Knowledge, Awareness, and Practices toward Colorectal Cancer and Its Dietary and Lifestyle-Related Risk Factors among Jordanian University Students: A Cross-Sectional Study

Background Colorectal cancer (CRC) is the third leading cause of malignancy in Syria. The aim of our study was to assess the awareness and knowledge of CRC and its screening methods among medical students at the University of Aleppo.Methods A cross-sectional study of medical students at the University of Aleppo was conducted using a self-administered 12-element questionnaire. The questionnaire consisted of demographics, awareness of CRC, knowledge of CRC and its screening methods. Awareness of CRC included three questions asking students if they ever heard of CRC and its screening methods. Knowledge of CRC was evaluated through three sets of questions about CRC risk factors, signs and symptoms, and preventative methods. The students were selected randomly during academic lectures. Aχ2or Fisher's exact tests for categorical variables were used for statistical analysis, as appropriate. A two-sidedp < 0.05 was considered statistically significant. We stratified students based on pre-clinical versus clinical years and average academic score.Results A total of 824 students completed the questionnaire. The majority of students were aware of CRC (98.9%) and CRC screening methods (79.8%). Students had poor knowledge of CRC risk factors (16.5% for non-modifiable factors and 11.7% for modifiable factors), signs and symptoms (52.6%), and protective factors (9.9%). Only 31.7% of students were able to identify the appropriate age to initiate screening for average-risk individuals. Clinical students had better awareness and knowledge of CRC and its screening methods. Clinical students with higher academic score showed better awareness and knowledge in some elements.Conclusion Our study reported high awareness and poor knowledge rates of CRC and its screening methods among medical students at the University of Aleppo. Although clinical students had higher awareness and knowledge of CRC compared to pre-clinical students, the impact of academic score revealed variable results.

BackgroundParticipation in Colorectal cancer (CRC) screening programs is low in Saudi Arabia. Public awareness of CRC and knowledge of available screening tools are crucial for improving screening uptake. This study aimed to examine the level of awareness and knowledge of CRC among the Saudi population. Materials and methodsA survey-based study was conducted on 1912 residents of Riyadh, Saudi Arabia. The survey comprised 20 questions; these concerned the definition of the colon and rectum; the function of the colon; the incidence, risk factors, symptoms, screening methods, prevention methods, and treatment methods for CRC; and the value of early detection of CRC. ResultsOf the 1912 participants who completed the survey, only 51.7% knew that the colon was the large intestine, while 57% knew that the rectum was the end of the large intestine. Colonoscopy was the preferred screening tool (72.8%). Most respondents believed early detection of CRC through colonoscopy is associated with high survival rates. However, 65.7% of the participants reported that they would not like to undergo a CRC screening. Higher education level was also associated with knowledge that CRC can develop asymptomatically, with postgraduates most likely to know this (P = 0.032). ConclusionsThere is a lack of knowledge regarding CRC among certain demographic groups in Saudi Arabia, and education and screening programs should target populations with the most limited knowledge.

The burden of colorectal cancer (CRC) has been on the rise globally over the last decade. Several studies point to the fact that there is a lack of knowledge and awareness for CRC which may be attributed to the increase in the burden over time. Therefore, we aimed to assess the level and predictors for knowledge of CRC and its risk factors. This study was a cross-sectional study conducted on the student population of the University of the West Indies, St. Augustine Campus, Trinidad. We assessed CRC knowledge using scales examining their level of knowledge for CRC and its risk factors. Lifestyle behaviors (smoking, physical activity, dietary behaviors, and alcohol consumption) and perceived risk for developing CRC were also collected using a standard survey. Predictors for CRC knowledge were assessed using forward stepwise linear and logistic regression models. The overall CRC knowledge was 54.740% ± 19.721%. Poor knowledge levels were seen among 36.23% while satisfactory/good knowledge was seen among 63.77%. Predictors of poor CRC knowledge were males (OR = 1.559; p = 0.003), frequent/excessive alcoholic drinkers (OR = 1.924; p = 0.029), and low physical activity (OR = 1.331; p = 0.042). Predictors of satisfactory/good CRC knowledge were those with higher scores for the prudent dietary pattern (OR = 0.893; p = 0.016), and compared with those who reported no risk, participants reporting low risk had an increased likelihood of obtaining good CRC knowledge scores (OR = 0.526; p = < 0.001) and high risk (0.310; p = < 0.001). The level of awareness/knowledge on CRC and its risk factors is low. Improvement of CRC awareness and healthy lifestyle campaigns among young adults is needed for the Caribbean region.

