Determinants of colorectal carcinoma screening amongst patients attending a public primary care health centre in Johor Bahru

INTRODUCTION: Colorectal cancer (CRC) is one of the major causes of cancer-related mortality in Malaysia. Early screening has proven to be effective in reducing mortality due to CRC. The Malaysian CRC Clinical Practice Guidelines (2017) recommends that immunochemical faecal occult blood test (iFOBT) as the best non-invasive method for screening CRC in asymptomatic or average risk population. Outcome data on CRC screening program in the community is scarce. This study was to evaluate the prevalence and determinants of CRC among patients attending a public primary care health centre who underwent the screening program.

MATERIALS AND METHODS: Reviews of CRC Screening Registry and medical case record were conducted on patients who underwent CRC screening program at Klinik Kesihatan Mahmoodiah, Johor Bahru (KKMJB) from 2016 to 2018 period. Sociodemographic data, clinical profile of patients, iFOBT results and colonoscopy outcomes were extracted for analysis. Descriptive and inferential statistics were performed using IBM SPSS version 25.

RESULTS: Out of 591 registered patients, 584 were included for analysis. Majority of the screened individuals were males (2016-2017) compared to females (2018). Chinese were most screened individuals in 2016 [94 (46.8%)] and 2017[87 (61.7%)]. Percentage of patients with appropriate indicators for screening and underwent colonoscopy for positive iFOBT were highest recorded in 2018 (74.7%, 58.8% respectively). Prevalence of CRC among those screened with iFOBT was 1 per cent for 2017 and 2018. Adherence to annual screening with iFOBT ranged between 1.1% (2016)- 2.2% (2018). Significant association observed between gender and iFOBT results, χ2(df)= 4.747, p=0.029 (2018). Median age and ethnicity were not significantly associated with iFOBT results (p>0.05) CONCLUSION: Screening for CRC among average risk groups in primary care should focus on recruiting female patients/clients as an organised activity. Prevalence of CRC detected from screening with iFOBT was 1 per cent. CRC screening programs should focus on proportion of iFOBT positive patients progressing to receive definitive colonoscopy and complying to annual surveillance screening.