Awareness of Colorectal Cancer and Attitudes Towards Its Screening Guidelines in Lebanon. Ann Glob Health. 2019;85. [PMID: 31148437 PMCID: PMC6634322 DOI: 10.5334/aogh.2437]

Assessment of Knowledge, Attitude, and Practice Regarding Colorectal Carcinoma Screening Among Healthcare Personnel

BACKGROUND

Colorectal carcinoma (CRC) is a rising issue worldwide, with high morbidity and mortality rates. It is the third most common cause of death globally. Early diagnosis can lead to prevention and treatment, making it crucial for healthcare professionals to have proper knowledge about CRC screening.

AIMS AND OBJECTIVES

This study aimed to assess the level of awareness, identify knowledge gaps, and update the knowledge of healthcare workers.

METHODS

 This descriptive cross-sectional study was conducted from May to October 2023, in multiple tertiary care hospitals of Khyber Pakhtunkhwa, Pakistan. Responses were collected manually through a designed proforma of questionnaires.

RESULTS

A total of 164 participants (137 male and 27 female) took part in our study. Among the participants, 92.1% (n = 151) were aware that colonoscopy is used for CRC screening. Other screening methods known to them included a fecal occult blood test (FOBT) (65.9%, n = 108), flexible sigmoidoscopy (48.2%, n = 79), stool DNA test (31.1%, n = 51), and virtual colonoscopy (34.1%, n = 56). Only 6.1% (n = 10) routinely recommended CRC screening for all patients, 22.6% (n = 37) recommended it occasionally, and 71.3% (n = 117) rarely or never recommended it. Regarding factors influencing the recommendation of CRC screening, 83.5% (n = 137) cited family history of CRC as the major factor, followed by patient age (68.3%, n = 112), availability of screening facilities (46.3%, n = 76), patient's overall health status (37.2%, n = 61), and patient's preference (20.7%, n = 34).

CONCLUSION

This study concluded that only a small proportion of healthcare personnel regularly recommend CRC screening. In addition, a small proportion are familiar with CRC screening guidelines, although most are well-informed about the various investigations used for screening.

Colorectal cancer screening among the public: knowledge, attitudes, and the perceived barriers

Colorectal cancer (CRC)1 screening tests help in early detection of CRC and improve disease prognosis. This study aimed to assess knowledge, attitude, and barriers to CRC screening and the associated factors among the general population in Jordan. A validated self-administered online survey was distributed on 1542 individuals in Jordan. The participants (n = 1542) reported several barriers and demonstrated insufficient knowledge but positive attitude towards CRC screening. Older age (OR = 1.021, 95% CI = 1.010-1.032, P < 0.001), working in medical field (OR = 3.198, 95% CI = 2.499-4.092, P < 0.001), family history of cancer (OR = 1.248, 95% CI = 1.002-1.555, P < 0.05), and knowing someone with CRC (OR = 1.601, 95% CI = 1.186-2.161, P < 0.01) were significantly associated with higher knowledge. Personal history of CRC (OR = 3.157, 95% CI = 1.188-8.387, P < 0.05), and high knowledge of CRC (OR = 2.795, 95% CI = 2.242-3.484, P < 0.001) were significantly associated with the positive attitude. Future healthcare programs should devise effective techniques to improve public understanding and perception of CRC screening and overcome the identified barriers.

Knowledge, Attitudes, and Practices Related to Colorectal Cancer's Prevention and Early Detection Among Older Adults in Kuwait: A Cross-Sectional Study

BACKGROUND

Worldwide, colorectal cancer is one of the significant public health concerns that imposes a substantial risk of morbidity and mortality. Early detection and management of colorectal cancer are necessary to improve the patient's prognosis and outcomes. Hence, several guidelines recommend screening patients at risk of colorectal cancer periodically. Patients' knowledge and attitudes toward screening measures influence their compliance with the guidelines. This study aimed to determine knowledge, attitudes, and practices related to prevention and early detection among older adults in Kuwait.

METHODS

A cross-sectional study was conducted among Kuwaiti adults aged between 45 and 75 years attending the outpatient department in Kuwait's seven major hospitals. A convenience sampling technique was used to recruit the participants. A self-administered questionnaire consisted of four parts: sociodemographic and baseline characteristics, knowledge of colorectal cancer screening, attitudes toward colorectal cancer screening, and practices toward colorectal cancer screening.

RESULTS

A total of 570 Kuwaiti patients were included, and half of them were males (n = 285). Most patients were aged between 45 and 50 years (53.8%), had a secondary school certificate (n = 357, 62.6%), and were unmarried (n = 419, 73.5%). Low levels of knowledge (<50%) and practices (<30%) toward colorectal cancer screening were seen among the participants. Statistically significant correlations were found between patients' knowledge about colorectal cancer screening and their attitudes (r = 0.317, P < 0.001) and practices (r = 0.330, P < 0.001). In addition, a moderately significant association was found between patients' attitudes and practices toward colorectal cancer screening.

CONCLUSION

The study found that despite positive attitudes, Kuwaiti patients have low levels of knowledge and practice regarding colorectal cancer screening. This suggests a need for targeted, culturally sensitive educational programs and national campaigns to improve screening rates and address knowledge gaps.

Enhancing colorectal cancer prevention: a national assessment of public awareness in Egypt

BACKGROUND

Despite the increasing incidence of colorectal cancer (CRC) in the Egyptian population, it still seems that there is a significant lack of awareness regarding the disease. This study aimed to assess the Egyptian population's awareness of CRC regarding its risk factors, the screening procedures, and the appropriate responses to its diagnosis.

METHOD

A cross-sectional study was conducted in Egypt between July 2022 and March 2023 and recruited a convenient sample of adults from seven governorates representing different geographic areas, and socioeconomic and educational backgrounds with the help of the validated Bowel Cancer Awareness Measure (CAM) version 2.1. The modified Arabic questionnaire was validated through a pilot study including 30 patients. Then it was presented through a Google form before being shared via online methods and face-to-face interviews. The questionnaire provided both numerical and categorical data, which were analyzed accordingly. The Chi-square, the Fisher exact, and the Man-Whitney test were used to compare colorectal cancer poor and good knowledge groups. Logistic regression analysis was conducted to predict the factors that affected the awareness level of the study population.

RESULTS

Nine hundred forty individuals participated in the survey. Their ages ranged from 18 to 86 years old, with an average of 37.38 ± 12.22 years. The mean Knowledge score was 14.29 ± 7.05 out of 37 with most of our participants (71%) having poor knowledge about CRC. Most of the participants (64.1%) chose colonoscopy as the best screening modality, followed by an abdominal CT (27.8%), and fecal occult blood (15.5%). The study revealed significant differences between participants with good and poor knowledge of colorectal cancer. (78.5%) of participants with good CRC knowledge lived in cities, (85.4%) attained university or higher educational level, and (87.2%) of them were nonsmokers (p < 0.05%).

CONCLUSION

In general, there was a lack of awareness about Colorectal cancer among the Egyptian population especially among rural and lower educational levels, and more health education campaigns are required to enhance CRC prevention efforts in Egypt.

Understanding the interplay of colorectal cancer awareness and attitudes among Palestinians: a national cross-sectional study

BACKGROUND

In Palestine, colorectal cancer (CRC) is the second most common cause of cancer-related mortality after lung cancer. No studies have examined the relationship between CRC awareness and attitudes. This study aimed to investigate the interplay between CRC awareness and attitudes among the Palestinian population.

METHODS

A nationwide cross-sectional survey was carried out between July 2019 and March 2020. Convenience sampling was used to collect data from hospitals, primary healthcare facilities, and public areas in 11 governorates. Modified, translated-into-Arabic versions of the validated Bowel Cancer Awareness Measure and Cancer Awareness Measure-Mythical Causes Scale were utilized to assess the awareness of CRC signs/symptoms, risk factors, and causation myths. The cumulative awareness score for each domain was computed and stratified into tertiles. The top tertile denoted 'high' awareness, while the remaining two tertiles denoted 'low' awareness.

RESULTS

The final analysis included 4,623 participants; of whom, 3115 (67.4%) reported positive attitudes toward CRC. In total, 1,849 participants (40.0%) had high awareness of CRC signs/symptoms. There was no association between displaying a high awareness of CRC signs/symptoms and having positive attitudes toward CRC. A total of 1,840 participants (38.9%) showed high awareness of CRC risk factors. Participants with high CRC risk factor awareness were more likely to display positive attitudes toward CRC (OR = 1.22, 95% CI: 1.07-1.39). Only 219 participants (4.7%) had high awareness of CRC causation myths. Participants with high awareness of CRC causation myths were more likely to exhibit positive attitudes toward CRC (OR = 2.48, 95% CI: 1.71-3.58).

