Participation and Barriers to Colorectal Cancer Screening in Malaysia

  • Yusoff, Harmy Mohamed (Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia) ;
  • Daud, Norwati (Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia) ;
  • Noor, Norhayati Mohd (Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia) ;
  • Rahim, Amry Abdul (Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia)
  • Published : 2012.08.31


In Malaysia, colorectal cancer is the most common cancer in males and the third most common in females. Mortality due to colorectal cancer can be effectively reduced with early diagnosis. This study was designed to look into colorectal cancer screening participation and its barriers among average risk individuals in Malaysia. A cross sectional study was conducted from August 2009 till April 2010 involving average risk individuals from 44 primary care clinics in West Malaysia. Each individual was asked whether they have performed any of the colorectal cancer screening methods in the past five years. The barrier questions had three domains: patient factors, test factors and health care provider factors. Descriptive analysis was achieved using Statistical Program for Social Sciences (SPSS) version 12.0. A total of 1,905 average risk individuals responded making a response rate of 93.8%. Only 13 (0.7%) respondents had undergone any of the colorectal cancer screening methods in the past five years. The main patient and test factors for not participating were embarrassment (35.2%) and feeling uncomfortable (30.0%), respectively. There were 11.2% of respondents who never received any advice to do screening. The main reason for them to undergo screening was being advised by health care providers (84.6%). The study showed that participation in colorectal cancer screening in Malaysia is extremely low and multiple factors contribute to this situation. Given the importance of the disease, efforts should be made to increase colorectal cancer screening activities in Malaysia.


Colorectal cancer screening;participation;barriers;colorectal cancer;uptake


  1. Béjar LM, Gili M, Infantes B, Marcott PF (2012). Incidence of colorectal cancer and influence of dietary habits in fifteen European countries from 1971 to 2002. Gaceta Sanitaria, 26, 69-73.
  2. Berkowitz Z, Hawkins NA, Peipins LA, White MC, Nadel MR (2008). Beliefs, Risk Perceptions, and Gaps in Knowledge as Barriers to Colorectal Cancer Screening in Older Adults. J Am Geriatr Soc, 56, 307-14.
  3. Beydoun HA, Beydoun MA (2008). Predictors of colorectal cancer screening behaviors among average-risk older adults in the United States. Cancer Causes Control, 19, 339-59.
  4. Brawarsky P, Brooks DR, Mucci LA, Wood PA (2004). Effect of physician recommendation and patient adherence on rates of colorectal cancer testing. Cancer Detection and Prevention, 28, 260-8.
  5. Classen C, Lambert R. Colorectal Cancer Screening in Europe. A survey of the International Digestive Cancer Alliance between November 2004 and March 2007. Available at: documents/Abstracts/Classen.pdf (5 July 2012).
  6. Garcıa AZ, Quintero E, Perez DN, Hernandez M, Sosa AJ (2011). Colorectal cancer screening in first-degree relatives of colorectal cancer: participation, knowledge, and barriers against screening. European Journal of Gastroenterology & Hepatology, 23, 1165-71.
  7. Goh KL, Quek KF, Yeo GTS, et al (2005). Colorectal cancer in Asians: a demographic and anatomic survey in Malaysian patients undergoing colonoscopy. Aliment Pharmacol Ther, 22, 859-64.
  8. Greiner KA, Engelman KK, Hall MA, Ellerbeck EF (2004). Barriers to colorectal cancer screening in rural primary care. Preventive Medicine, 38, 269-75.
  9. Guessous I, Dash C, Lapin P, et al (2010). Colorectal cancer screening. Barriers and facilitators in older persons. Preventive Medicine, 50, 3-10.
  10. Harmy MY, Norwati D, Norhayati MN, Amry AR (2011). Knowledge and attitude of colorectal cancer screening among moderate risk patients in West Malaysia. Asian Pacific J Cancer Prev, 12, 1957-60.
  11. Health Indicators, Ministry of Health, Malaysia (2010). Indicators for Monitoring and Evaluation of Strategy Health for All. Ministry of Health, Malaysia.
  12. International Cancer Screening Network . Inventory of Colorectal Cancer Screening Activities in ICSN Countries, May 2008. Available at icsn/colorectal/screening.html. (1 July 2012).
  13. James AS, Campbell MK, Hudson MA (2002). Perceived Barriers and Benefits to Colon Cancer Screening among African Americans in North Carolina : How Does Perception Relate to Screening Behavior. Cancer Epidemiol Biomarkers Prev, 11, 529-34.
  14. Janz NK, Wren PA, Schottenfeld D, Guire KE (2003). Colorectal cancer screening attitudes and behavior: a population-based study. Preventive Medicine, 37, 627-34.
  15. Kui C, Jae J, Hoo-Yeon L, et al (2010). Increasing uptake of colorectal cancer screening in Korea: a population-based study. BMC Public Health, 10, 265-73.
  16. Lasser KE, Ayanian JZ, Fletcher RH, Good MJ (2008). Barriers to colorectal cancer screening in community health centers: A qualitative study. BMC Fam Prac, 9, 15-22.
  17. Lemon S, Zapka J, Puleo E, Luckmann R, Chasan-Taber L (2001). Colorectal cancer screening participation: comparisons with mammography and prostate-specific antigen screening. Am J Public Health, 91, 1264-72.
  18. Lim GCC (2002). Overview of Cancer in Malaysia. Jpn J Clin Oncol, 32, S37-42.
  19. Malaysian Society of Gastroenterology & Hepatology (2001). Screening for colorectal cancer in Malaysia. Consensus/ clinical practice guidelines. view_file.cfm?fileid=209 (1 July 2012).
  20. McCaffery K, Wardle J, Waller J (2003). Knowledge, attitudes and behavioural intentions in relation to the early detection of colorectal cancer in the United Kingdom. Preventive Medicine, 36, 525-35.
  21. McGregor SE, Hilsden RJ, Li FX, Bryant HE, Murray A (2007). Low Uptake of Colorectal Cancer Screening 3 Yr After Release of National Recommendations for Screening. Am J Gastroenterol, 102, 1727-35.
  22. National Cancer Patient Registry-Colorectal Cancer, National Cancer Patient Registry-Colorectal Cancer and Clinical Research Centre (CRC) Malaysia (2010). The First Annual Report of the National Cancer Patient Registry-Colorectal Cancer 2007-2008.
  23. National Cancer Registry, Ministry of Health Malaysia (2006). Malaysian Cancer Statistics - Data And Figure Peninsular Malaysia.
  24. Nivens AS, Herman J, Weinrich SP, Weinrich MC (2001). Key points cues to participation in prostate cancer screening: a theory for practice. Oncol Nurs Forum, 28, 1449-56.
  25. O'Malley AS, Beaton E, Yabroff KR, Abramson R, Mandelblatt J (2004). Patient and provider barriers to colorectal cancer screening in the primary care safety-net. Prev Med, 39, 56-63.
  26. Pignone M, Saha S, Hoerger T, Mandelblatt J (2002). Costeffectiveness analyses of colorectal cancer screening: a systematic review for the US Preventive Services Task Force. Ann Intern Med, 137, 96-104.
  27. Power E, Miles A, von Wagner C, Robb K, Wardle J (2009). Uptake of colorectal cancer screening: system, provider and individual factors and strategies to improve participation. Future Oncol, 5, 1371-88.
  28. Seeff LC, Nadel MR, Klabunde CN, et al (2004). Patterns and Predictors of Colorectal Cancer Test Use in the Adult U.S. Population. Cancer, 100, 2093-103.
  29. Sung JJ, Lau JY, Young GP, et al (2008). Asia Pacific Working Group on Colorectal Cancer. Asia-Pacific consensus recommendations for colorectal cancer screening. Gut, 57, 1166-76.
  30. Sung JJY, Lau JYW, Goh KL, Leung WK (2005). Increasing incidence of colorectal cancer in Asia: implications for screening. Lancet Oncol, 6, 871-6.
  31. von Wagner C, Gianluca Baio G, Rosalind Raine R, et al (2011). Inequalities in participation in an organized national colorectal cancer screening programme: results from the first 2.6 million invitations in England. Int J Epidemiol, 40, 712-8.
  32. Walsh JME, Terdiman JP (2003). Colorectal cancer screening. Scientific Review. JAMA, 289, 1288-96.
  33. Weller D, Coleman D, Robertson R, et al (2007). The UK colorectal cancer screening pilot: results of the second round of screening in England. Br J Cancer, 97, 1601-5.
  34. World Health Organization. Fact sheet No. 297. February 2012. (20 June 2012).

