Department of Social and Preventive Medicine, Centre for Epidemiology and Evidenced-Based Practice, Faculty of Medicine, Lembah Pantai, Kuala Lumpur, Malaysia.
Batu 14 Health Clinic, Jalan Hulu Langat, Selangor, Malaysia.
JCO Glob Oncol. 2021 Feb;7:333-341. doi: 10.1200/GO.20.00460.
The Malaysian Ministry of Health had launched free opportunistic screening for colorectal cancer using immunochemical fecal occult blood test (iFOBT) targeting the average-risk individuals since 2014. This study aims to determine factors associated with colorectal cancer screening using iFOBT among the average-risk Malaysian population.
A cross-sectional study was conducted at five government-run health clinics in the state of Selangor. Adults with an average risk of colorectal cancer (age > 50 years, asymptomatic, and no family history of colorectal cancer) were recruited using systematic random sampling. An interviewer-administered questionnaire adapted from the Cancer Awareness Measure and Health Belief Model was used.
The median age of participants was 61 years (interquartile range, 56 to 66). Almost 60% of participants indicated their willingness to be screened. However, only 7.5% had undergone iFOBT. Good knowledge of risk factors of colorectal cancer, perceived susceptibility to the disease, and the doctor's recommendation were associated with increased willingness to be screened: adjusted odds ratio (aOR), 1.66 (95% CI, 1.12 to 2.46); aOR, 1.70 (95% CI, 1.08 to 2.70); and aOR, 5.76 (95% CI, 2.13 to 15.57), respectively. Nevertheless, being elderly (aOR, 0.67; 95% CI, 0.45 to 0.99) and high negative perception toward the testing method (iFOBT) (aOR, 0.12; 95% CI, 0.05 to 0.30) were independently associated with lower willingness to be screened. Multivariable analysis within the average-risk individuals who were willing to be screened for colorectal cancer showed that the doctor's recommendations remained as an important cue for positive action, whereas negative perception toward the test was a significant barrier to the actual uptake of iFOBT.
The present findings must be factored in when tailoring colorectal cancer screening promotion activities in multiethnic, middle-income settings.
自 2014 年以来，马来西亚卫生部针对一般风险人群开展了免费的结直肠癌机会性筛查，使用免疫化学粪便潜血试验（iFOBT）。本研究旨在确定一般风险马来西亚人群使用 iFOBT 进行结直肠癌筛查的相关因素。
在雪兰莪州的五家政府运营的诊所进行了一项横断面研究。使用系统随机抽样招募年龄在 50 岁以上、无症状且无结直肠癌家族史的一般风险成年人。使用改编自癌症意识量表和健康信念模型的问卷调查进行采访。
参与者的中位年龄为 61 岁（四分位距，56 至 66 岁）。近 60%的参与者表示愿意接受筛查。然而，只有 7.5%的人接受了 iFOBT。对结直肠癌危险因素的良好了解、对疾病的易感性感知以及医生的建议与增加筛查意愿有关：调整后的优势比（aOR）分别为 1.66（95%可信区间，1.12 至 2.46）、1.70（95%可信区间，1.08 至 2.70）和 5.76（95%可信区间，2.13 至 15.57）。然而，年龄较大（aOR，0.67；95%可信区间，0.45 至 0.99）和对检测方法（iFOBT）的高度负面看法（aOR，0.12；95%可信区间，0.05 至 0.30）与较低的筛查意愿独立相关。在愿意接受结直肠癌筛查的一般风险人群中进行的多变量分析表明，医生的建议仍然是采取积极行动的重要线索，而对测试的负面看法是实际采用 iFOBT 的重要障碍。
在制定多民族、中等收入环境中的结直肠癌筛查促进活动时，必须考虑到这些发现。
