In this issue of the Journal, the authors of “Effect of public knowledge, attitudes, and behavior on willingness to undergo colorectal cancer screening using the health belief model,” tried to identify factors associated with acceptance to undergo colorectal cancer screening in the Kingdom of Saudi Arabia.[1] This is a vital piece of information for any national body devising a policy for colorectal cancer screening in the Kingdom. Colorectal cancer screening is financially and professionally demanding and it may face total failure or huge waste of resources if the public did not buy in.
It is well accepted internationally that colorectal cancer screening should start at the age of 50 years since cost-effectiveness is very low if commenced below that age.[2] The sample selected in the article included 500 participants, but it did not target specifically the age group 50 years and older. That would have been very helpful in formulating an opinion about colorectal cancer screening in the Kingdom. Secondly, there was an inherent bias in the selection method of the participants as they were recruited from malls. Most malls are visited by younger age groups, mobile individuals, and predominantly of good financial background. The mean age of the sample was 41 years, which indicated that those concerned with screening were under-represented.
Despite these biases, the authors reported very interesting findings, with the most striking being that 68.9% of the participants accepted colonoscopy as a screening tool and this number did not drop even if they paid for the investigation. This important finding cannot be ignored and may allay the fears of the national policy makers when devising a screening policy for colorectal cancer. One should compare this finding with the result of a multicenter trial from the United Kingdom where acceptability for flexible sigmoidoscopy was only 55%.[3]
The second important finding was that only a minority, 38.4%, thought colonoscopy was painful. Moreover, 56.6% did not think colonoscopy was embarrassing and 65.6% did not think it was harmful. This finding fortifies the first one that Saudis look at screening colonoscopy favorably and are very receptive to its usage in any screening program for colorectal cancer.
The third finding is a global measure of how Saudis view screening for colorectal cancer and clinches their acceptability for any screening program. The authors reported that 70.7% of the surveyed population were willing to undergo a screening test for colorectal cancer.
The fourth finding is unfortunately a call for the concerned bodies to develop a national policy on the screening for colorectal cancer in Saudi Arabia. Less than 7% were screened for colorectal cancer in the age group 50-60 years, contrasted with 61% that were screened in the same age groups in Alabama, United States.[4] The low screening rate among Saudis is mainly due to the fact that there is no national screening program for colorectal cancer in the Kingdom.
The fifth finding busts a myth among the medical community in the Kingdom is that Saudis do not wish to be informed if they were diagnosed to have colorectal cancer. In this survey of 500 individuals, 63.3% disagreed with this notion and moreover, a substantial proportion showed strong disagreement. This is the first time, a survey of that magnitude reverses our understanding of the Saudi population and its attitude toward breaking bad news. Probably, one should use this finding in any argument against withholding information with regard to cancer in daily practice when dealing with Saudi patients.
REFERENCES
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