Attitudes Towards Colorectal Cancer (CRC) and CRC Screening Tests among Elderly Malay Patients

  • Al-Naggar, Redhwan A. ;
  • Al-Kubaisy, Waqar ;
  • Yap, Bee W. ;
  • Bobryshev, Yuri V. ;
  • Osman, Muhamed T.
  • Published : 2015.02.25


Background: Colorectal cancer (CRC) is the third most common malignancy in Malaysia, where data are limited regarding knowledge and barriers in regard to CRC and screening tests. The aim of the study was to assess these parameters among Malaysians. Materials and Methods: The questionnaires were distributed in the Umra Private Hospital in Selangor. The questionnaire had four parts and covered social-demographic questions, respondent knowledge about CRC and colorectal tests, attitude towards CRC and respondentaction regarding CRC. More than half of Malay participants (total n=187) were female (57.2%) and 36.9% of them were working as professionals. Results: The majority of the participants (93.6%) never had a CRC screening test. The study found that only 10.2% of the study participants did not consider that their chances of getting CRC were high. A high percentage of the participants (43.3%) believed that they would have good chance of survival if the cancer would be found early. About one third of the respondents did not want to do screening because of fear of cancer, and concerns of embarrassment during the procedure adversely affected attitude to CRC screening as well. Age, gender, income, family history of CRC, vegetable intake and physical activity were found to be significant determinants of knowledge on CRC. Conclusions: The major barriers identified towards CRC screening identified in our study were fear of pain and embarrassment. The findings have implications for understanding of similarities and differences in attitude to CRC amongst elderly patients in other cultural/geographic regions.


