Sociodemographic Predictors of Recall and Recognition of Colorectal Cancer Symptoms and Anticipated Delay in Help-Seeking in a Multiethnic Asian Population

  • 발행 : 2013.06.30


Background: 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. Materials and Methods: 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. Results: 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. Conclusions: 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.


  1. Ajzen I, Fishbein M (2000). Attitudes and the attitude-behavior relation: reasoned and automatic processes. Eur Rev Soc Psychol, 11, 1-33.
  2. Alter AL, Oppenheimer DM (2009). Uniting the tribes of fluency to form a metacognitive nation. Pers Soc Psychol Rev, 13, 219-35.
  3. Brown SC, Park DC (2003). Theoretical models of cognitive aging and implications for translational research in medicine. Gerontologist, 43, 57-67.
  4. Christou A, Thompson SC (2012). Colorectal cancer screening knowledge, attitudes and behavioural intention among Indigenous Western Australians. BMC Public Health, 12, 528.
  5. Dein S (2004). Explanatory models of and attitudes towards cancer in different cultures. Lancet Oncol, 5, 119-24.
  6. Ferraris R, Senore C, Fracchia M, et al (2004). Predictive value of rectal bleeding for distal colonic neoplastic lesions in a screened population. Eur J Cancer, 40, 245-52.
  7. Gimeno-Garcia AZ, Quintero E, Nicolas-Perez D, Jimenez-Sosa A (2011). Public awareness of colorectal cancer and screening in a Spanish population. Public Health, 125, 609-15.
  8. Greenlee RT, Hill-Harmon MB, Murray T, Thun M (2001). Cancer statistics, 2001. CA Cancer J Clin, 51, 15-36.
  9. Harmy MY, Norwati D, Noor NM, Amry AR (2011). Knowledge and attitude of colorectal cancer screening among moderate risk patients in West Malaysia. Asian Pac J Cancer Prev, 12, 1957-60.
  10. Hashim SM, Fah TS, Omar K, et al (2011). Knowledge of colorectal cancer among patients presenting with rectal bleeding and its association with delay in seeking medical advice. Asian Pac J Cancer Prev, 12, 2007-11.
  11. Heresbach D, Manfredi S, D'Halluin P N, Bretagne JF, Branger B (2006). Review in depth and meta-analysis of controlled trials on colorectal cancer screening by faecal occult blood test. Eur J Gastroenterol Hepatol, 18, 427-33.
  12. Hilmi I, Hartono JL, Goh K (2010). Negative perception in those at highest risk--potential challenges in colorectal cancer screening in an urban asian population. Asian Pac J Cancer Prev, 11, 815-22.
  13. Hou SI (2005). Factors associated with intentions for colorectal cancer screenings in a Chinese sample. Psychol Rep, 96, 159-62.
  14. Hyodo I, Suzuki H, Takahashi K, et al (2010). Present status and perspectives of colorectal cancer in Asia: colorectal cancer working group report in 30th Asia-Pacific cancer conference. Jpn J Clin Oncol, 40, 138-43.
  15. Jansen J, van Weert J, van der Meulen N, et al (2008). Recall in older cancer patients: measuring memory for medical information. Gerontologist, 48, 149-57.
  16. Keighley MR, O'Morain C, Giacosa A, et al (2004). Public awareness of risk factors and screening for colorectal cancer in Europe. Eur J Cancer Prev, 13, 257-62.
  17. Kerr J, Day P, Broadstock M, Weir R, Bidwell S (2007). Systematic review of the effectiveness of population screening for colorectal cancer. N Z Med J, 120, 2629.
  18. Koo JH, Leong RW, Ching J, et al (2012). Knowledge of, attitudes toward, and barriers to participation of colorectal cancer screening tests in the Asia-Pacific region: a multicenter study. Gastrointestinal Endoscopy, 76, 126-35.
  19. Langenbach MR, Schmidt J, Neumann J, Zirngibl H (2003). Delay in treatment of colorectal cancer: multifactorial problem. World J Surg, 27, 304-8.
  20. Lim G, Rampal S, Yahaya H (2008). Cancer incidence in Peninsular Malaysia 2003-2005: The third report of the National Cancer Registry. Malaysia: 33-58.
  21. Majid HA, Emery PW, Whelan K (2012). Definitions, attitudes, and management practices in relation to diarrhea during enteral nutrition: a survey of patients, nurses, and dietitians. Nutr Clin Pract, 27, 252-60.
  22. Majumdar SR, Fletcher RH, Evans AT (1999). How does colorectal cancer present? Symptoms, duration, and clues to location. Am J Gastroenterol, 94, 3039-45.
  23. Ministry of Health Malaysia. (2007). Malaysia Cancer Statistics: Data and Figure (2007). Retrieved 15 July 2012.
  24. Ministry of Human Resources Malaysia (2010). Malaysia Standard Classification of Occupations 2008. Malaysia.
  25. Mor V, Masterson-Allen S, Goldberg R, Guadagnoli E, Wool MS (1990). Pre-diagnostic symptom recognition and help seeking among cancer patients. J Community Health, 15, 253-66.
  26. Ng SC, Wong SH (2013). Colorectal cancer screening in Asia. Br Med Bulletin, 105, 29-42.
  27. Philipp R, Wood N, Heaton KW, Hughes A (1993). Perceptions and reactions of the public to diarrhoea. J R Soc Health, 113, 128-31.
  28. Power E, Simon A, Juszczyk D, Hiom S, Wardle J (2011). Assessing awareness of colorectal cancer symptoms: measure development and results from a population survey in the UK. BMC Cancer, 11, 366.
  29. Rashid MR, Aziz AF, Ahmad S, Shah SA, Sagap I (2009). Colorectal cancer patients in a tertiary referral centre in Malaysia: a five year follow-up review. Asian Pac J Cancer Prev, 10, 1163-6.
  30. Robb K, Stubbings S, Ramirez A, et al (2009). Public awareness of cancer in Britain: a population-based survey of adults. Br J Cancer, 101, 18-23.
  31. Roncoroni L, Pietra N, Violi V, et al (1999). Delay in the diagnosis and outcome of colorectal cancer: a prospective study. Eur J Surg Oncol, 25, 173-8.
  32. Simon AE, Waller J, Robb K, Wardle J (2010). Patient delay in presentation of possible cancer symptoms: the contribution of knowledge and attitudes in a population sample from the United kingdom. Cancer Epidemiology, Biomarkers and Prevention, 19, 2272-7.
  33. Smith LK, Pope C, Botha JL (2005). Patients' help-seeking experiences and delay in cancer presentation: a qualitative synthesis. Lancet, 366, 825-31.
  34. Steele RJ, McClements PL, Libby G, et al (2009). Results from the first three rounds of the Scottish demonstration pilot of FOBT screening for colorectal cancer. Gut, 58, 530-5.
  35. Stubbings S, Robb K, Waller J, et al (2009). Development of a measurement tool to assess public awareness of cancer. Br J Cancer, 101, 13-7.
  36. Tan YM, Rosmawati M, Ranjeev P, Goh KL (2002). Predictive factors by multivariate analysis for colorectal cancer in Malaysian patients undergoing colonoscopy. J Gastroenterol Hepatol, 17, 281-4.
  37. Waller J, McCaffery K, Wardle J (2004). Measuring cancer knowledge: comparing prompted and unprompted recall. Br J Psychol, 95, 219-34.
  38. Waller J, Robb K, Stubbings S, et al (2009). Awareness of cancer symptoms and anticipated help seeking among ethnic minority groups in England. Br J Cancer, 101, 24-30.
  39. Wong MC, Hirai HW, Luk AK, et al (2013). The knowledge of colorectal cancer symptoms and risk factors among 10,078 screening participants: are high risk individuals more knowledgeable? PLoS ONE, 8, 60366.
  40. Yardley C, Glover C, Allen-Mersh TG (2000). Demographic factors associated with knowledge of colorectal cancer symptoms in a UK population-based survey. Ann R Coll Surg Engl, 82, 205-9.
  41. Yusoff HM, Daud N, Noor NM, Rahim AA (2012). Participation and barriers to colorectal cancer screening in Malaysia. Asian Pac J Cancer Prev, 13, 3983-7.