Colorectal cancer (CRC) is the most common gastrointestinal cancer and the incidence is increasing in many developing countries. While it can be detected early and even prevented through screening and removal of premalignant lesions, there are barriers to screening which include low level of knowledge and awareness of CRC. This study assessed the level of knowledge of CRC in Brunei Darussalam. A total of 431 (262 male and 161 female) subjects participated in this questionnaire study. Subjects were scored on their knowledge of signs/symptoms (maximum 10 correct answers) and known risk factors for CRC (maximum 10 correct answers) and were categorised into poor (0-2), moderate (3-4) and satisfactory (5-10). Comparisons were made between the various patient factors. Overall, 54.1% could not name any CRC signs/symptoms or associated risk factors. Most were not aware of any screening modalities. The overall scores for CRC signs/symptoms and risk factors were 1.3±1.39 (range 0-6) and 0.6±1.05 (range 0-5) respectively. Overall, the breakdown of scores was: poor (78.1%), moderate (20.3%) and satisfactory (6.2%) for signs/symptoms and poor (93.2%), moderate (6.2%) and satisfactory (0.7%) for risk factors. Higher level of education, female gender and non-Malay race were associated with higher scores for both signs/symptoms and knowledge of screening modality; however the overall scores were low. Our study showed that the general knowledge of CRC in Brunei Darussalam is poor. Being female, with higher levels of education and non-Malay race were associated with higher scores, but they were still generally poor. More needs to be done to increase the public knowledge and awareness of CRC.

Purpose: Disparities in colorectal cancer (CRC) incidence and mortality persist in rural and underserved communities. As part of the NIH NCI’s long-term outreach and education plan to provide education and increase awareness about cancer risk reduction, the National Outreach Network Community Health Educator (NON-CHE) program was established to reach underserved areas through strong community partnerships. The NON-CHE project identified barriers to CRC screening and implemented the Screen 2 Save (S2S), a national initiative, to increase community knowledge, awareness, and engagement activities. In this study, we assessed the impact of this initiative in rural and underserved communities. Methods: Descriptive and comparative analyses were used to examine the role of the NON-CHE on CRC knowledge and CRC screening intent. Participants included the Massey Cancer Center (MCC) catchment area where 170 surveys were collected from rural and underserved communities. Data included demographics, participants’ current CRC knowledge, awareness, and future CRC health plans. A multivariate linear regression was fit to participants’ survey scores for CRC knowledge. All analyses were done in R 3.5.2. Results: NON-CHE engaged 441 participants in rural and underserved communities. At baseline, White participants had significantly higher CRC knowledge scores, correctly answering 1.94 (p=0.007) more questions on average. After the NON-CHE intervention, this difference was not statistically significant. The difference in participants’ CRC knowledge had an overall mean of 0.92, with a standard deviation of 2.56. Female participants exhibited significantly higher CRC knowledge after controlling for the effect of other demographic variables (p = 0.004). Female study participants also had significantly higher differences between their CRC knowledge scores, exhibiting an average gain in CRC knowledge of 1.08 questions higher than men (p = 0.043). Older participants also tended to demonstrate less improvement – specifically, a one-year increase in participant age corresponded to an adjusted average decrease in improvement of 0.02 questions. Greater than 95% of participants agreed that S2S sessions impacted their intent to get screened for CRC. Conclusions: The NON-CHE facilitated community connections and increased awareness of CRC risk reduction, screening, treatment, and research. Such programs should be considered as mechanisms that increase the knowledge, awareness, and engagement of rural and underserved communities. Equity of access to health information and the health care system can be achieved with precision population health strategies. The NON-CHE combined with S2S is a powerful way to engage rural and underserved communities and impact participants’ intent to “Get Screened”. Citation Format: Michael A. Preston, Debbie Cadet, Rachel Hunley, Reuben Retnam, Sarah Arezo, Vanessa B. Sheppard. How to improve health equity and colorectal cancer awareness: A Community Health Educator initiative [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-018.