Colorectal cancer (CRC);barriers;practice;elderly patients;Malaysia


  1. American Cancer Society. (2011). Cancer Facts and Figures Atlanta, Ga.
  2. American College of Sports Medicine (2000). ACSM's guidelines for exercise testing and prescription.6th ed., Lippincott, Williams, Wilkins, Baltimore, MD, USA.
  3. Beeker C, Kraft JM, Southwell BG, Jorgensen CM (2000). CRC screening in older men and women: Qualitative research findings and implications for intervention. J Commun Health, 25, 263-78.
  4. Biddle SJH, Gorely T, Stensel DJ (2004). Health-enhancing physical activity and sedentary behaviour in children and adolescents. J Sports Sci, 22, 679-701.
  5. Canadian Task Force on Preventive Health Care (2001). CRC screening. recommendation statement from the canadian task force on preventive health care. CMAJ, 165, 206-8.
  6. CDC; Centers for Disease Control and Prevention: CRC test use among persons aged 50 years-United States, 2001 (2003) MMWR, 52, 193-6.
  7. Christou A, Thompson SC (2012). CRC screening knowledge, attitudes and behavioural intention among Indigenous Western Australians. BMC Public Health, 12, 528.
  8. Colditz GA, Cannuscio CC, Frazier AL (1997). Physical activity and reduced risk of colon cancer: implications for prevention. Cancer Causes Control, 8, 649-67.
  9. Consedine NS, Ladwig I, Reddig MK, Broadbent EA (2011). The many faeces of CRC screening embarrassment: preliminary psychometric development and links to screening outcome. Br J Health Psychol, 16, 559-79.
  10. Cooper GS, Fortinsky RH, Hapke R, Landefeld CS (1997). Primary care physician recommendations for CRC screening.Patient and practitioner factors. Arch Intern Med, 157, 1946-50.
  11. Coups EJ, Hay J, Ford JS (2008). Awareness of the role of physical activity in colon cancer prevention. Patient Educ Couns, 72, 246-51.
  12. Denberg TD, Melhado TV, Coombes JM, et al (2005). Predictors of nonadherence to screening colonoscopy. J Gen Intern Med, 20, 989-95.
  13. Farraye FA, Wong M, Hurwitz S, et al (2004). Barriers to endoscopic CRC screening: are women different from men? Am J Gastroenterol, 99, 341-9.
  14. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917.
  15. Gimeno-Garcia AZ, Quintero E, Nicolas-Perez D, Parra-Blanco A, Jime'nez A (2009). CRC screening in a Spanish population. Med Clin, 133, 736-40.
  16. Giovannucci E, Rimm EB, Stampfer MJ,et al (1994).A prospective study of cigarette smoking and risk of colorectal adenoma and CRC in U.S. men. J Nat Cancer Inst, 86, 183-91.
  17. Guessous I, Dash C, Lapin P,et al (2010). CRC screening barriers and facilitators in older persons. Prev Med, 50, 3-10.
  18. Hardcastle JD, Chamberlain JO, Robinson MH, et al (1996). Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet, 348, 1472-7.
  19. Harmy MY, Norwati D, Noor NM, Amry AR (2011). Knowledge and attitude of CRC screening among moderate risk patients in West Malaysia. Asian Pac J Cancer Prev, 12, 1957-60.
  20. Hazreen A, Myint SM, Farizah H, et al (2005). An evaluation of information dissemination during the severe acute respiratory syndrome (SARS) outbreak among selected rural communities in Kuala Kangsar. Med J Malaysia, 60, 180-7.
  21. Huxley RR, Ansary-Moghaddam A, Clifton P, et al (2009). The impact of dietary and lifestyle risk factors on risk of colorectal cancer: a quantitative overview of the epidemiological evidence. Int J Cancer, 125, 171-80.
  22. Javanparast S, Ward PR, Carter SM, Wilson CJ (2012). Barriers to and facilitators of CRC screening in different population subgroups in Adelaide, South Australia. Med J Aust, 196, 521-3.
  23. Kim K, Yu ES, Chen EH, Kim J, Brintnall R (1998).CRC screening: Knowledge and practices among Korean Americans. Cancer Pract, 6, 167-75.
  24. Klabunde CN, Meissner HI, Wooten KG, Breen N, Singleton JA (2007).Comparing CRC screening and immunization status in older Americans. Am J Prev Med, 33, 1-8.
  25. Koo JH, Arasaratnam MM, Liu K, et al (2010).Knowledge, perception and practices of CRC screening in an ethnically diverse population. Cancer Epidemiology, 34, 604-10.
  26. Leard LE, Savides TJ, Ganiats TG (1997). Patient preferences for CRC screening. J FamPract, 45, 211-8.
  27. Levin B, Lieberman DA, McFarland B, et al (2008). Screening and surveillance for the early detection of CRC and adenomatous polyps. CA Cancer J Clin, 58, 130-60.
  28. Mandel JS, Bond JH, Church TR,et al (1993). Reducing mortality from CRC by screening for fecal occult blood. minnesota colon cancer control study. N Engl J Med, 328, 1365-71.
  29. Mandel JS, Church TR, Ederer F, Bond JH (1999). CRC mortality: effectiveness of biennial screening for faecal occult blood. J Natl Cancer Inst, 91, 434-7.
  30. McCaffery K, Borril J, Williamson S,et al (2001). Declining the offer of flexible sigmoidoscopy screening for bowel cancer: a qualitative investigation of the decision-making process. SocSci Med, 53, 679-91.
  31. McCaul KD, Tulloch HE (1999).Cancer screening decisions. J Natl Cancer InstMonogr, 25, 52-8.
  32. Miles A, Voorwinden S, Chapman S, Wardle J (2008). Psychologic predictors of cancer information avoidance among older adults: the role of cancer fear and fatalism. Cancer Epidemiol Biomarkers Prev, 17, 1872-9.
  33. Ogedegbe G, Cassells AN, Robinson CM, et al (2005). Perceptions of barriers and facilitators of cancer early detection among low-income minority women in community health centers. J Natl Med Assoc, 97, 162-70.
  34. Palmer RC, Midgette LA, Dankwa I (2008). CRC screening and African Americans: Findings from a qualitative study. Cancer Control, 15, 72-9.
  35. Power E, Simon A, Juszczyk D, Hiom S, Wardle J (2011). Assessing awareness of CRC symptoms: measure development and results from a population survey in the UK. BMC Cancer, 11, 2407.
  36. Rawl SM, Menon U, Champion VL, Foster JL, Skinner CS (2000). CRC screening beliefs: focus groups with firstdegree relatives. Cancer Pract, 8, 32-7.
  37. Rex K, Johnson D, Anderson J, et al (2009). American College of Gastroenterology Guidelines for CRC Screening.Retrieved from
  38. Robb KA, Solarin I, Power E, Atkin W, Wardle J (2008). Attitudes to CRC screening among ethnic minority groups in the UK. BMC Public Health, 8, 34.
  39. Sanderson PR, Weinstein N, Teufel-Shone N, Martinez ME (2011). Assessing CRC screening knowledge at tribal fairs. Prev Chronic Dis, 8, 16.
  40. Slevin TJ, Donnelly N, Clarkson JP, English DR, Ward JE (1999). Prostate cancer testing: behaviour, motivation and attitudes among Western Australian men. Med J Aust, 171, 185-8.
  41. Stead M, Caswell S, Craigie AM, et al (2012). Understanding the potential and challenges of adenoma treatment as a prevention opportunity: insights from the BeWEL formative study. Prev Med, 54, 97-103.
  42. Suha O, Ahmad Abedalkareem I (2010). Knowledge and beliefs of Jordanians toward CRC screening. Cancer Nursing, 33, 141-8.
  43. Sung JJ, Choi SY, Chan FK,et al (2008). Obstacles to CRC screening in Chinese: a study based on the health belief model. Am J Gastroenterol, 103, 974-81.
  44. Sung JJ, Lau JY, Goh KL, Leung WK (2005). Asia pacific working group on colorectal cancer. increasing incidence of CRC in Asia: implications for screening. Lancet Oncol, 6, 871-6.
  45. Sung JJ, Lau JY, Young GP, et al (2008). for The Asia Pacific Working Group on Colorectal Cancer. Asia Pacific consensus recommendations for CRC screening. Gut, 57, 1166-76.
  46. Tam TKW, Ng KK, Lau CM,et al (2011). Fecal occult blood screening: knowledge, attitudes, and practice in four Hong Kong primary care clinics. Hong Kong Med J, 17, 350-7.
  47. US Preventive Services Task Force (2002). Screening for colorectal cancer: recommendation and rationale. Ann Intern Med, 137, 129-31.
  48. Ward SH, Lin K, Meyer B, et al (2008).Increasing CRC screening among African Americans, linking risk perception to interventions targeting patients, communities and clinicians. J Natl Med Assoc, 100, 748-58.
  49. Winawer S, Fletcher R, Rex D,et al (2003). CRC screening and surveillance: clinical guidelines and rationale - update based on new evidence. Gastroenterology, 124, 544-60.
  50. Wong-Kim E, Sun A, DeMattos M (2003). Assessing cancer beliefs in a Chinese immigrant community. Cancer Control, 10, 22-8.