospective study (1981-1985)	Analyze the pattern and frequency of malignant diseases diagnosed at Libya’s sole oncology clinic between 1981 and 1985, with attention to histopathological confirmation, gender distribution, age groups, and cancer types	Retrospective descriptive	1981-1985	Both (51)	Libya
	R Singh (2001) 25	Cancer mortality in Benghazi	Investigate the magnitude, pattern and epidemiological characteristics of cancer deaths in Benghazi, to identify the categories of preventable cancer and to suggest further areas of research and intervention	Review	1991-1996	Both (119)	Benghazi
	Zuhir Bodalal (2014) 19	Cancers in eastern Libya: First results from Benghazi medical center	Determine cancer incidence rates in eastern Libya	Retrospective descriptive	2012	Both (174)	Benghazi
	Islam Elzouki (2018) 26	Cancer incidence in the western region of Libya: Report of the year 2009 from the Tripoli pathology-based cancer registry	Estimate age-standardized incidence rates	Retrospective analytical	2009	Both (108)	Tripoli
	Eman Gusbi (2021) 27	Cancer incidence in Southern Libya	Update cancer incidence data in southern Libya	Retrospective descriptive	2016-2018	Both (665)	Sabha
	Faisal Ismail (2021) 28	Cancer incidence in the Tobruk area, eastern Libya: First results from Tobruk medical centre	Report on regional cancer incidence data	Retrospective descriptive	2013-2020	Both (47)	Tobruk
	Afaf Aburwais (2021) 29	Demographic features of common cancers in the national cancer Institute, Misurata	Assess some demographic data, cancer rates, and prevalence based on the hospital cancer registry at the National Cancer Institute-Misurata	Retrospective descriptive	2016	Both (149)	Misrata
	Anas Zarmouh (2022) 30	Cancer incidence in the middle region of Libya: Data from the cancer epidemiology study in Misurata	Estimate cancer incidence and compare trends regionally and globally	Retrospective descriptive	2019-2020	Both (83)	Libya
	Atalel Fentahun Awedew (2022) 31	Burden and trend of colorectal cancer in 54 countries of Africa 2010-2019: a systematic examination for Global burden of disease	Investigate the burden and trends of incidence, mortality, and disability-adjusted life-years (DALYs) of colorectal cancer in Africa from 2010 to 2019	Retrospective descriptive	2019	Both (900)	Libya
	Hanan Garalla (2022) 32	Clinical and pathological characteristics of colorectal carcinoma	Analyze the clinicopathological characteristics of colorectal carcinoma in Benghazi Libya	Retrospective descriptive	2018-2020	Both (60)	Benghazi
	Abubaker Bakeer (2022) 33	Clinical and demographic profile of colorectal cancer	Analysis the incidence of colorectal cancer among Libyan patients in National Cancer Institute	Retrospective descriptive	2013	Both (47)	Misrata
	Mohammed Amir Miftah (2023) 34	Epidemiologic features of colorectal cancer in Zlitan city	Investigate CRC epidemiology using oncology department data	Retrospective descriptive	2022	Both (75)	Zlitan
	Abdulbasit Hadhr (2023) 35	Colorectal cancer: Insight into incidence, risk factors, diagnosis and prognostic markers	Highlight CRC burden, risks, diagnosis, and biomarkers	Review	—	Both (NA)	Libya
	Yahya Pasdar (2023) 36	The burden of colorectal cancer attributable to dietary risk in the middle East and north Africa from 1990 to 2019	Estimate the mortality and burden of CRC due to diet	Retrospective analytical	1990-2019	Both (NA)	Libya
	Naeima Houssein (2024)	Cancer incidence in Libya using estimates from GLOBOCAN 2020	Describe and discuss cancer incidence in Libya based on GLOBOCAN Libya 2020 estimates	Descriptive review	2020	Both (904)	Libya
Clinical characteristics and diagnosis (No. = 14)	Anuj Mishra (2010) 37	Right abdominal mass: Keep an open mind	Investigate the causes of the right abdominal mass	Case report	2010	Male (1)	Libya
