Public knowledge, attitudes and behaviour towards colorectal cancer screening

Abstract

Colorectal cancer (CRC) is the second most commonly diagnosed malignant neoplasm for both sexes combined in developed countries (Sessa et al., 2008). According to the Malta National Cancer Register (2011), between 1999 and 2008, the annual average number of new cases of CRC was 178, while the average annual number of deaths was 93. About 70% of CRC may be prevented by focusing on modifiable risk factors (Giovanucci, 2002) while screening can reduce the relative risk of CRC mortality by 16% (Hewitson et al., 2008). However, studies have shown that the general public has a low level of knowledge about CRC and the participation rate in screening programmes is low. In Malta plans are underway for a national CRC screening programme, however, knowledge, attitudes and behavior towards CRC screening have never been assessed. Therefore, a telephone interview was carried out on 430 Maltese residents aged 40 years and over to measure these variables. Participants had an overall poor level of knowledge, with an average score of 3.1 (95% CI: 2.9-3.3, range: 0-10) out of 11 correct answers. Variables which were statistically significantly associated (p-value <0.05) with knowledge were gender, education, personal or family history of CRC or precancerous lesions, positive attitude towards the utility of screening tests to prevent CRC, belief that CRC can be treated if diagnosed early and having received information about CRC in the past. Participants had a strong personal belief in the utility of screening test to prevent CRC, with a mean score of 8.2 (95% CI: 8.0-8.3, range: 2-10). This belief was influenced by gender, age, education, BMI, knowledge about CRC, perception of risk of developing CRC and intention to participate in CRC screening involving FOBT. Out of the study population, 76.5% and 52.6% claimed they would participate in a CRC screening programme involving FOBT or colonoscopy, respectively. This was associated with marital status, belief that CRC could be treated if diagnosed early, previous exposure to one of the CRC screening tests and recognition of the need for additional information about CRC. Participants with a positive attitude towards the utility of screening tests to prevent CRC did not have higher odds of accepting to participate in CRC screening programmes. This study has confirmed that there is an overall poor level of public knowledge about CRC, with the average scores being lower than those published in the literature (Sessa et al. 2008, Yardley et al. 2000). The National Cancer Plan for Malta (2011) proposed that CRC screening should be done using FOBT however, very few participants (3%) knew about the existence of FOBT. Some participants failed to make the link between screening and early diagnosis and they believed that there was no need to screen if there were no symptoms. This study also highlighted gaps in CRC knowledge, the characteristics of certain vulnerable groups and possible sources that could be employed to reach the public, such as general practitioners. This study provided information which could be used in future CRC education campaigns and highlighted issues that need to be tackled in order to obtain high uptake in a national CRC screening programme.