Background: Colorectal cancer (CRC) is a leading cause of cancer-related deaths in the United States despite the availability of effective preventive screening. Objective: This project was designed as a community awareness initiative to increase CRC awareness, knowledge, and intent to discuss and complete CRC screening. Methodology: This quasi-experimental study had a QI focus and used a convenience sample in a public setting assessing CRC awareness, knowledge, and intent to discuss and complete screening after participating in an inflatable colon tour. Results: CRC awareness and knowledge scores showed a statistically significant increase in posttest scores at p < .001. Posttour, there was an 82% and 133% increase in people who identified as "very likely" or "definitely" willing to discuss CRC with their healthcare provider and complete CRC screening within the next 6 months, respectively. Conclusions: In line with previous studies, the inflatable colon model was a successful means of increasing CRC knowledge, awareness, and intent to complete CRC screening. Implications for Nursing: This project is evidence that community events can successfully increase knowledge in underserved populations. Implementing community-based interactive education, such as an inflatable colon tour, is an effective way to incorporate evidence-based education for vulnerable populations.

A comparative study of knowledge and awareness of colorectal and breast cancerA comparative study of knowledge and awareness of colorectal and breast cancer

Introduction: According to the Saudi Cancer Registry, colorectal cancer ranked first among the male population and third among the female population. Objectives: To investigate the level of knowledge and awareness of colorectal cancer among students from different faculties at King Abdulaziz University, Jeddah, Saudi Arabia. Materials and methods: A cross-sectional study was conducted during February 2014. The questionnaire was adapted from surveys identified in relevant literature. The data were entered and analysed by IBM SPSS Statistics version 21 (IBM Corporation, Armonk, NY, USA). Results: A total of 523 undergraduate students answered the questionnaire (mean age of 21.49±2.47 years). The majority of the students (82.3%) had heard of colorectal cancer. Less than half (40%) of the students received information material regarding colorectal cancer within the school curriculum. More than half of the students (68.2%) recognized that colorectal cancer is a preventable disease. Only 33.6% were aware of screening tests, while 77.0% did not know any type of test that could help detect colorectal cancer. Approximately half of the students (52.0%) recognized that family history is one of the risk factors for colorectal cancer, while 59.4% knew that age was considered one of the non-modifiable risk factors. Conclusions: The findings of this study revealed that knowledge and awareness of colorectal cancer in a sample of undergraduate students from King Abdulaziz University were variable between different faculties, but, overall, were low. It warrants an extensive health education campaign on colorectal cancer as it is one of the most common cancers in Saudi Arabia.