	Raja Aljafil (2014)	E-cadherin expression in Libyan patients with colorectal carcinoma	Evaluate E-cadherin expression in a series of Libyan colorectal cancer cases to get insight into its potential prognostic value in colorectal cancer in Libyan patients	Retrospective descriptive	2007	Both (81)	Benghazi
	Kamal Verma (2014) 38	Unusual presentation of cancer colon	Describe an unusual colon cancer case	Case report	—	Female (1)	Libya
	Abdel-Naser Elzouki (2014) 39	Epidemiology and clinical findings of colorectal carcinoma in 2 tertiary care hospitals in Benghazi, Libya	Determine the pattern of CRC patients	Retrospective analytical	2007-2009	Both (152)	Benghazi
	Zuhir Bodalal (2014) 10	Colorectal carcinoma in a southern Mediterranean country: The Libyan scenario	Study features of CRC in Libya	Retrospective descriptive	2012	Both (174)	Benghazi
	Mussa Alragig (2015) 40	Clinicopathological characteristics of colon cancer in Libya	Characterize demographic and pathological traits of colon cancer	Retrospective analytical	2010-2014	Both (229)	Misrata
	Nabeia Gheryani (2017) 41	Nucleolar organizer regions (AgNORs) as a proliferative index in benign, premalignant and malignant colorectal lesions	Evaluate AgNORs to differentiate lesion types and malignancy grades	Retrospective analytical	2004-2006	Both (38)	Benghazi
	Ramadan Elamyal (2017) 42	Clinicodemographic profile of colorectal cancer patients in national cancer Institute of sabratha –Libya	Study demographics and tumor location in CRC patients	Retrospective descriptive	2013	Both (135)	Sabratha
	Manal Algallai (2019) 43	Colorectal cancer Implantation Metastasis in Hemorrhoidectomy wound, case report	Report rare missed rectal adenocarcinoma and management controversies	Case report	—	Male (1)	Benghazi
	Ahmed Elsayed (2020) 44	Evaluation of Cox2 Expression as A prognostic marker in colorectal adenocarcinoma	Evaluate COX2 expression in sporadic cases of colorectal adenocarcinoma in Tobruk-Libya	Retrospective analytical	2016-2019	Both (60)	Tobruk
	Abdussalam Hounki (2022) 45	Large Bowel obstruction caused by colon cancer: A retrospective study	Determine the frequency of large bowel obstruction due to colon cancer among patients who had large bowel obstruction and are admitted to the surgical department at Tripoli Medical Center (TMC). Additionally, to identify if there is an ass	Retrospective descriptive	2011	Both (18)	Tripoli
	Abdsalam Rabie (2023) 22	Comparative analysis of clinicopathological profiles and survival outcomes of early-onset versus late-onset colorectal cancer patients	Study the clinicopathological characteristics and survival of patients with early onset colorectal carcinoma (CRC) (i.e., patients with age of <50 years at time of diagnosis) vs late onset CRC (i.e., patients with age of ≥50 years at time of diagnosis	Retrospective analytical	2008	Both (466)	Misrata
	Osama Naseer (2023) 46	Clinical characteristics and Main findings of colonoscopy in Tripoli central hospital: A cross-sectional study of 1858 patients	Analyze demographics, indications, and findings from colonoscopy records	Retrospective descriptive	2009-2016	Both (1858)	Tripoli
	Mussa Alragig (2024) 23	Prognostic Value of carcinoembryonic Antigen (CEA) and carbohydrate Antigen (CA19-9) in colorectal cancer	Find an increased informative value when interpreting both tumor markers together to increase the chances of survival of patients and to optimize treatment in the future	Retrospective analytical	2008-2017	Both (397)	Misrata
Molecular & genetic (No. = 3)	Eman Abdul Razzaq. (2021) 47	HER2 overexpression is a putative diagnostic and prognostic biomarker for late-stage colorectal cancer in north African patients	Assess HER2 overexpression for CRC diagnosis and prognosis	Retrospective analytical	—	Both (17)	Libya