CONCLUSION

A high awareness level of CRC risk factors and causation myths was associated with a greater likelihood of demonstrating positive attitudes toward CRC in terms of perceived susceptibility, importance of early detection, and consequences of developing the disease. Future educational interventions should focus on raising public awareness about CRC, with a particular emphasis on risk factors and causation myths, to maximize the potential for shaping favorable attitudes toward the disease.

Health behaviors, knowledge, screening, and attitudes toward colorectal cancer among Iraqi adults

OBJECTIVE

This study aimed to evaluate the Iraqi population's health behaviors, knowledge, screening, attitudes toward colorectal cancer (CRC), and possible predictors that may affect their knowledge level.

DESIGN

Cross-sectional study.

SAMPLE

One thousand three hundred sixty-one Iraqi adults from Sulaymaniyah/Iraq.

MEASUREMENTS

The odds ratio (OR) was used to find the association between knowledge of CRC and associated factors.

RESULTS

Among participants, 6.1% had a colonoscopy, 4.0% had a sigmoidoscopy, and 60.8% heard CRC screening. Participants had low knowledge level of CRC risk factors (5.52 ± 1.39), and symptoms (3.73 ± 1.16) and had a medium knowledge of screening (4.35 ± 1.02). Respondents who retired (OR = 1.30; p = .00) and who had graduated from university (OR = 0.86; p = .01) had a high knowledge of CRC, while those who were aged 70 and above (OR = -1.08; p = .00) had a low knowledge of CRC. Furthermore, it was found that Iraqi adults who answered "no idea" to questions related to attitude and who answered incorrectly questions related to risk factors were likely to have low knowledge (p = .00).

CONCLUSIONS

We found a lack of knowledge, screening, and misconceptions about CRC and screening among Iraqi adults. Thus, health training and screening programs should target Iraqi populations.

Nutrition Knowledge, Attitudes, and Lifestyle Practices That May Lead to Breast Cancer Risk Reduction among Female University Students in Lebanon

Research has identified both nonmodifiable and modifiable risk factors for breast cancer (BC), with accumulating evidence showing that adopting adequate dietary practices could decrease the risk of this disease. This study aimed to assess nutrition knowledge, attitudes, and lifestyle practices (KAP) that may lead to BC risk reduction among female university students in Lebanon and examine the determinants of their practices. A cross-sectional survey was conducted using a convenience sampling method, comprising 356 (response rate: 71.2%) female students at the American University of Beirut aged 18 to 25 years with no history of BC. Participants completed a pre-tested questionnaire addressing the objectives of the study. The modified Bloom's cut-off of 75% was used to categorize knowledge and practice scores as poor or good and attitudes as negative or positive. Large proportions of students had poor knowledge (68.3%), negative attitudes (65.4%), and poor practices (98.0%) scores. Pursuing a health-related major and having a higher GPA were associated with better knowledge and attitudes while being older and having a lower degree of stress were associated with positive attitudes only. Having a lower body mass index (BMI) was associated with better practice scores. Better knowledge significantly predicted higher intake of fruits and vegetables. Overall knowledge and attitudes were significantly correlated with each other, but neither was significantly correlated with overall practice. These findings underscore the importance of implementing public health programs geared towards improving nutrition KAP that may lead to BC risk reduction.

Insights into Colorectal Cancer Screening Awareness: A Study in the Community of Taif City

Colorectal cancer (CRC) is highly prevalent among Saudi males and females. Understanding its symptoms, risk factors, and screening is vital. This study aims to gauge CRC awareness in Taif City, Saudi Arabia, based on demographics. An observational study in Taif City surveyed awareness on colorectal screening, gathering data from March-April 2023 via a questionnaire covering demographics, screening knowledge, symptoms, and risk factors. Involving 551 participants, most were 19-40 years old (59.2%), female (65.9%), and had a bachelor's degree (71.3%). Notably, 49.2% hadn't visited a family doctor. Awareness on CRC screening was low. 37.7% knew about fecal occult blood tests, 32.7% about sigmoidoscopy, and 34.8% about colonoscopy. Only 27.6% knew the recommended screening age, and 2.4% the frequency. Participants sought information mainly online (45.7%) or from friends (24.1%). Recognized risk factors included family history (57.0%), blood in stool (58.8%), and abdominal pain (47.9%). The study highlights inadequate awareness about CRC screening in Taif. It underscores the necessity for targeted education campaigns, collaboration with healthcare professionals, and diverse information sources to improve understanding among the population.

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

Background

Globally, colorectal cancer (CRC) incidence is rising, and it is a leading cause of mortality, with greater death rates pronounced in developing countries, including Jordan. Understanding knowledge and awareness of etiologic factors, unhealthy lifestyles, and dietary patterns is crucial for combating ailments. Hence, this study is aimed at investigating the level of knowledge and awareness of CRC-related risk factors, practices, and possible associations of studied variables among young Jordanians. Methodology. A cross-sectional, observational study was conducted using an online self-reported assessment of anthropometrics, knowledge, awareness, and dietary and lifestyle practices toward CRC and its related risk factors.

Results

A study of 795 Jordanian university students found that 93.8% were Jordanians, 73.0% were female, aged 18-24, and single. Most participants were from medical and science schools (69.4%). The vast majority (about 84%) were found to have good knowledge and awareness of CRC and its risk factors, but this was not reflected in their dietary practices. There are significant differences in physical activity, smoking, vegetable consumption, and serving sizes of red meat and processed meats between the sexes. Academic study specialties significantly impact knowledge and awareness.

Conclusion

The study reveals that while young Jordanian university students have good knowledge and awareness about CRC and its risk factors, these levels are not reflected in their dietary behaviors and food choices for CRC prevention, highlighting the need for national programs to improve these practices, particularly in the younger population.

Screening Perspectives: The Role of Colorectal Cancer Awareness in Shaping Attitudes Toward Colonoscopy in Palestine

PURPOSE

To assess colorectal cancer (CRC) awareness and its influence on attitudes toward colonoscopy in Palestine.

MATERIALS AND METHODS

Convenience sampling was used to recruit Palestinian adults from hospitals, primary health care centers, and public spaces across 11 governorates. To evaluate the awareness of CRC signs/symptoms, risk factors, and mythical causes, the Bowel Cancer Awareness Measure and Cancer Awareness Measure-Mythical Causes Scale were used after translation into Arabic. For each correctly recognized item, one point was given. The total awareness score of each domain was calculated and categorized into tertiles; the top tertile was considered high awareness, and the other two tertiles were considered low awareness.

RESULTS

A total of 4,623 questionnaires were included. Only 1,849 participants (40.0%) exhibited high awareness of CRC signs/symptoms. High awareness of CRC symptoms was associated with higher likelihood of showing positive attitudes toward colonoscopy (odds ratio [OR], 1.21 [95% CI, 1.07 to 1.37]). A total of 1,840 participants (38.9%) demonstrated high awareness of CRC risk factors. Participants with high awareness of CRC risk factors were more likely to display positive attitudes toward colonoscopy (OR, 1.20 [95% CI, 1.07 to 1.37]). Only 219 participants (4.7%) demonstrated high awareness of CRC causation myths. There was no association between awareness of CRC causation myths and positive attitudes toward colonoscopy.

CONCLUSION

Awareness of CRC was poor with less than half of the study participants demonstrating high awareness of CRC signs/symptoms and risk factors, and a minority (<5%) displaying high awareness of CRC causation myths. High awareness of CRC signs/symptoms and risk factors was associated with greater likelihood of demonstrating positive attitudes toward colonoscopy. Educational initiatives are needed to address knowledge gaps and dispel misconceptions surrounding CRC.

Colonoscopy screening for colorectal cancer in Egypt: a nationwide cross-sectional study

BACKGROUND

Current guidelines advocate for colorectal cancer (CRC) screening in adults who are at risk by using direct visualization methods such as colonoscopy. However, in Egypt, there is a paucity of data regarding the current practice of colonoscopy screening. Moreover, more information is needed about the knowledge and attitudes of potential participants regarding the procedure and possible barriers that can limit their participation.