Introduction: To assess awareness level of colorectal cancer (CRC) signs, symptoms, and risk factors among inflammatory bowel disease (IBD) patients attending King Khalid University Hospital (KKUH), and to determine factors associated with good knowledge of CRC. Methods: A quantitative, observational, cross-sectional designed study was conducted at KKUH, Riyadh, Saudi Arabia, from 2013 to 2014 using telephone interview-administered questionnaires to patients who were prospectively selected. An estimated sample of 384 was calculated using the standard equation. Patients’ confidentiality was maintained. Results: Prompted awareness of CRC symptoms and risk factors was much higher than unprompted awareness. When asked about risk factors, nearly 48% of patients could not recall any risk factors without aid. Overall, the most commonly identified risk factor for CRC unaided was IBD (27.1%) and it was followed by diet (20.5%). Out of all patients, aid was needed by over half of patients (58.4%) to recognize IBD as a risk factor. While on other hand, 14.5% couldn’t identify or didn’t know whether their own disease (IBD) is a risk factor for CRC. Conclusion: Overall level of awareness of CRC symptoms and risk factors among Saudi IBD patients was poor. However, knowledge towards CRC symptoms was observed higher than knowledge of risk factors. Customization of health-promotion programs for IBD patients is urgently needed to raise awareness of their own increased risk of developing CRC.Table 1: Patients’ Knowledge of CRC SymptomsTable 2: Patients’ Knowledge of CRC Risk Factors

BackgroundImproving public knowledge and awareness of cancer aids prevention and early detection, yet limited data exist on this subject in low- and middle-income African countries. This study aimed to assess knowledge and awareness of colorectal cancer (CRC) in the general population of central Uganda.MethodsA community-based, cross-sectional survey was conducted among a random sample of 428 individuals from the general population in 2 districts of central Uganda. Data were collected using a semi-structured questionnaire and a modified version of the validated bowel cancer awareness measure. Multiple linear regression analysis was performed to identify factors associated with CRC awareness.ResultsJust over half of respondents had good awareness of CRC warning signs (57.9%, ≥ 6/9 correct responses), and risk factors (55.8%, ≥ 7/10 correct responses). Participants scored higher for awareness (responses to prompted questions), than knowledge (responses to unprompted questions) in relation to CRC warning signs (mean: 5.60 vs 0.46, out of 9) and risk factors (mean: 6.46 vs 0.22, out of 10). Residing in an urban area, lacking awareness of screenable cancers and not having private health insurance were associated with lower awareness of CRC warning signs. Being female and having non-degree tertiary education were associated with lower awareness of CRC risk factors.ConclusionThis study found very low CRC knowledge in central Uganda, despite good recognition of warning signs and risk factors, with notable rural–urban disparities. These findings highlight the need of reinforcing CRC prevention messages within ongoing cancer sensitization efforts to improve public understanding of CRC.

Disparities in colorectal cancer (CRC) incidence and mortality persist in rural and underserved communities. Our Community Outreach and Engagement (COE) activities are grounded in a bi-directional Community-to-Bench model in which the National Outreach Network Community Health Educator (NON CHE) Screen to Save (S2S) initiative was implemented. In this study, we assessed the impact of the NON CHE S2S in rural and underserved communities. Descriptive and comparative analyses were used to examine the role of the NON CHE S2S on CRC knowledge and CRC screening intent. Data included demographics, current CRC knowledge, awareness, and future CRC health plans. A multivariate linear regression was fit to survey scores for CRC knowledge. The NON CHE S2S engaged 441 participants with 170 surveys completed. The difference in participants’ CRC knowledge before and after the NON CHE S2S intervention had an overall mean of 0.92 with a standard deviation of 2.56. At baseline, White participants had significantly higher CRC knowledge scores, correctly answering 1.94 (p = 0.007) more questions on average than Black participants. After the NON CHE S2S intervention, this difference was not statistically significant. Greater than 95% of participants agreed that the NON CHE S2S sessions impacted their intent to get screened for CRC. Equity of access to health information and the health care system can be achieved with precision public health strategies. The COE bi-directional Community-to-Bench model facilitated community connections through the NON CHE and increased awareness of CRC risk reduction, screening, treatment, and research. The NON CHE combined with S2S is a powerful tool to engage communities with the greatest health care needs and positively impact an individual’s intent to “get screened” for CRC.

