Barriers to Colorectal Cancer Screening in Pakistan

Abstract

BackgroundThe prevalence of colorectal cancer (CRC) is growing in Pakistan; however, there are no national screening programs or guidelines in place to curb its development. This study was conducted with the aim of ascertaining public awareness and attitudes regarding CRC and current screening practices. Furthermore, the study assessed perceived barriers which could impact future screening processes.MethodsA cross-sectional, questionnaire-based study was conducted among urban dwellers of Karachi, Pakistan. We excluded any individuals belonging to the medical profession, those diagnosed previously with CRC or having any significant co-morbidity. The validated and pre-tested questionnaire was administered among the study participants to record demographic information, awareness of CRC risk factors, symptoms and screening tests. Attitudes towards screening and perceived barriers to screening were also assessed. Data were analyzed using Statistical Package for Social Sciences (SPSS version 20.0) (IBM Corp., Armonk, NY). A knowledge score, out of a total of 14 points was calculated to reflect a participant’s overall knowledge regarding CRC risk factors and signs/symptoms.ResultsThe prevalence of CRC screening in eligible individuals (50 years or older) was 2.6% in our study population. Positive attitudes towards CRC management and screening were observed, with 75.1% (n = 296) acknowledging the preventive role of screening tests. Despite this only 14.9% (n = 58) of study participants expressed a future desire to undergo screening. Major barriers to screening were reported to be “a lack of knowledge regarding the screening procedure”, a “lack of screening facilities” and that the “screening procedure is too expensive”. A majority (n = 285, 72.3%) of the participants expressed a greater willingness to undergo screening if their doctor recommended it.ConclusionA national CRC screening and awareness program should be launched to promote awareness and facilitate screening in risk groups. General practitioners are needed to play a key role in counseling patients and endorsing healthy screening practices.

Awareness of Colorectal Cancer and Attitudes Towards Its Screening Guidelines in Lebanon

“…A low perceived risk is associated with lower preventive measures [25262728]. Barriers such as cost and inaccessibility to screening centers have been identified in the literature but were not shown to be significant in our study [8141821].…”

“…This is higher than the screening rate of CRC in Saudi Arabia, which was found to be 8.6% [19], and closer to that in Spain, where 12% of the surveyed population had undergone CRC screening [20]. In fact, the lack of knowledge that one should get screened has been found to be one of the most common barriers to CRC screening [914181921]. Primary care physicians were shown to play an important role in recommending CRC screening and increasing awareness of screening guidelines [10].…”

Mutation Analysis of TP53 in Colorectal Cancer, Peshawar, Khyber Pakhtunkhwa, Pakistan.

“…Pakistan, like many other South Asian countries, have been placed in low-risk zone CRC. Though, a latest study have reported in CRC cases for patients above the age of 50 years (Hasan et al, 2017). From global perspective, Pakistan falls into a high-risk region for colorectal cancer.…”

To do or not to do – a survey study on factors associated with participating in the Danish screening program for colorectal cancer

“…Thus, in contrast to many other countries where programs need to be paid out of pocket or where significant population subgroups may lack health insurance (for example Pakistan [ 2 ]), South Korea [ 3 ] or the US [ 4 ] there should not be financial barriers for accepting the screening offer in the Danish setting. However, despite the free offer, around 40% of Danes do not participate when they are initially invited [ 5 ].…”