METHODS

We conducted a nationwide cross-sectional study using an interview-based survey of patients aged 45 years or above who presented to outpatient clinics of nine university hospitals throughout Egypt. Participants were surveyed to assess their compliance with CRC colonoscopy screening guidelines, their knowledge of and attitude towards colonoscopy screening, and their perspective on potential barriers to colonoscopy screening.

RESULTS

A total of 1,453 participants responded to our survey in the nine study centers. Only a minority of participants (2.3%) were referred for CRC screening. Referral rates were higher among those who knew someone with a history of CRC (5.3% vs 1.5%, p < 0.001) or had a discussion with their physician about CRC (25.8% vs 0.7%, p < 0.001). Few responders (3.2%) had good knowledge regarding CRC screening. After introducing the concept of CRC screening to all participants, most patients (66.7%) showed a positive attitude towards having the procedure. Financial burden and fear of results were the two most frequently cited barriers to undergoing CRC screening (81.1%; and 60.1%, respecteively).

CONCLUSIONS

Despite the positive attitude, there is insufficient knowledge about CRC screening among eligible participants in Egypt. This has probably contributed to low compliance with current CRC screening guidelines and needs to be addressed at the national level.

An exploratory study of knowledge, attitudes, and practices toward HPV associated anal cancer among Pakistani population

Background

Anal cancer, mainly attributed to human papillomavirus (HPV) infection, is rising in prevalence among the general population in Pakistan. This study aimed to examine the knowledge, attitudes, and practices (KAP) towards anal cancer screening and HPV of the general population in Pakistan.

Method

We surveyed anal cancer KAP using social media and snowball sampling from December 2022 to May 2023. The questionnaire had 16 knowledge, 12 attitudes, 6 practice questions, and socio-demographic variables. We applied validity criteria for inclusion and exclusion and used cutoffs ≥50% for each KAP category. We analyzed data in R with Guttman's λ2 for reliability, did univariate and bivariate analysis, and reported frequencies, percentages, p-values, coefficients, odds ratios, and 95% confidence intervals.

Results

We surveyed 1620 people and discovered low awareness of HPV and anal cancer causes prevention, and screening (11%-24%), high stigma and embarrassment for screening (54%-70%), strong moral beliefs (89%), condom nonuse (91%), and low engagement in health services and programs (9.1%-14%). Knowledge (75.23%, OR = 1.0984, p = 0.05) was shaped by socio-demographic factors, attitude, and practice, with higher education enhancing knowledge (OR = 1.0984, p = 0.05). Attitude (78.45%, OR = 6.6052, p< 0.001) was influenced by socio-demographic factors, practice, and knowledge as well. Younger females, single, unemployed, students, living with more family members, earning more income, and residing in Islamabad had a more positive attitude (ORs from 1.0115 to 6.6052, p< 0.05), while religion did not affect attitude (p = 0.51). Practice (9.16%, OR = 0.1820, p< 0.001) was determined by socio-demographic factors, knowledge, and attitude. Older males, employed teachers, living with more family members, earning less income, and residing in Islamabad had better practice (ORs from 0.1323 to 3.8431, p< 0.05), but marital status and religion did not influence practice (p > 0.05).

Conclusion

Pakistani young adults need more education, awareness, health services, and programs on HPV and anal cancer, as they have low awareness, high stigma, and socio-cultural challenges. In addition, it is recommended for more research and policy initiatives are needed to address socio-cultural factors and increase anal Pap to overcome anal cancer.

Practice of colorectal cancer screening in the United Arab Emirates and factors associated - a cross-sectional study

BACKGROUND

Colorectal cancer is a significant public health concern globally, with high incidence and mortality rates. Despite the implementation of CRC screening guidelines, the uptake of screening among adults in the UAE remains low. This study aimed to assess the practice, factors associated, barriers, and knowledge gaps among adults in the UAE.

MATERIALS AND METHODS

2100 residents of the UAE, aged > = 40 years, participated in the study. A validated questionnaire was used to collect data. Data was collected through online platforms and face-to-face interviews in healthcare settings. Chi-Square test and binary logistic regression were used for data analysis.

RESULTS

The study revealed a low CRC screening rate of 9.1%. Factors analyzed included age groups, health insurance coverage, regular physician checkups, family history of CRC, awareness of CRC, and knowledge levels about CRC and its signs and symptoms. Participants in the 50-59 age group showed a slightly higher likelihood of CRC screening, but the difference was not statistically significant. However, individuals in the 60-69 and > = 70 age groups were more likely to undergo screening. Regular physician checkups, family history of CRC, prior knowledge of CRC, and knowledge about the disease and its signs and symptoms were associated with a higher likelihood of screening, with statistically significant OR.

CONCLUSION

A low CRC screening rate of 9.1% among adults. Barriers to screening included not being offered a test by physicians, fear of positive results, discomfort with the screening process, perception of pain, and lack of knowledge. Identifying particulate barriers and developing targeted measures requires larger-scale research.

Colorectal Cancer Awareness and Related Factors Among Adults Attending Primary Healthcare in North-Eastern of Iran: A Cross-sectional Study

BACKGROUND

Colorectal cancer (CRC) is the third most prevalent cancer in Iran. This study aimed to assess the level of awareness regarding CRC warning signs, risk factors, screening program, and related factors among adults in North-Eastern Iran. Study Design: A cross-sectional study.

METHODS

The multi-stage sampling method was used to survey 2614 participants attending primary healthcare centers in Mashhad, Iran. The data collection tools were the demographics section and Bowel/ CRC Awareness Measure (Bowel/Colorectal CAM). The data were analyzed by SPSS, version 25. The significance level of the data analysis was less than 0.05.

RESULTS

Mean awareness for CRC warning signs and CRC risk factors were 2.85±2.13 and 3.63±1.85, respectively. Most participants (97.2%) had no awareness of the CRC screening program. There was a significant association between marital status, education, job, income, and family history of CRC with awareness of warning signs (P<0.001); moreover, there was a significant association between age, education, job, income, and family history of CRC with awareness of risk factors (P<0.001). The results of logistic regression indicated that there was a significant association between age (P=0.022, OR=1.794, 95% confidence interval [CI]: 1.087, 2.962), gender (P=0.005, OR=0.488, 95% CI: 0.296, 0.803) and warning sign awareness (P<0.001, OR=1.278, 95% CI: 1.124, 1.454) with awareness of the CRC screening program.

CONCLUSION

In this study, most of the participants had low awareness of CRC. More aimed educational interventions are needed to promote Iranian adults' awareness of CRC.

A Review of Community Awareness for Colorectal Cancer Screening and Prevention in North and Central Asian Countries

OBJECTIVES

Colorectal cancer (CRC) incidence and mortality rates are increasing in low- and middle-income countries (LMIC), including North and Central Asian countries (NCAC). Screening and risk factor reduction can aid in the prevention of colorectal cancer, but communities lack awareness of these screening programs. The review assessed community awareness about CRC screening and prevention in NCAC to facilitate cancer control policies. Study type and methods: For this scoping review, we searched PubMed/Medline, Embase, and the Cochrane Library for articles on community awareness about CRC screening and prevention in NCAC according to inclusion and exclusion criteria.

RESULTS

Eight of 677 articles from five of the 15 NCAC countries met the criteria. Most of the studies utilized a survey design. The results indicated low awareness of the availability of CRC screening and poor knowledge of CRC symptoms. Knowledge of CRC screening modalities was also inadequate. Some countries also lack CRC screening programs.

CONCLUSION

Community unawareness is a significant barrier to screening program utilization and sustenance. Community health awareness programs (CHAP) are needed to improve the uptake of CRC screening in NCAC. The NCAC should include CHAP as an integral component of the CRC control plan. Long-term cancer control in LMIC could be adapted using the step-ladder pyramidal approach.

Colorectal Cancer Screening in the Middle East: What, Why, Who, When, and How?

The incidence of colorectal cancer (CRC) in the Middle East is increasing, especially among those younger than 50 years. Risk factors including obesity, sedentary lifestyle, and dietary changes are associated with the epidemiologic shift and are a result of socioeconomic changes happening in the region. Worldwide, CRC screening is associated with decreased incidence and mortality of CRC, but screening uptake is still low in the Middle East because of cultural barriers and lack of awareness; in addition, most countries do not have national screening programs. Knowledge of CRC screening and participation rates vary among different countries, but overall they are low. Both primary and secondary prevention approaches are needed in the Middle East, and cost-effectiveness is important in choosing screening modalities. Although colonoscopy is considered the most robust screening method, stool-based testing may be an acceptable screening strategy in resource-limited settings, and focusing on high-risk individuals such as those with hereditary CRC might be the most cost-effective strategy. In addition to financial limitations in many countries in the Middle East, human displacement places an extra toll on cancer control strategies in the region.

