Knowledge and Perception toward Colorectal Cancer Sreening in East of Iran

Document Type : Original Article


Research and Education Department, Razavi Hospital, Mashhad, Iran


Colorectal Cancer (CRC) is the third most common cancer in Iran and its early detection is necessary. This study is based on perception of people in the east of Iran toward CRC screening.
In a cross-sectional study, 1060 randomly selected individuals who referred to Razavi Hospital of Mashhad, Iran, between September the 1st, 2012 and February the 28th, 2013 as patients or their visitors involved in an interview to fill a questionnaire on CRC screening.
The participants’ age ranged from 40 to 88 years (mean= 55). More than 90% had no knowledge of CRC and screening tests. The most cited reasons for not having screening tests were “did not have any problem” and “did not think it was needed”. Although, older people had more knowledge of CRC (P= 0.033), there was no relationship between gender, health insurance status, family history of individuals and their knowledge about CRC (P> 0.050). Employment, education and higher income had positive effect on the perception of people toward CRC screening (P< 0.050).
Lack of knowledge in people in lower socio-economical class with limited literacy is the most important barrier to CRC screening. As such, designing educational programs involving physicians and media is important to improve CRC screening rates.


Main Subjects

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011; 61: 69–90. doi: 10.3322/caac.20107
    Sung JJ, Choi SY, Chan FK, Ching JY, Lau JT, Griffiths S. Obstacles to colorectal cancer screening in Chinese: a study based on the health belief model. Am J Gastroenterol 2008; 103: 974–81. doi: 10.1111/j.1572-0241.2007.01649.x
  2. Tu SP, Taylor V, Yasui Y, Chun A, Yip MP, Acorda E, et al. Promoting culturally appropriate colorectal cancer screening through a health educator. Cancer 2006; 107: 959–66. doi: 10.1002/cncr.22091
    Pourhoseingholi MA, Zali MR. Colorectal cancer screening: Time for action in Iran. World J Gastrointest Oncol 2012; 4: 82–3. doi: 10.4251/wjgo.v4.i4.82
  3. Consolo P, Luigiano C, Strangio G, Scaffidi MG, Giacobbe G, Di Giuseppe G, et al. Efficacy, risk factors and complications of endoscopic polypectomy: ten year experience at a single center. World journal of gastroenterology: WJG 2008; 14: 2364. doi: 10.3748/wjg.14.2364
    Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J  Med 2012; 366: 687–96.  doi:  10.1056/NEJMoa1100370
  4. Smith RA, Cokkinides V, Brawley OW. Cancer Screening in the United States, 2012 A Review of Current American Cancer Society Guidelines and Current Issues in Cancer Screening. CA Cancer J Clin 2012; 62: 129-42. doi: 10.3322/caac.20143
  5. Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, et al. Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008; 58: 130–60. doi: 10.3322/ca.2007.0018
  6. Winawer S, Fletcher R, Rex D, Bond J, Burt R, Ferrucci J, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale—update based on new evidence. Gastroenterology 2003; 124: 544–60. doi: 10.1053/gast.2003.50044
  7. Salimzadeh H, Delavari A, Montazeri A, Mirzazadeh A. Knowledge and practice of iranians toward colorectal cancer, and barriers to screening. Int J Prev Med 2012; 3: 29–35.
  8. O’Malley A, Beaton E, Yabroff K, Abramson R, Mandelblatt J. Patient and provider barriers to colorectal cancer screening in the primary care safety-net. Prev Med 2004; 39: 56. doi: 10.1016/j.ypmed.2004.02.022
  9. James AS, Campbell MK, Hudson MA. Perceived barriers and benefits to colon cancer screening among African Americans in North Carolina: how does perception relate to screening behavior? Cancer Epidemiol Biomarkers Prev 2002; 11: 529–34.
  10. Green PM, Kelly BA. Colorectal cancer knowledge, perceptions, and behaviors in African Americans. Cancer Nurs 2004; 27: 206–15.  doi: 10.1097/00002820-200405000-00004
  11. Jones RM, Woolf SH, Cunningham TD, Johnson RE, Krist AH, Rothemich SF, et al. The relative importance of patient-reported barriers to colorectal cancer screening. Am J Prev Med 2010; 38: 499–507.
  12. Tessaro I, Mangone C, Parkar I, Pawar V. Peer reviewed: knowledge, barriers, and predictors of colorectal cancer screening in an appalachian church population. Prev Chronic Dis 2006; 3: A123.
