Public Awareness and Barriers to Seek Medical Advice for Colorectal Cancer in the Gaza-Strip: A Cross-Sectional Study

Background: Raising awareness of colorectal cancer (CRC) symptoms for early recognition, reduction of lifestyle risk factors, and removing barriers to seek medical help could lower its mortality. This study aimed to assess the level of public awareness of CRC in the Gaza-Strip. Methods: This is a cross-sectional study conducted at three hospitals and ten high schools between September and October 2017. The Arabic version of the Bowel Cancer Awareness Measure (BoCAM) questionnaire was used to evaluate awareness of CRC symptoms, risk factors, and barriers to seek medical help. Adults (aged ≥18 years) in the three hospitals, and adolescents (aged 15-17 years) in ten schools were recruited for face-to-face interviews to complete the BoCAM. Findings: Of 3172 potential participants, 3080 completed the BoCAM (response rate = 97·1%). Among them, 1578 (51·2%) were adult and 1614 (52·4%) were females. Persistent abdominal pain was the most commonly recognized CRC symptom (n=1899, 61·7%). In total, 2177 (70·7%) were not confident in recognizing CRC symptoms. Having a bowel disease was the most frequently recognized CRC risk factor (n= 1456, 47·3%). The overall mean score for recognizing CRC symptoms was 4·3 ± 2·3 out of 9 and for risk factors 8·0 ± 3·1 out of 16. Emotional barriers were the most commonly reported barriers to seek medical help with feeling worried about doctor's findings as the first reason (n= 1522, 49·4%). Interpretation: Public awareness of CRC is suboptimal in Gaza. Improving CRC awareness (e.g., educational outreach) is needed, including in local schools. Funding Statement: No funding was received for this study. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study was approved from the Department of Human Resources Development at the Ministry of Health in the Gaza-Strip, the authorized body to provide approvals for clinical studies.