Perceived barriers to early presentation and symptom-specific time to seek medical advice for possible colorectal cancer symptoms among Palestinians

This study explored the anticipated time to seek medical advice for possible colorectal cancer (CRC) signs/symptoms and its association with CRC symptom awareness. In addition, it examined perceived barriers that may delay seeking medical advice. Palestinian adults were recruited from hospitals, primary healthcare centers, and public spaces in 11 governorates. A modified, translated-into-Arabic version of the validated Bowel Cancer Awareness Measure was used. The questionnaire comprised three sections: sociodemographics, assessment of CRC symptom awareness and time to seek medical advice, and barriers to early presentation. A total of 4623 participants were included. The proportion that reported seeking immediate medical advice for possible CRC signs/symptoms with blood or mass ranged from 47.1% for 'blood in stools' to 59.5% for 'bleeding from back passage'. Less than half of the participants reported immediate seeking of medical advice for non-specific symptoms (ranging from 5.4% for 'loss of appetite' to 42.0% for 'anemia') and other gastrointestinal symptoms (ranging from 7.7% for 'feeling persistently full' to 35.7% for 'change in bowel habits'). Good CRC symptom awareness was associated with higher likelihood of seeking medical advice within a week from recognizing a CRC symptom. About 13.0% reported a delay to visit their doctor after recognizing a CRC symptom. The most reported barriers were practical with 'would try some herbs first' (50.9%) as the leading barrier. CRC symptoms with blood or mass prompted earlier help seeking. Participants with good CRC awareness were more likely to seek medical advice within a week.

Does Health Literacy Affect Colorectal Cancer Screening Rates?

This study aims to determine the relationship between adult colorectal cancer screening behaviors and health literacy levels. This cross-sectional study aims to determine the relationship between adult colorectal cancer screening behaviors and health literacy levels. Of the participants, only a small proportion had undergone this screening (9.3%). Having an intestinal disease (OR = 23) and having a relative with colorectal cancer (OR = 8) had the highest effect on colorectal screening. There were significant differences between the colorectal screening groups concerning most THLS-32 subgroup scores, including the THLS-32 total score. Health literacy affects colorectal cancer screening rates. Primary care workers, especially community health nurses, are in an ideal position to increase health literacy and thereby increase cancer screening rates.

Preferences for Colorectal Cancer Screening Modalities Among the General Population in Saudi Arabia

BACKGROUND

Colorectal cancer (CRC) could be a leading explanation for cancer-related death. Numerous studies have shown the benefit of early screening for colorectal cancer in reducing mortality. Screening for colorectal cancer is a rational and cost-effective strategy for reducing the incidence of colorectal cancer and related mortality. Despite endorsement by academic and healthcare organizations, patient awareness and compliance with screening are low, partly due to patient-related barriers to screening.

AIM

This study aimed to explore the preferred screening method for colorectal cancer in Saudi Arabia in general.

METHODS

This is a cross-sectional study conducted among the Saudi adult population from September 2021 through February 2022. A self-developed questionnaire was distributed among the population using an online platform. Data were tabulated in Google Forms, and all statistical analyses were performed using SPSS version 26 (IBM Corp., Armonk, NY).

RESULTS

During this study, data from 10,781 participants were analyzed. Among them, the most preferred screening modality for colorectal cancer was the stool fecal immunochemical test (41.7%) and the most suitable (33.5%). The most commonly mentioned qualities that influenced choosing a particular screening test were "how the test was performed" (50.4%).

CONCLUSION

Because the stool fecal immunochemical test is the most preferred screening modality for colorectal cancer, this study could serve as a database to aid in the implementation of a colorectal cancer screening program that meets the preferences of the general population of Saudi Arabia.

Awareness of the Adult Population Toward Colorectal Cancer in Qassim Region, Saudi Arabia

Introduction Colon and rectal cancer are usually grouped together as they share similar features. They are the third most common cancer in the world and the second most common cancer in the Kingdom of Saudi Arabia (KSA). Awareness and preventive screening programs play a vital role in early diagnosis and improving the survival rate of such patients. This study aimed to assess the awareness and knowledge of colorectal cancer (CRC) among the adult population in the Qassim region of Saudi Arabia. Methods This is a cross-sectional study conducted among the adult population living in the Qassim region of Saudi Arabia. A self-administered questionnaire was disseminated among the adult population using WhatsApp and Twitter. The questionnaire contained demographic data and questions to assess the awareness, knowledge, and attitude regarding CRC risk factors and complications and the importance of screening. Results A total of 431 respondents were involved. The most common symptoms of colon cancer were abdominal pain and change in bowel habits. Risk factors associated with colon cancer were inflammatory bowel disease and fatty food. Colonoscopy was the most dominant choice for the detection of colon cancer. Conclusion The awareness of the adult population toward CRC was deficient. Better awareness can be predicted among individuals with better education. Addressing the gaps in awareness is vital to alleviate fears and misconceptions surrounding this disease.

Public Awareness of Colorectal Cancer Screening in the Al-Baha Region, Saudi Arabia, 2022

BACKGROUND

According to the WHO, cancer is ranked as the second leading cause of death, accounting for an estimated 9.6 million deaths in 2018. This study aimed to assess public awareness about colorectal cancer (CRC) screening and the barriers that prevent Saudi individuals from undergoing CRC screening.  Materials and methods: A cross-sectional study was conducted in the Prince Mishari Bin Saud General Baljurashi Hospital, and a supervised self-administered questionnaire was utilized. Sociodemographic data, knowledge about colorectal cancer, and attitude toward screening were included in the survey. Data were analyzed using IBM SPSS Version 23 (SPSS Inc., Chicago, IL, USA) and Pearson's chi-square test. A P<0.05 was considered statistically significant.

RESULTS

A total of 396 eligible participants completed the survey. About 209 (52%) were female, and 124 (31.3%) belonged to the age group of 18-29 years. Nearly (49.7%) knew that detecting colorectal cancer before symptoms appear is possible. About 64% of the participants cited colonoscopy as the screening method for CRC. More than half of the participants (58.1%) expressed their willingness to be screened for colorectal cancer, while only 2.8% reported that they had undergone screening before. Participants with higher educational status demonstrated better knowledge regarding CRC than others (p<0.05).

CONCLUSION

 The overall knowledge of CRC was found to be poor in Al-Baha residents, irrespective of age. Implementing new strategies to increase public awareness about colorectal cancer will aid in the early diagnosis of CRC. We recommend targeted education and screening programs to improve the level of screening awareness and aid in the early diagnosis of colorectal cancer.

The first Middle East and North Africa expert consensus recommendations for the management of advanced colorectal cancer

Colorectal cancer (CRC) is ranked as the third most prevalent and the second deadliest cancer worldwide. In the Middle East and North Africa (MENA) region, the number of CRC cases increased over the past decades and will nearly double by 2030. The lack of clear MENA guidelines for the management of patients with CRC represents a step backwards in the fight against this burden. Therefore a panel of 24 MENA experts in the field of gastrointestinal oncology developed, using a Delphi process, the first consensus recommendations for the management of patients with advanced CRC. Forty-seven different statements were formulated in the areas of epidemiology, screening, biomarkers and treatment. These recommendations will guide, standardize and unify the management of this cancer in the MENA region.

Awareness and Knowledge of Colorectal Cancer Screening Among Medical Students at the University of Aleppo: 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. A χ² or Fisher's exact tests for categorical variables were used for statistical analysis, as appropriate. A two-sided p  < 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.

Awareness of colorectal cancer signs and symptoms: a national cross-sectional study from Palestine

BACKGROUND

In low-resource settings, the awareness level of colorectal cancer (CRC) signs and symptoms plays a crucial role in early detection and treatment. This study examined the public awareness level of CRC signs and symptoms in Palestine and investigated the factors associated with good awareness.

