The immunochemical fecal occult blood test (iFOBT) that screens for colorectal cancer is offered free in government clinics in Malaysia, but 41.1% of study respondents aren’t aware of the zero cost.
KUALA LUMPUR, April 30 — A study found that although more than half of respondents were willing to undergo colorectal screening, only 7.5 per cent actually went ahead to get screened.
The Malaysian-based cross sectional study conducted by University Malaya, published in the American Society of Clinical Oncology journal, found that 51.4 per cent of the respondents were willing to undergo the immunochemical fecal occult blood test (iFOBT), where the stool sample of an individual is checked for hidden or occult blood which could be a sign of colorectal cancer.
The study was conducted in Selangor in 2019 among 508 respondents above the age of 50 years who were asymptomatic with no family history of colorectal cancer. Seventy-five per cent of participants of the study were from the bottom 40 per cent (B40) income earners group, while more than 90 per cent had comorbidities.
Although 51.4 per cent said they are willing to undergo the iFOBT test, only 7.5 per cent of them had actually undergone the test.
Among those who said that they were not willing to undergo iFOBT, 59 per cent said that they were asymptomatic hence did not require testing, 15 per cent said they preferred to wait for their doctor’s recommendation, while five per cent of the respondents cited additional reasons such as, lack of knowledge of the test and the screening process is dirty.
In a separate analysis, it was found that 65 per cent of the respondents had high-to-moderate negative perception towards iFOBT as a screening tool as almost half required them to handle stool. Twenty-one per cent agreed that it was embarrassing, while only 10 per cent perceived that iFOBT was harmful or painful.
It was also found that males (51.3 per cent) were more willing to be screened for colorectal cancer as compared to females (48.7 per cent). However, the study found that education status was not associated with the willingness of an individual to be screened for colorectal using the iFOBT method.
iFOBT has been offered for the public in government health clinics in Malaysia for free. But 41.1 per cent of respondents were not aware of the zero cost, while 30.9 per cent were unaware of the availability of the test in government clinics.
The study said that in a multicultural setting, open conversations between health care professionals and patients may not only be useful in removing the taboo associated with handling the faeces, but also help patients prepare themselves in handling the test with ease.
“Following multi-variable analysis, it was found that good knowledge of risk factors, perceived susceptibility, and recommendation from physicians were independent facilitators associated with willingness to be screened for colorectal cancer using iFOBT,” the study said.
The study said as doctors may not be routinely recommending iFOBT to average risk patients during primary care encounters because they are busy due to high patient load, educational videos on colorectal cancer in the waiting room can help improve the shared decision which also lessens the time with the physicians. Besides physicians, health advisors can also be recruited to educate the public.
Besides that, the study found that 74 per cent of the respondents did not perceive themselves to be susceptible to colorectal cancer, despite them being aware that colorectal cancer is severe.
“These findings indicate a lack of awareness that individuals with colorectal cancer might be asymptomatic at earlier stages,” researchers said, while pointing out that 40 per cent of the respondents did not possess good knowledge about the risk factors of colorectal cancer.
“Policy initiatives are necessary to increase the awareness of colorectal cancer in the com- munity with the development of structured government and community-endorsed messages for the general public about risk factors of colorectal cancer, who should undergo screening, and modalities of colorectal cancer screening”.