피인용 문헌

  1. Quality of Life and Psychological Well-Being of Colorectal Cancer Survivors in Jordan vol.15, pp.18, 2014,
  2. Colorectal Carcinoma in Malaysians: DNA Mismatch Repair Pattern in a Multiethnic Population vol.15, pp.7, 2014,
  3. Modulation of transforming growth factor-β signaling transducers in colon adenocarcinoma cells induced by staphylococcal enterotoxin B vol.13, pp.1, 2015,
  4. Knowledge and Beliefs of Malaysian Adolescents Regarding Cancer vol.16, pp.3, 2015,
  5. Colorectal Cancer Awareness and Screening Preference: A Survey during the Malaysian World Digestive Day Campaign vol.16, pp.18, 2016,
  6. Cancer beliefs in ethnic minority populations: a review and meta-synthesis of qualitative studies vol.26, pp.1, 2016,
  7. Survival rates and predictors of survival among colorectal cancer patients in a Malaysian tertiary hospital vol.17, pp.1, 2017,
  8. Objective and Subjective Cancer Knowledge Among Faith-Based Chinese Adults vol.38, pp.1, 2017,
  9. The ‘Be Cancer Alert Campaign’: protocol to evaluate a mass media campaign to raise awareness about breast and colorectal cancer in Malaysia vol.18, pp.1, 2018,
  10. Colorectal Cancer: How Familiar Are Our Future Doctors with the Cancer of Tomorrow? vol.2018, pp.2314-6141, 2018,