  13. Berkowitz Z, Hawkins NA, Peipins LA, White MC, Nadel MR. Beliefs, risk perceptions, and gaps in knowledge as barriers to colorectal cancer screening in older adults. J Am Geriatr Soc 2008; 56: 307–14. doi: 10.1111/j.1532-5415.2007.01547.x
  14. Holmes-Rovner M, Williams GA, Hoppough S, Quillan L, Butler R, Given CW. Colorectal cancer screening barriers in persons with low income. Cancer Pract 2002; 10: 240–7. doi: 10.1046/j.1523-5394.2002.105003.x
  15. Tang TS, Solomon LJ, McCracken LM. Barriers to Fecal Occult Blood Testing and Sigmoidoscopy Among Older Chinese-American Women. Cancer Pract 2001; 9: 277–82. doi: 10.1046/j.1523-5394.2001.96008.x
  16. Klabunde CN, Schenck AP, Davis WW. Barriers to colorectal cancer screening among Medicare consumers. Am J Prev Med  2006; 30: 313. doi: 10.1016/j.amepre.2005.11.006
  17. Wee CC, McCarthy EP, Phillips RS. Factors associated with colon cancer screening: the role of patient factors and physician counseling. Prev Med 2005; 41: 23. doi:10.1016/j.ypmed.2004.11.004
  18. Greiner KA, Born W, Nollen N, Ahluwalia JS. Knowledge and perceptions of colorectal cancer screening among urban African Americans. J Gen Intern Med 2005; 20: 977–83. doi: 10.1007/s11606-005-0244-8
  19. Goodman MJ, Ogdie A, Kanamori MJ, Canar J, O’Malley AS. Barriers and facilitators of colorectal cancer screening among mid-Atlantic Latinos: Focus group findings. Ethn Dis 2006; 16: 255–61.
  20. McCaffery K, Wardle J, Waller J. Knowledge, attitudes, and behavioral intentions in relation to the early detection of colorectal cancer in the United Kingdom. Prev Med 2003; 36: 525–35. doi: 10.1016/s0091-7435(03)00016-1
  21. Koo JH, Arasaratnam MM, Liu K, Redmond DM, Connor SJ, Sung JJY, et al. Knowledge, perception and practices of colorectal cancer screening in an ethnically diverse population. Cancer Epidemiol 2010; 34: 604–10. doi: 10.1016/j.canep.2010.05.013
  22. Omran S, Ismail AA. Knowledge and beliefs of Jordanians toward colorectal cancer screening. Cancer Nurs 2010; 33: 141. doi: 10.1097/ncc.0b013e3181b823f3
  23. Beydoun HA, Beydoun MA. Predictors of colorectal cancer screening behaviors among average-risk older adults in the United States. Cancer Causes Control 2008; 19: 339–59. doi: 10.1007/s10552-007-9100-y
  24. Roozitalab M, Moatari M, Gholamzadeh S, SaberiFiroozi M, Zare N. [The effect of health belief on participation of the official administrative personnel in colorectal cancer screening programs in Shiraz University of Medical Sciences: 2004]. Govaresh 2012; 13: 19–24.
  25. Libbuti SK, Saltz LB, Willett CG. Cancer of the colon. In: DeVita VT, TS Lawrence, SA Rosenberg, editors. Cancer Principles and Practice of Oncology. 9th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2011. p. 1084–90.
  26. Janz N, Champion V, Strecher V, Glanz K, Rimer B, Lewis F. The health belief model.In: Glanz k, Rimer BK, Lewis FM, editors.Health behavior and health education: Theory, research and practice. San Francisco: Jones and Bartlett;2002. p. 45-66. doi: 10.1177/109019819101800409
  27. CDC Vital Signs [internet].  Atlanta GA: Centers for Disease Control and Prevention; 2014 [updated 2013 May 11; cited 2014 April 19]. Available from:
  28. Guessous I, Dash C, Lapin P, Doroshenk M, Smith RA, Klabunde CN. Colorectal cancer screening barriers and facilitators in older persons. Prev Med 2010; 50: 3. doi: 10.1016/j.ypmed.2009.12.005
  29. Miller D, Brownlee C, McCoy T, Pignone M. The effect of health literacy on knowledge and receipt of colorectal cancer screening: a survey study. BMC Fam Pract 2007; 8: 16.doi: 10.1186/1471-2296-8-16
  30. Koo JH, Leong RWL, Ching J, Yeoh KG, Wu DC, Murdani A, et al. Knowledge of, attitudes toward, and barriers to participation of colorectal cancer screening tests in the Asia-Pacific region: a multicenter study. Gastrointest Endosc 2012; 76: 126–35. doi: 10.1016/j.gie.2012.03.168
    Janz NK, Wren PA, Schottenfeld D, Guire KE. Colorectal cancer screening attitudes and behavior: a population-based study. Prev Med 2003; 37: 627–34. doi: 10.1016/j.ypmed.2003.09.016
  31. Gennarelli M, Jandorf L, Cromwell C, Valdimarsdottir H, Redd W, Itzkowitz S. Barriers to colorectal cancer screening: inadequate knowledge by physicians. Mt Sinai J Med 2005; 72: 36. doi: 10.1016/s0016-5085(01)83002-x
  32. Smith A, Young GP, Cole SR, Bampton P. Comparison of a brush-sampling fecal immunochemical test for hemoglobin with a sensitive guaiac-based fecal occult blood test in detection of colorectal neoplasia. Cancer 2006; 107: 2152–9.doi: 10.1002/cncr.22230