	Asma Abudabous (2021) 48	KRAS mutations in patients with colorectal cancer in Libya	Investigate KRAS/HRAS mutations and their link to CRC type/stage	Retrospective analytical	2016-2017	Both (34)	Misrata
	Asma A. Abudabbous (2023) 49	Detection of MUTYHgene mutations in hereditary colorectal cancer Libyan families	Detection of mutations in the MUTYH gene in Libyan families have heredity CRC	Retrospective analytical	2022	Both (10)	Misrata
Treatment & outcomes (No. = 6)	Khaled Ben Salah (2021) 21	Prevalence and pattern of KRAS and NRAS mutations in colorectal cancer: A Libyan retrospective study	Characterize the frequency and patterns of KRAS and NRAS mutations in Libyan patients with colorectal cancer referred to the pathology department at the National Cancer Institute (NCI) of Misrata city in Libya for KRAS mutation analysis or subsequently to NRAS testing in	Retrospective analytical	2018-2020	Both (79)	Libya
	Khaled Ben Salah (2022) 20	KRAS testing for colorectal cancer patients: Our laboratory experience in the Libyan national cancer Institute	Discuss the KRAS mutation analysis approach that is in use at the department of Histopathology/National cancer Institute (NCI) of Misrata	Retrospective descriptive	−1	Both (79)	Misrata
	Fatema Belgasem (2022) 18	The influence of capox (Xelox) and Folfox on colorectal cancer patients in Tripoli university hospital, Tripoli, Libya	Evaluate and to provide information about the toxicity and side effects of the 2 chemotherapies (Capox and Folfox), which are used for CRC treatment in the oncology department in Tripoli University Hospital, Libya	Not clear	2016-2020	Both (100)	Tripoli
	Naseralla Suliman (2023) 50	Factors influencing postoperative hospital stay following colorectal cancer resection	Identify variables that prolong the hospital stay after colorectal surgery	Retrospective analytical	2016-2018	Both (98)	Benghazi
	Mussa Alragig (2023) 51	Correlations of sociodemographic and clinicopathological features with survival outcome of colorectal cancer: A retrospective study from A Libyan cohort	Analyze the correlation between patient factors and CRC outcome	Retrospective analytical	2023	Both (466)	Misrata
	Othman Tajoury (2023) 52	Management of complicated colorectal cancer in Benghazi hospitals	Identify optimal treatment for emergency complicated CRC patients	Retrospective analytical	2023	Both (98)	Benghazi
Risk factors & etiology (No. = 4)	Salah Bashir (2021) 53	Association between Streptococcus bovis and colorectal cancer among Libyan patients	Address the association between Streptococcus Bovis/gallolyticus and colorectal cancer among Libyan patients, to determine the dominant biotype of Streptococcus Bovis/gallolyticus associated with colorectal cancer patients, and to evaluate the antibiotic susceptibility	Case-control	2017	Both (20)	Tripoli
	Heithum Baiu (2024) 54	Evaluation of the Association between unhealthy lifestyle and colon cancer among the patients treated in the oncology unit of Benghazi medical center	Evaluate the association between an unhealthy lifestyle and colon cancer	Case-control	2024	Both (95)	Benghazi
	Fahimeh Haghighatdoost (2024) 55	Burden of colorectal cancer and its risk factors in the north Africa and middle East (NAME) region, 1990-2019: a systematic analysis of the global burden of disease study	Estimate the burden of CRC and the share of its risk factors in the north Africa and Middle East (NAME), from 1990 to 2019	Systematic review	1990-2019	Both (NA)	Libya
	Mohamed Bohlala (2024) 56	Exploring the Multifactorial landscape of colorectal cancer risk: Insights from a cohort study at the oncology centre in derna, Libya	Identify and evaluate patient characteristics, demographic factors, and lifestyle behaviours associated with the risk of colorectal cancer at the time of diagnosis	Case-control	2022- 2023	Both (158)	Derna

