Colon Cancer among Older Saudis: Awareness of Risk Factors and Early Signs, and Perceived Barriers to Screening

Abstract

Background: Colon cancer screening (CRCS) uptake is markedly affected by public awareness of the disease. This study was conducted to assess levels of knowledge of CRC, to explore the pattern of CRCS uptake and identify possible barriers to screening among Saudis older than 50 years of age and primary care providers (PCPs) in Al Hassa region, Saudi Arabia. Materials and Methods: This cross-sectional study was conducted in randomly selected primary health care (PHC) centers, 884 Saudis and 39 PCPs being enrolled for data collection. Structured interviews were conducted to obtain information regarding socio-demographic characteristics, personal information relevant to CRC, awareness about early signs/symptoms and risk factors, and barriers to CRCS. Also, a self-administered data collection form was used to assess barriers to CRCS from the physicians' perspectives. Results: More than 66% of participants were lacking knowledge about CRC. Participants with higher educational levels, having ever heard about CRC, and having relatives with CRC had a significantly higher awareness of the disease. The rate of reported CRCS was low (8.6%). After conducting a logistic regression analysis, it was observed that female gender (OR=0.28; 95% CI=0.14-0.57; P=0.001), being unmarried (OR=0.11; 95% CI=0.10-0.23; P=0.001), lower levels of education (OR=0.36; 95% CI=0.16-0.82; P=0.015), and having no relatives with CRC (OR=0.30; 95% CI=0.17-0.56; P=0.001) were significantly associated with a lower CRCS uptake. There was a significant difference between most of the perceived barriers to CRCS and gender. Exploratory factor analysis showed that personal fear (especially fear of the screening results and shyness) was the major factor that hindered CRCS with high loading Eigen value of 2.951, explaining 34.8% of the barriers of the included sample toward utilization of CRCS, followed by lack of awareness of both person and providers (high Eigen value of 2.132, and explaining 23.7% of the barriers). The most frequently cited barriers to CRCS from the physicians' perspectives were lack of public awareness, lack of symptoms and signs, and fear of painful procedures. Conclusions: Poor levels of knowledge about CRC were found among older Saudis attending PHC centers in Al Hassa, Saudi Arabia. It is crucial to implement an organized national screening program in Saudi Arabia to increase public awareness.

Knowledge and utilization of colorectal cancer screening in Saudi society

“…Our results revealed that the respondents' level of awareness and knowledge about CRC prevalence, risk factors, and screening was poor and inadequate. Many studies have reported similar results in different countries including SA, [11][12][13][14][15][16] Greece, 17 Australia, 18 Iran, 19 and Spain. 9 With regards to the prevalence of CRC among the Saudi population, only 22.2 per cent of the respondents correctly placed it as the most common in men, while the remaining undermined its magnitude by assigning it the second and third ranks.…”

“…Al Wutayd et al 15 stated that less than one-fifth CRC was known only to 34.8 per cent of the surveyed individuals. Galal et al 11 conducted a study in Al Hassa governorate, SA and found that about one-third knew that obesity is a risk factor. Similarly, Al Eid et al 12 stated that 49 per cent of the respondents knew about the risk factors of CRC such as obesity and smoking.…”

Non-medical university students are not more knowledgeable than general population concerning serious diseases

“…12 Yasmine et al showed 61.5% of respondents who agreed and this may be explained because the participants are above 50 years old who are expected to be more aware of such problems, but Taha et al showed only (21.5%) (male 23% and female 20%) which is very low compared with other study. 14,16 Majority of our respondents agreed that alcohol l is a risk factor to CRC. This result is in agreement with that from Malaysian study.…”

“…11,12 Other studies reported 40.1%, 38%, 29.7% of the respondents agreed that CRC occurs in elderly. [13][14][15] Around one fifth of our participants answered that family history of CRC is a risk for CRC. This finding is consistent with that reported by Yasmine et al 14 , about 19% agreed that CRC may be familial.…”

“…[13][14][15] Around one fifth of our participants answered that family history of CRC is a risk for CRC. This finding is consistent with that reported by Yasmine et al 14 , about 19% agreed that CRC may be familial. This points to that the knowledge of our students is same as elderly people whom included in Yasmine et al study.…”