METHODS

This was a national cross-sectional study conducted at hospitals, primary healthcare centers, and public spaces in 11 governorates across Palestine between July 2019 and March 2020. A translated-into-Arabic version of the validated bowel cancer awareness measure (BoCAM) was utilized to assess the awareness level of CRC signs and symptoms. For each correctly identified CRC sign/symptom, one point was given. The total score (ranging from 0 to 12) was calculated and categorized into three categories based on the number of symptoms recognized: poor (0 to 4), fair (5 to 8), and good awareness (9 to 12).

RESULTS

Of 5254 approached, 4877 participants completed the questionnaire (response rate = 92.3%). A total of 4623 questionnaires were included in the analysis; 1923 were from the Gaza Strip and 2700 from the West Bank and Jerusalem (WBJ). Participants from the Gaza Strip were younger, gained lower monthly income, and had less chronic diseases than participants in the WBJ. The most frequently identified CRC sign/symptom was 'lump in the abdomen' while the least was 'pain in the back passage'. Only 1849 participants (40.0%, 95% CI: 39.0%-41.0%) had a good awareness level of CRC signs/symptoms. Participants living in the WBJ were more likely to have good awareness than participants living in the Gaza Strip (42.2% vs. 37.0%; p = 0.002). Knowing someone with cancer (OR = 1.37, 95% CI: 1.21-1.55; p < 0.001) and visiting hospitals (OR = 1.46, 95% CI: 1.25-1.70; p < 0.001) were both associated with higher likelihood of having good awareness. However, male gender (OR = 0.80, 95% CI: 0.68-0.94; p = 0.006) and following a vegetarian diet (OR = 0.59, 95% CI: 0.48-0.73; p < 0.001) were both associated with lower likelihood of having good awareness.

CONCLUSION

Less than half of the study participants had a good awareness level of CRC signs and symptoms. Future education interventions are needed to improve public awareness of CRC in Palestine.

Colorectal cancer screening knowledge and uptake in lebanon: a national survey

OBJECTIVE

The main aim of this national survey was to identify the levels of colorectal cancer screening knowledge and uptake in Lebanon.

METHODS

A total of 1200 participants were enrolled in this cross-sectional household survey targeting the Lebanese population aged 50 years and above. The sample was recruited using a two-stage stratified cluster sampling approach.

RESULTS

Of the total sample, 38.3% knew about any screening test for colorectal cancer but only 7.5% had ever used any. Thirty-nine percent of the participants rated their risk of getting colorectal cancer as very low or low, and only 53.5% were confident in their ability to undertake a screening test. Almost all participants agreed that medical advice and test reimbursement would encourage them to do a screening test. At the multivariate analysis level, hearing of an awareness campaign in the last two years showed the strongest association with the knowledge of a colorectal cancer screening test with an estimated OR_adj = 5.12 (95%CI: 3.67 - 7.15). Other factors that were significantly associated with this knowledge variable included: a family history of colorectal cancer, a personal history of colorectal illness, having a health coverage, and knowledge of colorectal cancer signs and symptoms.

DISCUSSION

This national study highlights an alarming lack of uptake and low levels of knowledge of colorectal cancer screening tests even though it is among the most prevalent cancers in Lebanon and its prevalence has been continuously increasing in the past years. The evidence suggests that people who had an experience with colorectal cancer diagnostic tests, either personally or through a family member, and those who have heard of an awareness campaign about colorectal cancer in the last two years are more likely to know its screening tests.

CONCLUSION

Colorectal cancer screening knowledge and uptake in Lebanon are limited and justify the need for public health interventions. This study gives evidence that awareness campaigns, coupled with the involvement of medical providers and the reimbursement of screening test fees, would alleviate the burden of colorectal cancer in Lebanon.

Knowledge and awareness of colorectal cancer risk factors, screening, and associated factors in advanced colorectal cancer patients: a multicenter cross-sectional study in China

Background

Colorectal cancer (CRC) is the 3rd most common malignancy globally, and its disease burden is increasing rapidly in China. But CRC patients' knowledge and awareness of CRC have not yet been examined, which could facilitate the identification of targeted population from public for intervention.

Methods

A nationwide multicenter cross-sectional survey was conducted in 19 tertiary hospitals (10 cancer hospitals and 9 general hospitals) from March 2020 to March 2021 in China. During study period, all Stage III and IV CRC patients were invited to complete a semi-structured survey that had been designed to collect information about their socio-demographic characteristics, and knowledge and awareness of CRC risk factors and screening. A multivariate logistic regression model was used to identify factors associated with their knowledge and awareness.

Results

In total, 4,589 advanced CRC patients were enrolled in this study, of whom, 46.2% were from tertiary cancer hospitals, and 59.5% were male. Patients had a mean age of 60.1±11.6 years. Before diagnosis, 65.1% of the patients had no related knowledge of the CRC risk factors, and 84.9% were unaware of the CRC screening-related information. Only 30.4% of patients had actively sought to acquire CRC-related knowledge before diagnosis. The 3 most common knowledge sources were relatives or friends who had been diagnosed with CRC (13.2%), popular science television/broadcast shows (12.9%), and community publicity and education (9.6%). Generally, knowledge and awareness were positively associated with better education level [odds ratios (ORs) ranged from 1.49 to 2.54, P<0.001], annual household income ranged from 50,000 Chinese Yuan (CNY) to 100,000 CNY (OR =1.32, P<0.001), being manual laborer (OR =1.25, P<0.001) and being white-collar worker (OR =1.47, P<0.001).

Conclusions

Advanced CRC patients' knowledge and awareness of CRC were severely limited before diagnosis. Thus, those who had limited knowledge and awareness should has a priority for intervention.

Public Awareness of Bowel Cancer Risk Factors, Symptoms and Screening in Tasmania, Australia: A Cross-Sectional Study

Tasmania has one of the highest bowel cancer incidence and death rates in the world. Public awareness of risk factors, symptoms, and early detection of bowel cancer is important for minimising the burden of disease. This study measured awareness levels of bowel cancer risk factors, symptoms and screening in Tasmania. An online survey of 3703 participants aged 18 years and older found that alcohol consumption, low physical activity levels, and having diabetes were the least known risk factors for bowel cancer. Over half of all participants were unaware the risk of bowel cancer increased with age, and 53 percent were not confident they would notice a bowel cancer symptom. Over a third of survey respondents did not know that screening commenced at the age of 50. The results indicate that a targeted campaign to increase bowel cancer awareness in Tasmania may help reduce the high rates of morbidity and mortality from the disease.

Barriers and facilitators of colorectal cancer screening in Asia

Purpose

One of the most common cancers in Asia is colorectal cancer (CRC). Early diagnosis and timely treatment are necessary for preventing complications and advanced stages of the disease. It is important to evaluate barriers and facilitators of screening in different countries. This systematic review aimed to identify the barriers and facilitators of CRC screening in Asia.

Methods

In this systematic review, for identifying barriers and facilitators of CRC screening, a comprehensive search was conducted in PubMed, Web of Science and Scopus in 12 December 2020. Combination keywords such as colorectal cancer, screening, sigmoidoscopy, colonoscopy, faecal occult blood test, barriers, facilitators and the names of each Asian country were used for searching. Full text original studies in English language were accepted in the review.

Results

In total, 36 articles were included in the review. Barriers and facilitators were evaluated. The most common reported barriers were lack of knowledge, fear of result, fear of procedure, fear of pain, lack of awareness, high cost and lack of gastrointestinal symptoms. The most frequent facilitators were having knowledge and awareness of CRC screening, perceived risk and severity, family history of cancer and physician recommendation.

Conclusion

For promoting success in CRC screening programmes, knowing what the barriers and facilitators are is necessary. Awareness and various personal, professional and social factors have been shown to be the major barriers toward CRC screening in most Asian countries.

Knowledge and Beliefs of Cancer Risk Factors and Early Cancer Symptoms in Lebanon: A Cross-sectional Survey Among Adults in the Community

Background

Lebanon has an increasing cancer burden. Sufficient knowledge of cancer risk factors and early cancer symptoms can help lower cancer burden by facilitating primary prevention and early diagnosis. This study (i) assessed Lebanese adults’ knowledge and beliefs of cancer risk factors and early cancer symptoms, (ii) analyzed whether knowledge was correlated with personal behavior, and (iii) assessed the presence of barriers that keep knowledge from turning into healthcare seeking behavior.

Methods

We performed a cross-sectional survey in the Lebanese adult population, consisting of a questionnaire administered during face-to-face interviews on a community-based non-probability sample (n = 726) that was frequency matched to national government estimates on age, level of education and gender.