Cited by

  1. Sociodemographic Predictors of Recall and Recognition of Colorectal Cancer Symptoms and Anticipated Delay in Help-Seeking in a Multiethnic Asian Population vol.14, pp.6, 2013,
  2. Implementation of Screening Colonoscopy amongst First-Degree Relatives of Patients with Colorectal Cancer in Turkey: a Cross-Sectional Questionnaire Based Survey vol.15, pp.14, 2014,
  3. Colorectal Cancer Screening Practices of Primary Care Providers: Results of a National Survey in Malaysia vol.15, pp.6, 2014,
  4. Evaluation of Chemopreventive Effects of Acanthus ilicifolius against Azoxymethane-Induced Aberrant Crypt Foci in the Rat Colon vol.9, pp.5, 2014,
  5. Diet and Colorectal Cancer Risk in Asia - a Systematic Review vol.16, pp.13, 2015,
  6. Preferences and Acceptance of Colorectal Cancer Screening in Thailand vol.16, pp.6, 2015,
  7. Analysis of Hereditary Nonpolyposis Colorectal Cancer in Malay Cohorts using Immunohistochemical Screening vol.16, pp.9, 2015,
  8. Colorectal Cancer Awareness and Screening Preference: A Survey during the Malaysian World Digestive Day Campaign vol.16, pp.18, 2016,
  9. Survival rates and predictors of survival among colorectal cancer patients in a Malaysian tertiary hospital vol.17, pp.1, 2017,
  10. Hyaluronidase Enzyme-responsive Targeted Nanoparticles for Effective Delivery of 5-Fluorouracil in Colon Cancer vol.35, pp.4, 2018,