Raising awareness: The key to improving outcomes of colorectal cancer
Dr Sunu Alice Cherian1, Nisha Kurian1
1. Pushpagiri Centre for Evidence Based Practice: A JBI Centre of Excellence, Tiruvalla, Kerala, India
Introduction
Colorectal cancer (CRC) is a major public health issue globally. It ranks as the third most common cancer worldwide, and is the second leading cause of cancer-related deaths. Hence it is important to understand its causes, ways of prevention, and early detection.
What is colorectal cancer?
CRC arises in the colon or rectum, which forms a part of the digestive system. This begins as polyps or growths on the inner lining of the colon or rectum, which develop into cancer over time. Factors that increase the risk of developing CRC include age, family history, dietary habits, physical inactivity, and lifestyle choices such as smoking and alcohol consumption. CRC can be prevented or treated more effectively through community education, screening, and early detection programs.
The increase in CRC cases has been attributed to changing lifestyle and dietary patterns, especially in high-income countries, whereas in lower-income countries, it is attributed to urbanization and changes in diets. This highlights the need for a global response to combat CRC effectively.
The problem
A significant problem in the prevention and/or early detection of CRC is the lack of public awareness regarding its risk factors and warning signs. Factors such as insufficient educational resources, cultural stigma, and limited outreach efforts play a significant role, particularly in rural and semi-urban areas where understanding of cancer remains minimal.
Many individuals overlook or misinterpret the warning signs, such as unexplained weight loss, persistent changes in bowel habits, or blood in stools. These signs may be viewed as minor digestive issues until it is too late for effective treatment. Awareness campaigns must provide clear and effective information that dispels myths surrounding CRC and encourages people to take proactive health-seeking behavior. Additionally, the lack of accessible statistics and educational programs tailored to specific regions further compounds these issues. While health care facilities may offer treatment options, their preventive capabilities largely depend on community knowledge about CRC and its risk factors.
The search for answers
We conducted a study in Kerala, India, to assess the level of awareness among adults regarding the risk factors and warning signs associated with CRC. We sought to answer the following key questions: What do adults know about CRC risk factors? Are they familiar with the warning signs? Which demographics exhibit lower awareness levels?
We gathered data using surveys administered to a representative sample of adults in semi-urban and rural south Kerala, across various socio-economic backgrounds and educational levels. The study focused on several aspects, including dietary habits, lifestyle practices such as exercise, family history of CRC, age, stress, infections of the intestines, diabetes mellitus, and other cancers. Warning signs that were considered in the study included abdominal pain/mass, weight loss, fatigue, loss of appetite, changes in bowel habits, anemia, and blood in stools.
Most participants showed a very low level of awareness concerning both risk factors and warning signs. While some recognized established risk factors (e.g., lifestyle practices, family history) and warning signs (e.g., loss of appetite, changes in bowel habits), many failed to recognize both risk factors and warning signs. Notably, women were found to have lower awareness than men.
Potential global impact
The implications of this study are significant beyond the local context, emphasizing the importance of CRC awareness globally. As lifestyle-related diseases become more widespread, effective strategies to educate communities about risk factors and warning signs are critical components of public health initiatives.
Lessons learned from this awareness study can inform similar efforts in other regions of India and globally, where public knowledge about CRC is limited. Understanding the cultural beliefs, social norms, and barriers to health care access can lead to the development of more community-centric education programs targeting people at high risk of CRC.
Moreover, focusing on screening facilitated by community awareness can significantly reduce the disease and deaths associated with CRC, leading to better health care outcomes. By implementing effective screening programs and preventive measures, countries can expect to see a reduction in CRC incidence and mortality rates. Reducing CRC cases can not only improve health, but also alleviate the economic burden.
Lessons learned
Regular screening for CRC may not be feasible in low- and middle-income countries, as practiced in high-income countries. As such, public education on the risk factors and warning signs of CRC can be a more practical and cost-effective approach in these countries.
Limited access to healthcare services also remains a barrier. Many people in rural and semi-urban areas often face logistical challenges in reaching diagnostic facilities and may avoid seeking medical help altogether due to perceived costs, time constraints, or the absence of nearby health care institutions.
Effective community engagement must recognize the importance of collaboration among healthcare providers, local authorities, and advocacy groups. They should share the responsibility of educating the public to overcome cultural barriers and promote an environment conducive to open discussions about health.
Next steps
To strengthen evidence about the lack of awareness leading to increased morbidity and mortality due to CRC, more primary studies are essential from different parts of the world, especially from LMICs. Intervention studies are also required to show the effect of public education in the prevention and early detection of CRC. These must follow a systematic reviews and meta-analysis to draw evidence from these studies.
To build on current efforts and effectively combat CRC, promoting public awareness, strengthening screening initiatives, enhancing research funding, prioritizing health equity, and regularly updating guidelines are all important.
Artificial Intelligence and social media platforms can be leveraged for creating public awareness and help in screening. Mobile applications (e.g., ColorApp and MyLife Cloud) have been found to be useful in creating awareness and increasing CRC screening. Social media platforms such as Facebook and Twitter are helpful, but the users have to verify the information is credible, which can happen only if public institutions and organization participate in social media and provide reliable information. Local community networks such as Residents’ Associations and Self-help Groups or village festival gatherings can be used for effectively communicating the information either through street-play or flash mob or through social media platforms.
Conclusion
The increase in CRC cases requires continuous public education to improve the awareness of its risk factors and warning signs. Both old and new methods /technologies can be effectively used for public education. By improving awareness, early diagnosis and prevention, particularly in regions where regular screening is not accessible or cost effective can be facilitated.
References
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To link to this article - DOI: https://doi.org/10.70253/UCJY7591
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