Results

Recognition was high for carcinogens and protective factors (75%), but low for neutral factors (22%) which were often seen as carcinogenic. A quarter of participants (27.8%) could not name any early warning signs. For some risk factors, high knowledge scores were correlated with low-risk behavior, but this was not the case for cigarette smoking. The most frequent barriers for not seeking timely care were financial (57.0%) fear of finding illness (53.7%), and having other things to worry about (42.4%).

Conclusion

This study revealed important knowledge gaps which are likely to hamper primary prevention and early diagnosis. However, we also showed that high knowledge of risk was not always correlated with low-risk behavior. This, together with the barriers we found that kept people from seeking timely health care, emphasizes that efforts to lower cancer burden should not only focus on increasing knowledge.

Elevated N6-Methyladenosine RNA Levels in Peripheral Blood Immune Cells: A Novel Predictive Biomarker and Therapeutic Target for Colorectal Cancer

Effective biomarkers for the diagnosis of colorectal cancer (CRC) are essential for improving prognosis. Imbalance in regulation of N6-methyladenosine (m⁶A) RNA has been associated with a variety of cancers. However, whether the m⁶A RNA levels of peripheral blood can serve as a diagnostic biomarker for CRC is still unclear. In this research, we found that the m⁶A RNA levels of peripheral blood immune cells were apparently elevated in the CRC group compared with those in the normal controls (NCs) group. Furthermore, the m⁶A levels arose as CRC progressed and metastasized, while these levels decreased after treatment. The area under the curve (AUC) of the m⁶A levels was 0.946, which was significantly higher than the AUCs for carcinoembryonic antigen (CEA; 0.817), carbohydrate antigen 125 (CA125; 0.732), and carbohydrate antigen 19-9 (CA19-9; 0.771). Moreover, the combination of CEA, CA125, and CA19-9 with m⁶A levels improved the AUC to 0.977. Bioinformatics and qRT-PCR analysis further confirmed that the expression of m⁶A modifying regulator IGF2BP2 was markedly elevated in peripheral blood of CRC patients. Gene set variation analysis (GSVA) implied that monocyte was the most abundant m⁶A-modified immune cell type in CRC patients' peripheral blood. Additionally, m⁶A modifications were negatively related to the immune response of monocytes. In conclusion, our results revealed that m⁶A RNA of peripheral blood immune cells was a prospective non-invasive diagnostic biomarker for CRC patients and might provide a valuable therapeutic target.

Public awareness of environmental risk factors of cancer and attitude towards its prevention among the Lebanese general population

Introduction

Since the majority of cancers occur as a result of modifiable risk factors, cancer is being seen more as a preventable disease. The primary objective of our study was to assess the level of awareness of environmental risk factors of cancer among the Lebanese general population. The secondary objective focused on identifying the predictors of the preventability of the disease.

Methods

We conducted a cross-sectional study between June and July 2020. An online questionnaire was used to collect data pertaining to the knowledge of environmental risk factors of cancer, source of information and personal practice of the participants. Bivariate and multivariate analyzes were performed.

Results

About 387 respondents agreed to participate in the study. The study showed low awareness regarding infectious agents, lifestyle, diet and many work exposures. The predictors of the attitude of respondents regarding the preventability of cancer were: believing that cancer has an environmental cause (p=.014), not having a healthy lifestyle (p = 0.004), not smoking waterpipe (p = 0.023), being single (p = 0.013), and having a university degree (p = 0.049).

Conclusions

Efforts should be made to improve awareness of the cancer risk factors regarding infectious agents, lifestyle, diet and many work exposures. This can also be followed by further studies assessing the impact of these community and governmental cancer prevention initiatives on cancer risk factors level of awareness.

Rab1A promotes cell proliferation and migration by upregulating Gli1 in colorectal cancer

Rab1A, as a highly conserved small guanosine triphosphatase (GTPase), plays contentious roles in different types of cancers. The role of Rab1A in colorectal cancer (CRC) has been described in previous studies, but the molecular mechanisms of Rab1A in CRC remain far from being addressed. In the present study, we found that Rab1A expression was significantly upregulated in CRC tissues and increased Rab1A expression correlated with tumor size, lymph node metastasis (LNM) and tumor-node-metastasis (TNM) stage of CRC patients. We also found that Rab1A exerts its promotive effect on CRC cell proliferation, migration and EMT progress. Further mechanistic experiments showed that glioma-associated oncogene-1 (Gli1), as a key transcriptional factor of the Hedgehog pathway, was implicated in Rab1A-mediated regulation of CRC cell proliferation and migration. In addition, Rab1A upregulated Gli1 expression through Smoothened homolog (SMO)-independent pathway. Finally, Rab1A activated mechanistic target of rapamycin (mTOR) signaling in CRC cells. Collectively, our results define Rab1A as a novel regulator of Gli1 to promote CRC cell proliferation and migration, and suggest that the Rab1A/mTOR/Gli1 axis may serve as a promising therapeutic target for the treatment of CRC.

Awareness of Colorectal Cancer and Associated Factors Among Adult Patients in Jimma, South-West Ethiopia: An Institution-Based Cross-Sectional Study

Background

Colorectal cancer (CRC) is the first commonest diagnosed cancer in men and the fourth commonest in women in Ethiopia. Awareness of CRC and associated factors is crucial in the prevention of CRC. However, there have not been studies about the awareness of CRC and associated factors among adult patients in Ethiopia. Therefore, the study aimed to assess the awareness of CRC and associated factors among adult patients in Jimma, South-West Ethiopia, 2020.

Methods

This institution-based cross-sectional study design was conducted among 422 adult patients. The study respondents were recruited by a systematic random sampling method. The Cancer Awareness Measure questions were used to measure awareness of CRC of adult patients. Descriptive and logistic regression analyses were conducted.

Results

More than half (57.6%) of respondents had low-level awareness of CRC. Respondents who were females (adjusted odds ratio [AOR] = 1.86; 95% CI: 1.26, 2.75), who are residing in urban areas (AOR = .45; 95% CI: .30, .67), who had a monthly income of 3000 Ethiopian Birr and above (AOR = 4.72; 95% CI: 3.11, 7.15), who heard about CRC (AOR = 4.48; 95% CI: 2.90, 6.93), who get information through social media about CRC (AOR = 2.51; 95% CI: 1.18, 5.37), and who had a family history of CRC (AOR = 3.27; 95% CI: 1.45, 7.36) had a high level of awareness of CRC, while those who cannot read and write (AOR = 2.83; 95% CI: 1.49, 5.37) and learn elementary school (AOR = 2.12; 95% CI: 1.15, 3.93) had a low level of awareness of CRC.

Conclusion

This study indicated that awareness of CRC of adult patients was inadequate. Adult patients’ gender, residency, level of education, monthly income, heard about CRC, sources of information about CRC, and a family history of CRC were found to be independent predictors of the awareness of CRC. Therefore, there is a need for health education and awareness campaigns for promoting awareness of CRC of adult patients, and the government should develop policy on CRC prevention and screening program.

Knowledge, beliefs, and practices related to cancer screening and prevention in Lebanon: community and social media users' perspectives

OBJECTIVE

Common to many countries in the Middle East, Lebanon has an increasing cancer burden; however, national screening programs are limited to breast cancer. The literature on cancer screening practices and beliefs is scarce. This cross-sectional study investigates the knowledge, beliefs, and practices related to the prevention and screening for breast, cervical, colon, lung, and skin cancers among Lebanese residents, recruited through social media advertisements and community outreach activities.

METHODS

Participants filled an anonymous questionnaire either via a web-based interface or using tablets distributed at primary health clinics. The characteristics of the two cohorts were compared with chi-square and t-tests. We performed descriptive analysis, followed by multivariate logistic regression for predictors of cancer screening.

RESULTS

A total of 407 participants completed the survey online, and 262 filled the study in tablets available at primary care clinics. The two samples were significantly different in terms of age, education, and perceived socioeconomic status. Online participants demonstrated higher knowledge and higher participation in screening practices than their counterparts recruited through community outreach. Mammography (44.7% online and 39.9% in-person), and cervical cancer screening (44.5% online and 36.7% community) had the highest participation rates. In both samples, participants who were older and more educated were more likely to report engagement with cancer screening practices.

