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Original article
peer-reviewed

Barriers to Colorectal Cancer Screening in Pakistan



Abstract

Background

The 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.

Methods

A 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.

Results

The 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.

Conclusion

A 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.



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Original article
peer-reviewed

Barriers to Colorectal Cancer Screening in Pakistan


Author Information

Fariha Hasan Corresponding Author

Department of Internal Medicne, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Sayed Mustafa Mahmood Shah

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Misbah Munaf

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Muhammad R. Khan

Deparrment of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Shayan Marsia

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Syed Muhammad Haaris

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Muhammad Hammad Shaikh

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Ismail Abdur Rahim

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Muhammad Salar Anwar

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Kassam S. Qureshi

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Maham Iqbal

Department of Internal Medicine, Jinnah Medical and Dental College

Sara Qazi

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Burhanuddin A. Kasi

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Mahnoor Tahir

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Syed Inam Ur Rehman

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Kaneez Fatima

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Informed consent obtained. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Original article
peer-reviewed

Barriers to Colorectal Cancer Screening in Pakistan


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Original article
peer-reviewed

Barriers to Colorectal Cancer Screening in Pakistan

Fariha Hasan">Fariha Hasan , Sayed Mustafa Mahmood Shah"> Sayed Mustafa Mahmood Shah, Misbah Munaf">Misbah Munaf, Muhammad R. Khan">Muhammad R. Khan, Shayan Marsia">Shayan Marsia, Syed Muhammad Haaris">Syed Muhammad Haaris, Muhammad Hammad Shaikh">Muhammad Hammad Shaikh, Ismail Abdur Rahim">Ismail Abdur Rahim, Muhammad Salar Anwar">Muhammad Salar Anwar, Kassam S. Qureshi">Kassam S. Qureshi, Maham Iqbal">Maham Iqbal, Sara Qazi">Sara Qazi, Burhanuddin A. Kasi">Burhanuddin A. Kasi, Mahnoor Tahir">Mahnoor Tahir, Syed Inam Ur Rehman">Syed Inam Ur Rehman, Kaneez Fatima">Kaneez Fatima

  • Author Information
    Fariha Hasan Corresponding Author

    Department of Internal Medicne, Dow University of Health Sciences (DUHS), Karachi, Pakistan

    Sayed Mustafa Mahmood Shah

    Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

    Misbah Munaf

    Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

    Muhammad R. Khan

    Deparrment of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

    Shayan Marsia

    Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

    Syed Muhammad Haaris

    Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

    Muhammad Hammad Shaikh

    Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

    Ismail Abdur Rahim

    Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

    Muhammad Salar Anwar

    Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

    Kassam S. Qureshi

    Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

    Maham Iqbal

    Department of Internal Medicine, Jinnah Medical and Dental College

    Sara Qazi

    Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

    Burhanuddin A. Kasi

    Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

    Mahnoor Tahir

    Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

    Syed Inam Ur Rehman

    Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

    Kaneez Fatima

    Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Informed consent obtained. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: July 16, 2017

    DOI

    10.7759/cureus.1477

    Cite this article as:

    Hasan F, Mahmood shah, Munaf M, et al. (July 16, 2017) Barriers to Colorectal Cancer Screening in Pakistan. Cureus 9(7): e1477. doi:10.7759/cureus.1477

    Publication history

    Received by Cureus: May 17, 2017
    Peer review began: May 30, 2017
    Peer review concluded: July 06, 2017
    Published: July 16, 2017

    Copyright

    © Copyright 2017
    Hasan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background

The 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.

Methods

A 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.

Results

The 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.

Conclusion

A 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.



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Create a free account to continue reading this article.

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Fariha Hasan, Medical Student

Department of Internal Medicne, Dow University of Health Sciences (DUHS), Karachi, Pakistan

For correspondence:
farihahassan100@gmail.com

Sayed Mustafa Mahmood Shah

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Misbah Munaf

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Muhammad R. Khan

Deparrment of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Shayan Marsia

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Syed Muhammad Haaris

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Muhammad Hammad Shaikh

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Ismail Abdur Rahim

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Muhammad Salar Anwar

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Kassam S. Qureshi

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Maham Iqbal

Department of Internal Medicine, Jinnah Medical and Dental College

Sara Qazi

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Burhanuddin A. Kasi, Medical Student

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Mahnoor Tahir

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Syed Inam Ur Rehman

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Kaneez Fatima

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Fariha Hasan, Medical Student

Department of Internal Medicne, Dow University of Health Sciences (DUHS), Karachi, Pakistan

For correspondence:
farihahassan100@gmail.com

Sayed Mustafa Mahmood Shah

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Misbah Munaf

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Muhammad R. Khan

Deparrment of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Shayan Marsia

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Syed Muhammad Haaris

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Muhammad Hammad Shaikh

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Ismail Abdur Rahim

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Muhammad Salar Anwar

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Kassam S. Qureshi

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Maham Iqbal

Department of Internal Medicine, Jinnah Medical and Dental College

Sara Qazi

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Burhanuddin A. Kasi, Medical Student

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Mahnoor Tahir

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Syed Inam Ur Rehman

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan

Kaneez Fatima

Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan