Abstract
Colorectal cancer is the second most common cancer in Malaysia. The prognosis of the disease is excellent if detected at an early stage, but the majority of Malaysian patients present at late stages. We aimed to assess the awareness of cancer warning signs and anticipated delay in help-seeking as possible contributors to this phenomenon. A population-based cross-sectional survey using the Colorectal Cancer Awareness Measure was initiated in Perak, Malaysia. A total of 2,379 respondents aged 18 years and above were recruited using a multi-stage sampling in five locations. Analysis of covariance was used to examine independent sociodemographic predictors of scores for symptom awareness. Younger age, being female, a higher education, and higher income were significantly associated with better scores for both recall and recognition of warning symptoms. Among the ethnic groups, Malays had better recognition of symptoms whereas Chinese recalled the most symptoms. Passing bloody stool was associated with the least anticipated delay and unexplained anal pain had the highest anticipated delay. The level of awareness across all ethnicities in Malaysia is generally low, especially among minorities. Targeted public education, which is culturally and linguistically appropriate, should be developed to encourage early help-seeking and improve clinical outcomes.
Highlights
Colorectal cancer (CRC) is one of the most common cancers in the world
In the recall format, abdominal pain was the of which the respondents would contact their doctor to most commonly cited symptom, mentioned by 10.9 to discuss each of the nine cancer symptoms listed in the questionnaire
The chi-square tests showed significant differences between ethnic groups for all symptoms except unexplained weight loss, blood in stools and tiredness or anaemia. This is the first community-based study to explore ethnic differences in awareness of cancer warning signs, and anticipated delay in help seeking in a multi-ethnic rural population using the standardized Colorectal CAM as the mode of assessment
Summary
In contrast to the West, the incidence of CRC in Asian populations has been increasing rapidly (Ng et al, 2013) This trend is seen in Malaysia, where it is the second most common cancer in both males and females (Ministry of Health Malaysia, 2007), with an age-specific incidence of 10.2 per 100,000 population. In developed Asian countries, national CRC screening programmes have been initiated (Hyodo et al, 2010) as they have been shown to reduce mortality (Heresbach et al, 2006; Kerr et al, 2007; Steele et al, 2009) Such a programme does not exist in Malaysia. Targeted public education, which is culturally and linguistically appropriate, should be developed to encourage early help-seeking and improve clinical outcomes
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