CONCLUSIONS

Our study revealed significant knowledge gaps in cancer prevention and screening. Different sampling techniques accessed diverse populations, highlighting the need for educational messages and targeted screening programs to be inclusive of socio-economically disadvantaged communities with low education and health literacy.

Serum Chemokine CXCL7 as a Potential Novel Biomarker for Obstructive Colorectal Cancer

Due to the lack of typical symptoms and signs and sensitive indicators for early diagnosis of obstructive colorectal cancer (OCRC), it is critically needed to find new novel biomarkers to ameliorate the management of OCRC patients. In this study, 472 blood samples were collected and measured by enzyme-linked immunosorbent assay (ELISA) to investigate the value of serum chemokine ligand 7 (CXCL7) in diagnosis and prognosis for OCRC patients. The median concentrations of CXCL7 in non-OCRC and OCRC were both higher than that in controls (both P < 0.05). Importantly, the median serum concentration of CXCL7 in OCRC was also higher than that in non-OCRC (P < 0.001). In all OCRC patients, the area under the curve (AUC) of CXCL7 was 0.918 with a sensitivity of 86.54% and a specificity of 81.87%. Similarly, the AUC of CXCL7 was 0.684 when the diagnostic test was performed between OCRC and CRC patients. CXCL7 had a higher AUC than other markers. The concentration of CXCL7 in 40 postoperative OCRC patients was higher than normal people and lower than preoperative patients. The median survival time was 62.00 months and the 5-year overall survival (OS) rate of the patients was 51.80% in all 155 OCRC patients. Multivariate Cox proportional hazard regression model analysis showed that high CXCL7 in serum was independent factors associated with poor OS of OCRC patients (HR = 2.216, P = 0.032). These results demonstrate that serum CXCL7 may be a potential biomarker both in diagnosis and prognosis for OCRC patients.

Colorectal Cancer in Lebanon: Incidence, Temporal Trends, and Comparison to Regional and Western Countries

Global trends in the incidence and mortality rates of colorectal cancer show a steady increase with significant predilection to western developed countries, possibly linking it to westernized lifestyles among other risk factors. This study aims to investigate the incidence and trends of colorectal cancer in Lebanon, a country in the Middle East and North Africa region, and to compare these rates to those in regional and western countries. Colorectal cancer incidence data were extracted from the Lebanese National Cancer Registry for the currently available years 2005 to 2016. The calculated age-standardized incidence rates and age-specific rates were expressed as per 100,000 population. The age-standardized incidence rates of colorectal cancer in Lebanon increased from 16.3 and 13.0 per 100,000 in 2005 to 23.2 and 20.2 per 100,000 in 2016, among males and females, respectively. The incidences were higher for males, and they increased with age. The annual percent change was +4.36% and +4.45%, in males and females respectively (p-value < 0.05). There was a non-statistically significant trend of decrease in recent years (since 2012 in males and since 2011 in females). The age-standardized incidence rates in Lebanon were higher than those in the majority of the regional countries, but lower than the rates in developed western countries. There were high age-specific incidence rates at age groups 40-44 and 45-49 years in Lebanon in both males and females (with significant rising temporal trend) compared to other countries, including the ones reported to have the highest colorectal cancer age-standardized incidence rate worldwide. Therefore, the burden of colorectal cancer is significant in Lebanon. This raises the necessity to develop national strategies tailored to reduce colorectal cancer incidence through promoting healthy lifestyles, raising awareness, and early detection as of 40 years of age.

Cancer Warning Symptoms Awareness and Associated Factors Among Individuals Living in Assella Town, Ethiopia

Introduction

Community awareness about cancer warning symptoms and risk factors in the general population is essential and can be considered as a basis for cancer control programs. Since Patients are rarely aware of the early warning symptoms and cancer risk factors, the burden of disease is increasing everywhere in the world. Evidences has been shown that cancer is highly prevalent in Ethiopia in which the diagnosis is made at later stages of the disease.

Objective

To assess Cancer Warning Symptoms awareness and associated factors among individuals living in Assella Town, Ethiopia.

Methods

A community-based cross-sectional study was employed in Assella town from May 1^st to June 1^st, 2020 among 410 adult residents 18 years old and above. A systematic random sampling technique was employed to select the households from which the study subjects randomly identified. Data were collected through face-to-face interview by using pre-tested structured questionnaire and entered into Epi data version 3.1 then exported to SPSS version 25.0 for analysis. Logistic regression analyses were used to identify factors associated with outcome variables. Odds ratio and 95% CI at P-values <0.05 was used to determine the presence of association.

Results

The findings of this study revealed that the overall level of awareness of cancer warning symptoms is 214 (52.2% (AOR = 95% CI 47.1, 56.8)). Educational level (AOR = 3.44, 95%CI, 1.50–7.88 (p = 0.003)), awareness of cancer risk factors (AOR = 2.56, 95% CI, 1.67, 3.93, (p < 0.001)) and economic status (AOR = 3.13 (95% CI 1.84, 5.33, p < 0.001)) were identified as factors significantly associated with awareness of cancer warning symptoms among adult populations.

Conclusion

Almost one-out-of-two adults residing in Assella town has awareness about cancer warning symptoms. Educational level, awareness of cancer risk factors, and economic status among Assella town residents were identified as factors associated with good level of awareness about cancer warning symptoms.

AIM2 inhibits colorectal cancer cell proliferation and migration through suppression of Gli1

Colorectal cancer (CRC) is a common malignant tumor and is one of the leading causes of cancer-related deaths worldwide. Absent in melanoma 2 (AIM2), as a member of the pyrin-HIN family proteins, plays contentious roles in different types of cancers. In the present work, we provide evidence that AIM2 was commonly downregulated in human CRC and loss of AIM2 significantly correlated with tumor size, depth of invasion, lymph node metastasis (LNM) and TNM (Tumor, Node, Metastases) stage in patients suffering from CRC. AIM2 knockdown promoted CRC cell proliferation, migration and epithelial-mesenchymal transition (EMT) progress, whereas AIM2 overexpression did the opposite. AIM2 inhibited glioma-associated oncogene-1 (Gli1) expression through Smoothened homolog (SMO)-independent pathway and regulated CRC cell proliferation and migration in a Gli1-dependent manner. Moreover, AIM2 could modulate Protein kinase B (AKT)/mechanistic target of rapamycin (mTOR) signaling pathway and the increased Gli1 expression and EMT progress induced by AIM2 depletion was reversed after incubation with AKT inhibitor Ly294002 in CRC cells. In conclusion, our results define AIM2 as a novel regulator of Gli1 in CRC cell growth and metastasis, and suggest that the AIM2/AKT/mTOR/Gli1 signaling axis may serve as a potential target for treatment of CRC.

Colorectal Cancer Screening in Ghana: Physicians' Practices and Perceived Barriers

Introduction

Ghana has seen a rise in the incidence of colorectal cancer (CRC) over the past decade. In 2011, the Ghana National Cancer Steering Committee created a guideline recommending fecal occult blood testing (FOBT) for CRC screening in individuals over the age of 50. There is limited data available on current Ghanaian CRC screening trends and adherence to the established guidelines.

Methods

We conducted a survey of 39 physicians working at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. The survey evaluates physician knowledge, practice patterns, and perceived personal-, patient- and system-level barriers pertaining to CRC screening.

Results

Almost 10% of physicians would not recommend colorectal cancer screening for asymptomatic, average risk patients who met the age inclusion criteria set forth in the national guidelines. Only 1 physician would recommend FOBT as an initial screening test for CRC. The top reasons for not recommending CRC screening with FOBT were the lack of equipment/facilities for the test (28.1%) and lack of training (18.8%). The two most commonly identified barriers to screening identified by >85% of physicians, were lack of awareness of screening/not perceiving colorectal cancer as a serious health threat (patient-level) and high screening costs/lack of insurance coverage (system-level).

Conclusion

Despite creation of national guidelines for CRC screening, there has been low uptake and implementation. This is due to several barriers at the physician-, patient- and system-levels including lack of resources and physician training to follow-up on positive screening results, limited monetary support and substantial gaps in knowledge at the patient level.

Risk prediction rule for advanced neoplasia on screening colonoscopy for average-risk individuals

BACKGROUND

In resource-limited countries, risk stratification can be used to optimize colorectal cancer screening. Few prospective risk prediction models exist for advanced neoplasia (AN) in true average-risk individuals.

AIM

To create and internally validate a risk prediction model for detection of AN in average-risk individuals.

