Colorectal Cancer Screening Practices of Primary Care Providers: Results of a National Survey in Malaysia

  • Norwati, Daud ;
  • Harmy, Mohamed Yusoff ;
  • Norhayati, Mohd Noor ;
  • Amry, Abdul Rahim
  • Published : 2014.03.30


The incidence of colorectal cancer has been increasing in many Asian countries including Malaysia during the past few decades. A physician recommendation has been shown to be a major factor that motivates patients to undergo screening. The present study objectives were to describe the practice of colorectal cancer screening by primary care providers in Malaysia and to determine the barriers for not following recommendations. In this cross sectional study involving 132 primary care providers from 44 Primary Care clinics in West Malaysia, self-administered questionnaires which consisted of demographic data, qualification, background on the primary care clinic, practices on colorectal cancer screening and barriers to colorectal cancer screening were distributed. A total of 116 primary care providers responded making a response rate of 87.9%. About 21% recommended faecal occult blood test (FOBT) in more than 50% of their patients who were eligible. The most common barrier was "unavailability of the test". The two most common patient factors are "patient in a hurry" and "poor patient awareness". This study indicates that colorectal cancer preventive activities among primary care providers are still poor in Malaysia. This may be related to the low availability of the test in the primary care setting and poor awareness and understanding of the importance of colorectal cancer screening among patients. More awareness programmes are required for the public. In addition, primary care providers should be kept abreast with the latest recommendations and policy makers need to improve colorectal cancer screening services in health clinics.


Colorectal cancer screening;practices;barriers;colorectal cancer;primary care;Malaysia


  1. Klabunde CN, Lanier D, Breslau ES, et al (2007). Improving colorectal cancer screening in primary care practice: innovative strategies and future directions. Gen Intern Med, 22, 1195-205.
  2. Van Rossum LG, Van Rijn AF, Laheij RJ, et al (2008). Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population. Gastroenterology, 135, 82-90.
  3. Tan YM, Rosmawati M, Ranjeev P, et al (2002). Predictive factors by multivariate analysis for colorectal cancer in Malaysian patients undergoing colonoscopy. J Gastroenterol Hepatol, 17, 281-4.
  4. Ministry of Health (2006). National Cancer Registry, Malaysia Cancer Statistic; Data and Figure Peninsular Malaysia.
  5. Klabunde CN, Frame PS, Meadow A, et al (2003). A national survey of primary care physicians' colorectal cancer screening recommendations and practices. Prev Med, 36, 352-62.
  6. Ministry of Health, Malaysia (2008). Saringan Status Kesihatan (BSSK/W/1/2008). component/jdownloads/viewdownload/13-reten/79-bsskwarga- emas.
  7. Othman NH, Nor ZM, Biswal BM (2008). Is Kelantan joining the global cancer epidemic? - Experience from Hospital Universiti Sains Malaysia; 1987-2007. Asian Pac J Cancer Prev, 9, 473-8.
  8. Patel P, Forjuoh SN, Avots-Avotins A, et al (2004). Identifying opportunities for improved colorectal cancer screening in primary care. Prev Med, 39, 239-46.
  9. Rashid MR, Aziz AF, Ahmad S, et al (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.
  10. 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.
  11. Sung JJY, Lau JYW, Young GP, et al (2008). Asia Pacific consensus recommendations for colorectal cancer screening. Gut, 57, 1166-76.
  12. Mandel JS, Bond JH, Church TR, et al (1993). Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota colon cancer control study. N Engl J Med, 328, 1365-71.
  13. Federici A, Giorgi RP, Bartolozzi F, et al (2005). Survey on colorectal cancer screening knowledge, attitudes, and practices of general practice physicians in Lazio, Italy. Prev Med, 41, 30-5.
  14. Feeley TH, Cooper J, Foels T, et al (2009). Efficacy expectations for colorectal cancer screening in primary care: identifying barriers and facilitators for patients and clinicians. Health Commun, 24, 304-15.
  15. 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.
  16. Harmy MY, Norwati D, Norhayati MN, et al (2011). Knowledge and attitude of colorectal cancer screening among moderate risk patients in west Malaysia. Asian Pac J Cancer Prev, 12, 1957-60.
  17. Harmy MY, Norwati D, Norhayati MN, et al (2012). Participation and barriers to colorectal cancer screening in Malaysia. Asian Pac J Cancer Prev, 13, 3983-7.
  18. 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.
  19. Institute for Public Health. Ministry of Health Malaysia (2006). National Health Morbidity Survey.

Cited by

  1. Awareness of Risk Factors for Cancer among Omani adults- A Community Based Study vol.15, pp.13, 2014,
  2. Accuracy of Self-Checked Fecal Occult Blood Testing for Colorectal Cancer in Thai Patients vol.15, pp.18, 2014,
  3. Chemopreventive Efficacy of Andrographis paniculata on Azoxymethane-Induced Aberrant Colon Crypt Foci In Vivo vol.9, pp.11, 2014,
  4. Preventive Care for Gastrointestinal Disorders; Role of Herbal Medicines in Traditional Persian Medicine vol.10, pp.4, 2015,
  5. Preferences and Acceptance of Colorectal Cancer Screening in Thailand vol.16, pp.6, 2015,
  6. Poor Knowledge of Colorectal Cancer in Brunei Darussalam vol.16, pp.9, 2015,
  7. Psychometric Validation of the Bahasa Malaysia Version of the EORTC QLQ-CR29 vol.16, pp.18, 2016,
  8. Safety and Management of Toxicity Related to Aflibercept in Combination with Fluorouracil, Leucovorin and Irinotecan in Malaysian Patients with Metastatic Colorectal Cancer vol.17, pp.3, 2016,
  9. Contrasts in Practices and Perceived Barriers to Colorectal Cancer Screening by Nurses and Physicians Working in Primary Care Settings in Oman vol.31, pp.1, 2016,
  10. Family Physicians’ Knowledge, Attitudes, and Practices Toward Colorectal Cancer Screening vol.32, pp.4, 2017,
  11. Barriers to Colorectal Cancer Screening in a Primary Care Setting in Turkey vol.42, pp.1, 2017,
  12. Andrographolide Exhibits Anticancer Potential Against Human Colon Cancer Cells by Inducing Cell Cycle Arrest and Programmed Cell Death via Augmentation of Intracellular Reactive Oxygen Species Level vol.70, pp.5, 2018,