*(Number of Libyan CRC patients), NA = Not available.

Tumor Characteristics and Reporting Gaps

Reporting on tumor biology and staging varied considerably among the included studies. Histological subtype was unspecified in 71.4% of the included studies, while 9.5% identified adenocarcinoma and 19% reported multiple types.

Tumor location was described as “colorectal” without anatomical detail in 57.1% of studies; 19% included multiple locations, and only one study focused solely on rectal cancer. Notably, 21.4% of studies did not specify the tumor site.

Staging information was absent in 66.7% of studies. Among those that did report staging, 28.6% described mixed-stage populations and 4.8% focused on late-stage disease. Overall, inconsistencies and omissions in histological, locational, and staging data limit the potential for meaningful cross-study synthesis and comparative analysis.

Publication Trends and Research Capacity

CRC publication activity in Libya shows a steep rise in recent years. The peak year for publications was 2023 with 9 studies (21.4% of the total), closely followed by 2021 with 8 studies (19%), and 2022 with 6 studies (14.3%). In 2024, 5 publications (11.9%) were documented at the time of this review. International journals were the venue for 23 studies (54.8%), while 19 studies (45.2%) were published in local journals.

Of the 42 included studies, most were published in peer-reviewed journals that are not indexed or ranked in major citation databases. Specifically, 69% lacked an available impact factor, and 76.2% had no quartile ranking. Among the journals with reported metrics, impact factors ranged from 0.7 to 4.2, with most falling below 2.0. Quartile rankings were distributed across Q1 (4.8%), Q2 (7.1%), and Q3 (11.9%). Most journals claim to follow peer-review standards, although the rigor and consistency of review processes appear variable. In several cases, articles exhibited limitations in clarity, methodological rigor, or adherence to reporting standards. This distribution may influence the generalizability and methodological transparency of the included evidence.

Male first authors led the majority of studies (64.3%, n = 27), more than twice the proportion of studies led by female first authors (28.6%, n = 12). The gender of the first author could not be determined for 7.1% (n = 3) of the included publications. These 3 studies, published in 1993, 2001, and 2010, likely represent foreign research efforts, as Libyan-led first authorship only began in 2013 (n = 1 male) and 2014 (n = 1 female). This initial gap and subsequent emergence of Libyan leadership align with the major political shifts in the country, as significant foreign presence in Libya declined sharply after the 2011 revolution. Notably, 75% (9 of 12) of all female-led publications occurred in the last 4 years of the analysis (2021 to 2024), suggesting a recent acceleration in female lead authorship within the local research sphere.

Across all 42 studies, authorship was widely distributed, with 38 unique first authors contributing. Most authors (90%) appeared only once, reflecting a dispersed and episodic research landscape. Four individuals were listed as first authors on more than one publication: Mussa Alragig (n = 3; 2015, 2023, 2024), Zuhir Bodalal (n = 2; both in 2014), Khaled Ben Salah (n = 2; 2021, 2022), and Asma Abudabous (n = 2; 2021, 2023). Among these, Asma Abudabous is the only female repeat contributor. No author demonstrated consistent or consecutive annual contributions.

Of the 42 included studies, 22 (52.4%) explicitly reported a section on ethics or patient consent. Ethical reporting varied by study type: 9 out of 10 internationally collaborative studies (90%) included an ethics section, compared to only 13 out of 32 locally conducted studies (40.6%). Funding disclosure was similarly limited. Only 18 studies (42.9%) provided information about their funding sources. Among collaborative studies, 6 out of 10 (60%) included funding details, while just 12 of 32 local studies (37.5%) did so. The remaining 24 studies (57.1%) offered no funding information.

Discussion

This scoping review synthesized the evidence from 42 publications on CRC in Libya, revealing critical limitations in the current research landscape. The body of evidence, while growing, suffers from significant methodological homogeneity, profound regional disparities, and a narrow thematic focus. The majority of studies employed retrospective designs (73.8%) and relied heavily on hospital-based data (85.7%), underscoring a dependence on easily accessible institutional records and a deficit in primary, prospective data collection. Furthermore, the clinical utility and comparability of studies are severely hampered by major reporting gaps, notably the infrequency of detailed data on cancer histology and staging.

Geographically, research is concentrated in northern urban centers, particularly Benghazi, Misrata, and Tripoli, with a critical lack of representation from southern and peripheral regions. The thematic focus similarly remains restricted to Epidemiology and Clinical Characteristics, with limited exploration of treatment outcomes, molecular profiling, or risk factors necessary for precision oncology.

Despite a noticeable surge in publication volume (peaking in 2023), local research output struggles with visibility due to challenges in indexing and journal impact metrics. Compounding these limitations, analysis of authorship and reporting practices revealed structural issues: low research continuity among first authors and inconsistent ethical and funding disclosures.

These intrinsic limitations mirror and are likely exacerbated by systemic, region-wide barriers to research maturity in Libya and the Arab world. As documented in broader analyses, Libya has faced significant conflict-related disruptions, including fund diversion and brain drain, which undermine the development of a sustainable research infrastructure. ¹² This environment reflects the limited geographic scope and the reliance on lower-intensity retrospective studies observed in our review. Arab universities also contend with a crisis of global recognition, struggling to prioritize and adequately fund research amidst social, economic, and political instability.^13,57 Challenges such as inadequate infrastructure, limited resources for specialized training, and a shortage of well-indexed publications further restrict the global visibility and impact of Libyan science. These regional dynamics underscore the urgent need for targeted capacity-building efforts, inclusive mentorship structures, and policy reforms to enhance Libya’s contribution to peer-reviewed publications on CRC research and integrate it more effectively into global scientific discourse.