P-217 The knowledge and awareness for colorectal cancer in advanced colorectal cancer patients in China: A national multicenter study

Purpose: Participation in colorectal cancer (CRC) screening lags behind screening for other types of cancer despite the ability to prevent the development of CRC and down-stage disease. The purpose was to describe the association of CRC awareness and knowledge with CRC screening. Methods: Trained interviewers from a professional survey firm conducted computer-assisted, random digit dialed telephone interviews, with landline and cell phone numbers, using a 144-item instrument developed via literature review, expert panel review, and pretesting. South Carolina residents aged 45-75 years were contacted. For this paper, analysis was restricted to respondents aged 50-75 (n=1,302) who fall in the recommended screening age range and answered knowledge, awareness, and screening items. Data were analyzed with SAS and STATA. Odds ratios were adjusted for race and gender. Results: Respondents (n=1,503) were mostly female (63%), EA (77%), had at least some college education (59%), had household income of less than $49,999 (48%), married or lived with a partner (62%), had health insurance (91%), and unemployed/not working (57.1%). Mean age was 60.3 years (SD=8.6). A majority of respondents had heard of CRC (91%). Of those who had heard of CRC, the majority had heard of CRC screening (96%). More than half of respondents (69%) could name any of the CRC screening tests. The most common CRC screening test named was colonoscopy (90%). Respondents who had heard of a CRC had greater odds of having had any CRC screening test (aOR=1.71; CI: 1.06-2.76; p&amp;lt;0.028) and colonoscopy (aOR=1.59; CI: 1.03-2.45; p&amp;lt;0.034) than those who had not heard. Respondents who could correctly name at least one CRC screening test had greater odds of having had any CRC screening test (aOR=3.74; CI: 2.76-5.08; p&amp;lt;0.001) and colonoscopy (aOR=3.69; CI: 2.83-4.82; p&amp;lt;0.001) than those who could not name a test. A CRC awareness index score (range 0-4) was created by assigning a +1 to each of four awareness items. A one-unit increase in the awareness score significantly increased respondents being more likely to have had CRC screening test (aOR=1.44; CI: 1.30-1.59; p&amp;lt;0.001), colonoscopy (aOR=1.43; CI: 1.29-1.57; p&amp;lt;0.001), flex sigmoidoscopy (aOR=1.27; CI: 1.13-1.41; p&amp;lt;0.001), or FOBT (aOR=1.13; CI: 1.02-1.25; p&amp;lt;0.016). The CRC knowledge item answered correctly most often was “colon cancer can start as a polyp, which is a small growth found in the colon” (97%) and least often was “colon cancer is most often caused by a person's behavior or lifestyle” (26%). A CRC knowledge index score (range=0-14) represented total number of correct responses. A one unit increase in knowledge score significantly increased respondents being more likely to have had any CRC screening test (aOR=1.05; CI: 1.02-1.10; p&amp;lt;0.004), colonoscopy (aOR=1.05; CI: 1.02-1.09; p&amp;lt;0.004), or FOBT (aOR=1.04, CI: 1.00-1.07; p=0.043). There were also statistically significant differences by race and gender. Conclusion: Generally, there were high levels of awareness and knowledge scores, but modest participation in CRC screening. Higher levels of awareness and knowledge showed increased likelihood of CRC screening, yet CRC screening rates continue to be lower pointing to the need for interventions in addition to those focused on awareness and knowledge to improve adherence to recommended screening guidelines and reduced CRC cases. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B112.

