Awareness of colorectal cancer signs and symptoms: a national cross-sectional study from Palestine

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Abstract

Background

In low-resource settings, the awareness level of colorectal cancer (CRC) signs and symptoms plays a crucial role in early detection and treatment. This study examined the public awareness level of CRC signs and symptoms in Palestine and investigated the factors associated with good awareness.

Methods

This was a national cross-sectional study conducted at hospitals, primary healthcare centers, and public spaces in 11 governorates across Palestine between July 2019 and March 2020. A translated-into-Arabic version of the validated bowel cancer awareness measure (BoCAM) was utilized to assess the awareness level of CRC signs and symptoms. For each correctly identified CRC sign/symptom, one point was given. The total score (ranging from 0 to 12) was calculated and categorized into three categories based on the number of symptoms recognized: poor (0 to 4), fair (5 to 8), and good awareness (9 to 12).

Results

Of 5254 approached, 4877 participants completed the questionnaire (response rate = 92.3%). A total of 4623 questionnaires were included in the analysis; 1923 were from the Gaza Strip and 2700 from the West Bank and Jerusalem (WBJ). Participants from the Gaza Strip were younger, gained lower monthly income, and had less chronic diseases than participants in the WBJ.

The most frequently identified CRC sign/symptom was ‘lump in the abdomen’ while the least was ‘pain in the back passage’. Only 1849 participants (40.0%, 95% CI: 39.0%-41.0%) had a good awareness level of CRC signs/symptoms. Participants living in the WBJ were more likely to have good awareness than participants living in the Gaza Strip (42.2% vs. 37.0%; p = 0.002). Knowing someone with cancer (OR = 1.37, 95% CI: 1.21–1.55; p < 0.001) and visiting hospitals (OR = 1.46, 95% CI: 1.25–1.70; p < 0.001) were both associated with higher likelihood of having good awareness. However, male gender (OR = 0.80, 95% CI: 0.68–0.94; p = 0.006) and following a vegetarian diet (OR = 0.59, 95% CI: 0.48–0.73; p < 0.001) were both associated with lower likelihood of having good awareness.

Conclusion

Less than half of the study participants had a good awareness level of CRC signs and symptoms. Future education interventions are needed to improve public awareness of CRC in Palestine.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13285-8.

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Most cited references 48

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Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

Hyuna Sung, Jacques Ferlay, Rebecca Siegel … (2021)

This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.

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The global burden of cancer: priorities for prevention

Michael Thun, John Oliver DeLancey, Melissa M Center … (2009)

Despite decreases in the cancer death rates in high-resource countries, such as the USA, the number of cancer cases and deaths is projected to more than double worldwide over the next 20–40 years. Cancer is now the third leading cause of death, with >12 million new cases and 7.6 million cancer deaths estimated to have occurred globally in 2007 (1). By 2030, it is projected that there will be ∼26 million new cancer cases and 17 million cancer deaths per year. The projected increase will be driven largely by growth and aging of populations and will be largest in low- and medium-resource countries. Under current trends, increased longevity in developing countries will nearly triple the number of people who survive to age 65 by 2050. This demographic shift is compounded by the entrenchment of modifiable risk factors such as smoking and obesity in many low-and medium-resource countries and by the slower decline in cancers related to chronic infections (especially stomach, liver and uterine cervix) in economically developing than in industrialized countries. This paper identifies several preventive measures that offer the most feasible approach to mitigate the anticipated global increase in cancer in countries that can least afford it. Foremost among these are the need to strengthen efforts in international tobacco control and to increase the availability of vaccines against hepatitis B and human papilloma virus in countries where they are most needed.

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Author and article information

Contributors

Mohamedraed Elshami: mohamedraed.elshami@gmail.com

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 30 April 2022

Publication date PMC-release: 30 April 2022

Publication date Collection: 2022

Volume: 22

Electronic Location Identifier: 866

Affiliations

[1 ]GRID grid.443867.a, ISNI 0000 0000 9149 4843, Division of Surgical Oncology, Department of Surgery, , University Hospitals Cleveland Medical Center, ; 11100 Euclid Avenue, Lakeside 7100, Cleveland, OH USA

[2 ]Ministry of Health, Gaza, Palestine

[3 ]GRID grid.16662.35, ISNI 0000 0001 2298 706X, Faculty of Medicine, , Al-Quds University, ; Jerusalem, Palestine

[4 ]Almakassed Hospital, Jerusalem, Palestine

[5 ]GRID grid.133800.9, ISNI 0000 0001 0436 6817, Faculty of Pharmacy, , Al-Azhar University of Gaza, ; Gaza, Palestine

[6 ]Beit Jala Governmental Hospital (Al-Hussein), Bethlehem, Palestine

[7 ]GRID grid.442890.3, ISNI 0000 0000 9417 110X, Faculty of Medicine, , Islamic University of Gaza, ; Gaza, Palestine

[8 ]Palestine Medical Complex, Khanyounis, Palestine

[9 ]GRID grid.11942.3f, ISNI 0000 0004 0631 5695, Faculty of Medicine, , An-Najah National University, ; Nablus, Palestine

[10 ]GRID grid.440578.a, ISNI 0000 0004 0631 5812, Faculty of Dentistry, , Arab American University, ; Jenin, Palestine

[11 ]GRID grid.440580.d, ISNI 0000 0001 1016 7793, Faculty of Nursing and Health Sciences, , Bethlehem University, ; Bethlehem, Palestine

[12 ]GRID grid.440578.a, ISNI 0000 0004 0631 5812, Faculty of Allied Medical Sciences, , Arab American University, ; Jenin, Palestine

[13 ]GRID grid.133800.9, ISNI 0000 0001 0436 6817, Faculty of Medicine, , Al-Azhar University, ; Gaza, Palestine

[14 ]Faculty of Medicine, Al-Quds Abu Dis University Al-Azhar Branch of Gaza, Gaza, Palestine

[15 ]GRID grid.442890.3, ISNI 0000 0000 9417 110X, Faculty of Nursing, , Islamic University of Gaza, ; Gaza, Palestine

Article

Publisher ID: 13285

DOI: 10.1186/s12889-022-13285-8

PMC ID: 9063349

PubMed ID: 35501803

SO-VID: a65e411e-3f46-4d49-ab75-5aaea225d926

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 29 October 2021

Date accepted : 25 April 2022

Custom metadata

ScienceOpen disciplines: Public health

Keywords: colorectal cancer,awareness,signs,symptoms,early detection,early presentation,health education,palestine

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ScienceOpen disciplines: Public health

Keywords: colorectal cancer, awareness, signs, symptoms, early detection, early presentation, health education, palestine

Awareness of colorectal cancer signs and symptoms: a national cross-sectional study from Palestine

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Supplementary Information

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Global Health Next Generation Network

Most cited references 48

Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

The global burden of cancer: priorities for prevention

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