Methodology Patterns

Study Design and Setting: Current Trends and Contextual Barriers

The heavy methodological skew in peer-reviewed published CRC research in Libya is a direct reflection of reliance on readily available institutional records amid profound infrastructural, financial, and logistical constraints. While the use of secondary data enables cost-effective analysis in a resource-limited setting, it introduces an inherent epistemological bias. This methodology often excludes critical patient-reported outcomes, data on early symptomatology, and community-level risk behaviors, thereby limiting generalizability and limit the evidence needed for effective preventative strategies. ⁵⁸

This situation is not unique to Libya but is common in other LMICs, where cancer research frequently adopts retrospective, single-center designs due to fragmented health information systems and a lack of formalized research strategies. ⁶ Parallels exist in sub-Saharan Africa, where studies face similar challenges in obtaining reliable staging data due to gaps in pathology and electronic records. ³ Such parallels underscore the need for system-level reforms that address both technical and sociocultural barriers to inclusive research.

A critical gap in Libyan CRC literature is the absence of community-based studies, likely driven by sociocultural norms and structural limitations. For instance, household-based data collection is often impractical due to safety concerns and cultural norms discouraging women from interacting with unfamiliar visitors.^59,60 Resource constraints further hinder feasibility, as community-based research demands transportation, data collection tools, flexible scheduling, and participant incentives, resources typically unavailable to students and trainees lacking institutional support.

Nonetheless, Libya’s shifting social landscape offers new opportunities for culturally sensitive research. Public venues such as malls, gyms, and clubs provide safer, more accessible settings for participant recruitment and data collection. While these alternatives may reduce cultural barriers, scaling community-based designs remains challenged by persistent funding limitations.

Thematic Gaps

Geographic and Institutional Distribution: Bridging Regional Gaps and Expanding Research Collaboration

Peer-reviewed publication on CRC research in Libya is overwhelmingly concentrated in major urban centers, a trend clearly evidenced by first-author affiliations: Benghazi, Misurata, and Tripoli collectively account for over 76% of all research output. This extreme clustering, coupled with minimal contribution from peripheral areas, particularly southern Libya, creates a critical research gap that obscures regional epidemiological patterns, population-specific risk factors, and disparities in care delivery. This imbalance is driven by structural challenges, including the sparse distribution of academic institutions, limited healthcare infrastructure, and the centralization of the country’s few dedicated cancers care facilities. ⁶¹ This centralization fragments national CRC surveillance and undermines the relevance and equity of resulting control strategies.

While international collaborations represent an emerging avenue of engagement (11.8% of affiliations), the urgent need is to transition research efforts beyond isolated institutional contributions and individual partnerships. To advance equitable and comprehensive cancer control, formal, large-scale initiatives are mandatory. These strategies include the activation of a comprehensive national cancer registry, the establishment of centralized data sharing platforms, and formal academic twinning programs. These initiatives are essential for integrating fragmented data, building sustainable research capacity across all regions, and ensuring that future research is inclusive of the currently underrepresented populations in the south.

Thematic Focus and Population Characteristics: Gaps in Scope and Representation

The current thematic focus of peer-reviewed publications on CRC research in Libya demonstrates an overreliance on descriptive epidemiology, with insufficient investigation into molecular and genetic markers, modifiable risk factors, and treatment outcomes. The limited studies on genetic predispositions and environmental contributors hinder the development of context-specific prevention strategies. Additionally, the limited data on treatment outcomes restricts the formulation of localized clinical guidelines and effective resource allocation.

Compounding these issues is the underrepresentation of rural and underserved populations in hospital-based data, which predominantly reflects urban centers. These biases risk misinterpreting disease burden and may lead to policies that neglect high-risk or underdiagnosed groups. Consequently, clinicians and policymakers face challenges in tailoring interventions to local needs.