Background: As the second leading cause of cancer-related deaths in the United States (US), colorectal cancer (CRC) may be prevented through screening along with early education to promote screening. In the past decade, an NCI-funded Partnership comprised of New Mexico State University (NMSU), a minority serving institution, and the Fred Hutchinson Cancer Research Center (FHCRC), a comprehensive cancer center, have increased the cancer outreach programs in their respective communities by targeting underserved populations. Purpose: In both sites, education about CRC has taken place during a tour through an Inflatable Colon (IC). In this study, we focus on the similarities and differences among the two sites. Methods: Each site, NMSU and FHCRC, measured gains in CRC knowledge and intention to be screened, but engaged distinct populations and measured site specific outcomes. In New Mexico (NM), study participants included 485 college faculty, staff, and students, 67% female, between 20 and 69 years of age. Ethnic comparisons were limited to non-Hispanic Whites (NHW) (31%) and Hispanics (51%) due to the low sample size for other race/ethnicities in this group. Overall, the NM participants demonstrated significant increases in CRC knowledge and awareness after touring the inflatable colon (p-values &amp;lt; .001). Interestingly, both NHW men and Hispanics started off with lower CRC awareness at pre-test, but exhibited maximum awareness gains equal to that of women and NHWs after touring the colon. Behavioral intentions to obtain CRC screening in the future and to promote CRC awareness also significantly increased (p-value &amp;lt; .001). Gender differences in behavioral intentions to act as advocates for CRC education were found (p &amp;lt; .05), with women being more likely to educate others about CRC than men. In the Yakima Valley of Washington State, pre- and post-surveys were collected from 947 participants (76.4% Hispanic, 12.3% NHW, and 7.8% Native American) who toured the inflatable colon. Of the respondents, 76% were female. Knowledge about CRC increased significantly from pre-test to post-test (p &amp;lt;0.001). A comparison of those under 50 years of age with those 50 and older showed no differences in knowledge at post-test; they were uniformly high. There was also a significant increase in those who stated they were likely to be screened, from 64.3 at pre-test to 79.3 at post-test (p&amp;lt;0.01). There were no significant differences by gender or ethnicity. Conclusions: The results from both of these areas showed that using a novel educational tool, such as the walk through colon, can increase CRC knowledge and intention to be screened. Use of the inflatable colon educational tool with both young and age-eligible (&amp;gt; 50 years of age) adults may facilitate the dissemination of CRC information among social networks of both groups of adults. The partnership between the research studies permits comparisons of the results of both studies on a wide array of ethnic- and age-disparate populations. Citation Format: Janet Sanchez, Rebecca Palacios, Katherine Briant, Elizabeth Carosso, Mary O'Connell, Beti Thompson. The inflatable colon is a unique tool for educating people about colorectal cancer in New Mexico and Washington states. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A59. doi:10.1158/1538-7755.DISP13-A59

Colorectal cancer (CRC) is the commonest site for malignancy in Europe. The Commissioner for Health wishes to promote screening for colorectal, breast and cervical cancer in Europe. The aim of this study was to assess public knowledge of CRC in Europe and likely take up of free screening. To this end 20710 members of the public from 21 European countries were interviewed by means of a regular survey amongst consumers (Omnibus survey) using 13 stem questions. Forty-eight per cent thought the population were at equal risk of CRC, only 57% were aware of age and 54% of family history as risk factors. Although 70% were aware of dietary factors, only 30% knew that lack of exercise might be a risk factor. Only 51% had knowledge of CRC screening but 75% were 'very', or 'quite interested, in taking up faecal occult blood (FOB) screening if offered free. Barriers to screening were lack of awareness of risk (31%), youth (22%) and an un-anaesthetic test (19%). There was a big cultural difference in willingness of the public to discuss bowel symptoms: there was a major barrier in Finland (91%), Britain (84%), Luxembourg (82%), Poland (81%) and Portugal (80%); less of a barrier in Spain (49%), Italy (44%) and Iceland (39%). In conclusion, the challenge of achieving high compliance for CRC screening must be a major objective amongst EU member states and non-aligned countries of Europe in the next decade, because it is known that the non-compliant group are those at greatest risk of death from CRC. This study has shown that awareness of CRC is low in Europe and that an educational programme will be essential to achieve high compliance for CRC screening as a means of reducing deaths from bowel cancer.