METHODS

Prospective study of asymptomatic individuals undergoing first screening colonoscopy. Detailed characteristics including diet, exercise and medications were collected. Multivariate logistic regression was used to elucidate risk factors for AN (adenoma ≥1 cm, villous histology, high-grade dysplasia or carcinoma). The model was validated through bootstrapping, and discrimination and calibration of the model were assessed.

RESULTS

980 consecutive individuals (51% F; 49% M) were enrolled. Adenoma and AN detection rates were 36.6% (F 29%: M 45%; P < 0.001) and 5.1% (F 3.8%; M 6.5%) respectively. On multivariate analysis, predictors of AN [OR (95%CI)] were age [1.036 (1.00-1.07); P = 0.048], BMI [overweight 2.21 (0.98-5.00); obese 3.54 (1.48-8.50); P = 0.018], smoking [< 40 pack-years 2.01 (1.01-4.01); ≥ 40 pack-years 3.96 (1.86-8.42); P = 0.002], and daily red meat consumption [2.02 (0.92-4.42) P = 0.079]. Nomograms of AN risk were developed in terms of risk factors and age separately for normal, overweight and obese individuals. The model had good discrimination and calibration.

CONCLUSION

The prevalence of adenoma and AN in average-risk Lebanese individuals is similar to the West. Age, smoking, and BMI are important predictors of AN, with obesity being particularly powerful. Though external validation is needed, this model provides an important platform for improved risk-stratification for screening programs in regions where universal screening is not currently employed.

Metformin and Probiotics in the Crosstalk between Colitis-Associated Colorectal Cancer and Diabetes in Mice

The co-occurrence of colorectal cancer (CRC) and diabetes mellitus along with inflammation and dismicrobism has been frequently reported. Several studies shed light on the antioncogenic potential of metformin on colorectal carcinogenesis. This study aimed to demonstrate that metformin in association with probiotics acts in a synergic effect in breaking the crosstalk, thus inhibiting CRC progression, improving diabetes, and reducing inflammation. Ninety-six male Balb/c mice, 6–8 weeks old, were divided into 16 control and experimental groups to assess the effect of the different treatments and combinations at the clinical, histological, and molecular levels. Metformin and probiotics showed beneficial outcomes on CRC and diabetes, alone and most importantly in combination. Their effects were exerted by inhibiting the inflammatory process whereby a downregulation of IL-6 and TNF-α as well as oxidative stress were depicted. The characterization of the effects of probiotics and metformin on CRC and diabetes sheds light on the role of inflammation and microbiota in this crosstalk. Deciphering the downstream signaling pathways elicited by these compounds will help in developing new effective targeted treatment modalities.

Knowledge, attitude, preventive practices and perceived barriers to screening about colorectal cancer among university students of newly merged district, Kpk, Pakistan - A cross-sectional study

INTRODUCTION

Colorectal cancer is the third most common type of cancer in the world and in Pakistan it ranks at fifth position. The present study was conducted to evaluate the knowledge, attitude, preventive practices and perceived barriers to screening about colorectal cancer among university students.

METHOD

A cross-sectional study was conducted after developing a self-administered questionnaire among the university students of newly merged districts of Kpk, Pakistan.

RESULT

A total of 302 students (232 male and 70 female) participated in the study. The knowledge score of the participants regarding the risk factors and warning signs of colorectal cancer was 59.9% and 40%. More than 90% of the participants were of the view that colorectal cancer diagnosis at initial stages can improve treatment and around 80% were in favor of undergoing regular physical examination to avoid colorectal cancer. Only 37.7% of the participants had intentionally collected information about colorectal cancer. The percentage of participants who intentionally participated in educational activities related to colorectal cancer was 33.1%. Furthermore, only 24.4% of the participant had ever taken part in colorectal cancer screening. The barriers toward colorectal cancer screening were fear of finding colorectal cancer and the anxiety of screening procedures. However, around 32% of the participants had no knowledge about colorectal cancer screening.

CONCLUSION

In view of the findings of this study, it can be suggested that community awareness programs that are focused towards screening of colorectal cancer may be initiated in the newly merged districts of Kpk, Pakistan. The implementation of such colorectal cancer screening program can help in its early detection and can potentially lower the associated mortality and morbidity risk with this disease.

Giant Inflatable Colon Model Enhances Lebanese Community Knowledge and Intention for Colorectal Cancer Screening

PURPOSE

To assess the knowledge and intention for colorectal cancer (CRC) screening within the Lebanese community before and after a guided tour through an inflatable colon model.

METHODS

The Cancer Prevention and Control Program, Naef K. Basile Cancer Institute at the American University of Beirut Medical Center in collaboration with AMALOUNA educational nongovernmental organization launched awareness campaigns during which a walk-through inflatable colon was displayed. Pre- and post-surveys related to the age of screening, risk factors, symptoms, and CRC prevention were collected anonymously before and after touring the inflatable colon to assess the effectiveness of this educational tool.

RESULTS

Compiled data collected from 782 participants revealed that older age and higher education were predictors of favorable CRC screening knowledge and behaviors before entering the inflatable colon. Interestingly, touring the inflatable colon model significantly improved participants’ awareness and knowledge about CRC. Most importantly, it increased their willingness for screening and social engagement and comfort discussing and promoting CRC screening.

CONCLUSION

Overall, these results indicate that the interactive colon is an effective educational tool that can make a positive impact by improving the community CRC awareness and interest in CRC screening. They also highlight the importance of such educational efforts conducted in the community to create more awareness about CRC and emphasize the importance of its prevention.

Prevalence of Severe Depression in Iranian Women with Breast Cancer: A Meta-Analysis

BACKGROUND

Breast cancer is one of the most common cancers in women and has mental and emotional effects, which lead to a decline in their quality of life. This study is aimed at determining the prevalence of severe depression in Iranian women with breast cancer.

METHODS

This meta-analysis study was conducted at Zabol University of Medical Sciences in 2019. Seven electronic databases were searched and evaluated for original research papers published on the prevalence of severe depression in Iranian women with breast cancer. Finally, 13 articles were selected and analyzed via Comprehensive Meta-Analysis software.

RESULTS

Overall, the prevalence of severe depression in Iranian women with breast cancer was 11% (95% CI (7.2, 16.5)). The highest prevalence was 44% in Tehran City in 2015 (95% CI (31, 57.9)), and the lowest prevalence was 0.8% in Qom City in 2017 (95% CI (0.01, 6.2)). A significant statistical correlation was observed between the prevalence of severe depression and sample size (p < 0.05).

CONCLUSION

According to the results of this study, the prevalence of severe depression affects more than one-tenth of women with breast cancer.

Serum Chemokine CXCL7 as a Diagnostic Biomarker for Colorectal Cancer

Identification of effective biomarkers is crucial for monitoring the treatment and remission of colorectal cancer (CRC) and improving survival. It is particularly important to diagnose CRC before the tumor metastasizes (stage I–II disease) where possible, to provide the greatest opportunity for patient recovery. Here, we evaluated the clinical value of serum chemokine (C-X-C) ligand 7 (CXCL7) concentration as a biomarker for CRC diagnosis. An enzyme-linked immunosorbent assay was used to measure CXCL7 concentration in 560 serum samples from patients with CRC and controls. Logistic regression and receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic efficacy and build mathematical diagnostic models. The concentration of CXCL7 in the CRC group was significantly higher than that in the control group (P < 0.001), with an area under the ROC curve (AUC) value of 0.862 [95% confidence interval (CI): 0.831–0.890]. Further, the AUC of a regression model including the markers carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and carbohydrate antigen 125 (CA125), along with CXCL7, was 0.933 (95% CI: 0.909–0.952). For stage I–II tumors, CXCL7 had the highest AUC (0.823, 95% CI: 0.783–0.858) among the four individual biomarkers. The AUC value for combination model analysis of samples from patients with stage I–II tumors was 0.904 (95% CI: 0.872–0.930), with a sensitivity of 82.76% and a specificity of 87.14%, and an optimal cut-off value of 2.66. AUC values for application of the regression model in subgroup analysis were 0.947 (0.917–0.968) and 0.919 (0.874–0.951) for males and females, respectively. These results suggest that CXCL7 has potential as a serum diagnostic biomarker for detection of CRC. Importantly, the combination of CXCL7, CEA, CA125, and CA19-9 may facilitate diagnosis of CRC with relatively high sensitivity and specificity.

Clinical Trial Registration Number: LS2017001.