These limitations also restrict the ability to trace etiological patterns or assess care effectiveness. Such gaps, biases, and thematic imbalances have been observed across other LMIC, where peer-reviewed publication on CRC research often prioritizes facility-based data due to resource constraints and limited molecular infrastructure. A recent review of CRC screening interventions in LMICs revealed that most studies were opportunistic and clinic-based, with minimal population-level outreach or genomic profiling. These findings underscore the need for systemic investment, inclusive sampling strategies, and a broader research scope. ³

Tumor Characteristics and Reporting Gaps: Implications for Surveillance and Clinical Strategy

A significant limitation in Libyan peer-reviewed publications on CRC is the inconsistent and often absent reporting of critical tumor characteristics, particularly histological subtypes, anatomical tumor locations, and staging information. The prevalent use of vague descriptors (e.g., “colorectal” without site specificity) and the limited data on cancer staging hinder the understanding of disease progression and clinical behavior within the Libyan population.

This lack of detail obstructs both national and international comparative analyses, complicating the exploration of geographic and demographic variations in tumor patterns. Most critically, it impairs the development of stage-specific treatment strategies and early detection programs. In a healthcare landscape characterized by centralized oncology services, geographic disparities in access, and the absence of a national screening program, these reporting gaps become increasingly consequential. Without robust early detection infrastructure and widespread educational initiatives, patients are more likely to be diagnosed at advanced stages, yet the research framework remains ill-equipped to systematically capture or analyze this trend. As a result, public health planning and clinical decision-making are hampered by an incomplete understanding of disease burden and progression.

These challenges are common in other LMICs, where tumor staging and histological reporting are frequently underdeveloped due to limited pathology infrastructure, fragmented data systems, and inconsistent adoption of international classification standards. A recent study from the Philippines, for instance, revealed that over half of hospital-based cancer registries lacked staging data, particularly in treatment and follow-up modules. ⁶² These parallels emphasize the urgent need for systemic reforms that prioritize data completeness and clinical relevance.

Structural Barriers

Publication Trends and Research Capacity: Barriers, Equity, and Systemic Reform

The analysis of publication trends reveals a landscape characterized by dispersed authorship and minimal sustained contributions across consecutive years, suggesting a fragmented or nascent research community. While a few individuals contributed multiple times as first authors, the absence of consistent leadership or mentorship lineages points to challenges in building enduring research programs. Fluctuations in annual publication activity further reflect an inconsistent rhythm of research output.

The emergence of female authorship between 2014 and 2024, with dispersed authorship, highlights both progress in gender inclusion and the difficulty of sustaining diversity. This pattern mirrors global trends, where female authorship in oncology journals has increased modestly but remains underrepresented in senior roles. ⁶³ Promoting equitable participation is essential to harness the full intellectual capital available in Libya.

Libyan authorship conventions differ from international norms, with the first author typically regarded as the most senior and responsible for the research rather than the last author. Accordingly, this analysis focused on first authorship.

Inconsistent reporting of ethical approval and funding across studies raises fundamental concerns regarding transparency and research oversight. Of the included studies, 47.6% did not report ethical approval, a gap primarily attributed to contextual factors within the local research environment. In some cases, research may proceed without mandatory, centralized institutional review, and local journal submission guidelines often do not explicitly require ethical declarations. This omission, particularly pronounced in locally conducted studies, suggests a research culture where transparency is not routinely enforced, potentially undermining trust and limiting reproducibility. Several of these studies were published in journals lacking formal indexing, impact metrics, or consistent ethical reporting. While such features may raise concerns about editorial rigor, they do not in themselves confirm predatory publishing. This pattern suggests that collaborative or internationally affiliated research may adhere more consistently to formal ethical reporting standards. Conversely, the absence of ethical documentation in over half of the locally conducted studies highlights a potential gap in research governance and transparency within the local research landscape. This disparity is not unique to Libya; similar patterns have been documented across LMICs, where ethical and financial reporting often lags due to limited infrastructure and inconsistent journal requirements.^64,65 Further assessment of journal practices and transparency is warranted.

The publication landscape reveals a trend towards dissemination in lower-visibility or unranked journals. Many of these journals lack impact metrics or quartile rankings, making their reach and influence harder to gauge. A significant hurdle contributing to this trend is the high cost of publishing in high-impact journals. For instance, the median cost for publishing an open-access (OA) article in a medical journal is about $4600, with fees ranging widely from $2000 to $12,000.^14,66

Although some journals qualify Libya for partial APC waivers as an upper-middle-income country, the lack of institutional coverage and the devaluation of the local currency render these fees prohibitive. This financial constraint disproportionately affects early-career researchers and those without external funding.

Moreover, the primary motivation for research in this setting is often tied to academic promotion, rather than broader scientific contribution or policy impact. As a result, researchers may opt for more accessible journals that, despite claiming peer-review status, may lack rigorous editorial standards. This includes the absence of ethical approval declarations, conflict of interest disclosures, and transparent peer-review processes, practices routinely enforced by higher-tier journals.

The consequence is a self-reinforcing cycle: publishing in lower-tier venues limits peer critique, reduces methodological refinement, and diminishes global visibility. This weakens the credibility of Libyan research and hinders its integration into international discourse. In the long term, this cycle undermines both academic development and institutional capacity to conduct impactful, policy-relevant research.

Recommendations and Future Directions

Methodological Patterns

This section presents recommendations focused on improving the quality, rigor, and diversity of research designs employed in CRC studies.

To address the limitations in study design, regional coverage, and thematic focus, future research efforts should adopt more robust and inclusive methodologies.

• Adopt Prospective and Mixed-Methods Designs: Future studies should move beyond retrospective designs to incorporate prospective and mixed-methods approaches. This will allow for richer data collection, including patient-reported outcomes and longitudinal follow-up on disease progression, which are crucial for understanding the patient journey and informing long-term care strategies.

• Broaden Research Scope: Research should expand beyond descriptive epidemiology to investigate critical areas like lifestyle factors, environmental exposures, and genetic markers. This will provide a more comprehensive understanding of CRC risk factors and facilitate the development of tailored prevention and screening strategies.

• Conduct Community-Based Studies: Innovative and culturally sensitive recruitment strategies, such as using public venues or mobile screening units, are necessary to include rural and underrepresented populations. This approach will improve the external validity and equity of findings and ensure that policy recommendations are relevant to all Libyan communities.

• Standardize Data Collection: National guidelines for tumor reporting should be developed and adopted to mandate the consistent collection of essential data, including histological subtypes, anatomical location, and staging. Aligning these standards with international frameworks like TNM staging will improve data comparability, research quality, and global integration.

Thematic Gaps

This section summarizes the key contributions of this review to the literature on CRC research in resource-limited settings.

1. Addressing Structural Barriers to Inclusive Research: The review highlights how cultural norms, logistical challenges, and resource constraints in Libya have hindered the adoption of community-based and prospective research designs. These insights underscore the need for innovative, context-sensitive approaches to engage broader populations and overcome structural barriers common in LMICs.

2. Strengthening the Research Ecosystem: The analysis of publication trends, ethical oversight, and funding disclosure reveals systemic gaps that are often pervasive in LMIC research environments. The recommendations to develop national funding mechanisms, subsidize high-impact publishing, and establish centralized monitoring systems aim to strengthen the overall integrity and visibility of Libyan CRC research, aligning with global efforts to enhance research capacity in resource-limited settings.

3. Emphasizing Tumor Profiling and Data Standardization: The review’s focus on the critical gaps in tumor characteristics reporting underscores a common challenge in LMIC cancer research, where fragmented data systems and limited pathology infrastructure constrain the quality and comparability of evidence. The proposed strategies to standardize reporting protocols, build pathology capacity, and create centralized registries are broadly applicable to strengthen cancer surveillance and research in other LMIC contexts.

4. Fostering Equitable and Sustainable Research Collaborations: The review’s recommendations to promote gender equity, establish long-term mentorship programs, and facilitate international partnerships respond to the need for more inclusive and enduring research ecosystems in LMIC settings. These approaches can help overcome the fragmentation and lack of institutional capacity that often hinder the development of impactful, policy-relevant cancer research in resource-constrained environments.

Structural Barriers

Strengthening Infrastructure and Collaboration

To build a more resilient and integrated research ecosystem, systemic investments in infrastructure and collaboration are essential.

• Establish National Consortia and Data Platforms: Creating national research consortia and shared data platforms will foster inter-institutional cooperation, reduce research fragmentation, and facilitate large-scale, multi-site studies. These frameworks are critical for generating representative findings and supporting evidence-informed policy development.

• Create a National Cancer Registry: A unified national cancer registry is necessary to systematically collect and manage standardized data on tumor characteristics, demographics, and clinical outcomes across institutions. This centralized system would be a vital tool for public health planning, surveillance, and longitudinal trend analysis.

• Invest in Molecular Infrastructure: Building local capacity for molecular profiling and genomic studies is crucial for advancing personalized medicine in Libya. Investment in laboratory infrastructure and researcher training will enable the identification of hereditary cancer syndromes and the development of targeted therapies.

• Build Capacity for Local Researchers: Targeted investments in research funding, training, and mentorship programs will support early-career researchers and build sustained research programs. This will help transition the research landscape from academically driven, descriptive studies to policy-relevant, outcome-focused research.

Enhancing Publication and Research Integrity

To improve the visibility and credibility of Libyan research, reforms are needed to enhance publication standards, ethical practices, and international engagement.

• Support High-Impact Publishing: Institutions or national bodies should subsidize APC for researchers publishing in reputable journals. This would reduce the financial barrier to publishing in high-tier venues, thereby increasing the visibility, credibility, and citation impact of Libyan research.

• Standardize Ethical Review and Transparency: Mandating ethical approval and funding disclosures for all research is critical. Establishing national ethics committees and integrating ethics training into academic curricula will ensure all research adheres to international standards of integrity, accountability, and transparency.

• Improve Author Guidance and Visibility: Researchers need training on how to evaluate journal quality and avoid predatory publishers. Facilitating international collaborations through joint grants and exchange programs will also integrate Libyan researchers into global networks, enhancing their access to peer review, mentorship, and dissemination opportunities.

Limitations and Scope of Findings

The findings and conclusions of this analysis are strictly limited to peer-reviewed articles published on CRC research in Libya. This study examines research output and publication practices, not the totality of all research conducted within Libya on this topic. As the activities of research and their subsequent publication are distinct processes, the identified gaps reflect limitations only within the current body of peer-reviewed literature and should not be generalized to represent the entire scope of all research activities undertaken in the country. Methodologically, this scoping review was constrained by limited access to certain subscription-based databases, which may have led to an incomplete mapping of available evidence. Furthermore, the lack of direct author engagement prevented the inclusion of unpublished or supplementary data, and despite a rigorous internal revision to exclude known repeated samples of tissue or subjects, the potential for residual overlap in reported cases cannot be guaranteed as fully resolved, which introduces uncertainty regarding the distinctiveness of study populations.

Strengths of the Scoping Review

Despite these limitations, the review employed a robust, multi-pronged search strategy and adhered strictly to PRISMA-ScR guidelines, ensuring methodological transparency and reproducibility. The interdisciplinary composition of the review team minimized bias and enhanced data extraction quality. Moreover, the study’s targeted focus on the Libyan context offers valuable, localized insights into peer-reviewed publications on CRC research within an LMIC setting.

Conclusion

In summary, the Libyan peer-reviewed publication on CRC research landscape remains in a developmental phase, characterized by methodological heterogeneity, concentrated geographic activity, and limited structural support. Despite sociopolitical challenges, including prolonged conflict, the current evidence does not suggest a significant disruption in peer-reviewed publication on CRC capacity, given the low output observed before 2011. However, persistent barriers, such as underreporting of tumor characteristics, inconsistent ethical oversight, and limited access to high-impact publishing, continue to hinder the visibility and utility of local research. Encouragingly, Libya’s evolving social dynamics offer new opportunities for ethical and culturally grounded research, particularly through alternative recruitment venues like malls and gyms. Future efforts should prioritize the adoption of mixed-methods and community-based designs, the establishment of research consortia, and the development of national funding and ethics frameworks. By embracing these strategies, Libya can cultivate a more representative and impactful peer-reviewed publication on CRC research, one capable of guiding evidence-informed policies and improving cancer outcomes across diverse population groups.

ORCID iDs

Abeir El-Mogassabi https://orcid.org/0000-0002-3710-2380

Lugien Elshakmak https://orcid.org/0009-0000-6346-8469

Nadin Omer Hassan https://orcid.org/0009-0009-2766-9007

Enas Mohamed Salem https://orcid.org/0009-0009-7698-4687

Khalil Tamoos https://orcid.org/0000-0003-2455-6508

Ethical Consideration

Ethical approval was not required for this scoping review, as it involved the analysis of publicly available literature and did not include human participants, personal data, or biological samples.

Data Availability Statement

All relevant data are presented within the manuscript. Additional information is available from the corresponding author upon reasonable request.*