Colorectal Cancer Screening using Immunochemical Faecal Occult Blood Testing (iFOBT) in Urban-Poor Communities in Cheras, Malaysia: A Cross-Sectional Study.

Abstract

Background: Colorectal cancer (CRC) is one of the most common cancers globally, with the immunochemical faecal occult blood test (iFOBT) frequently used for population level screening. This study evaluated CRC screening uptake among urban-poor individuals aged 40-65, assessed their knowledge of CRC risk factors and symptoms before and after an educational programme, and identified determinants of polyps and CRC within this group.

Methods: A cross-sectional study recruited 577 individuals from seven People's Residential Project (PPR) areas in Cheras, Kuala Lumpur and Malaysia Madani Carnival between March 2022 and July 2023. Inclusion criteria were age 40-65 and smartphone ownership, excluding those with CRC history, acute gastritis, inflammatory bowel disease, or recent CRC screening. The iFOBT was administered, followed by questionnaires and educational talks. A follow-up questionnaire was conducted via phone two weeks post-programme.

Results: Overall, 321 participants fulfilled the eligibility criteria. Most iFOBT-positive participants were in their 50s (median [interquartile range, IQR]: 56 [16]), female (65%), 86.3% non-smokers, and 62.5% with moderate CRC risk based on the Asia Pacific Colorectal Screening (APCS) Score, showing no significant differences from iFOBT-negative participants. Among the 267 who returned iFOBT kits, 30.0% tested positive, with 28.8% undergoing colonoscopy. Polyps and CRC were detected in 21.74% and 4.35% of the participants, respectively. The mean knowledge score on CRC symptoms was significantly lower post-programme, with no significant change in awareness of CRC risk factors.

Conclusion: Detection rates for polyps and CRC are low. Awareness of CRC symptoms is higher pre-screening than post-screening, highlighting challenges in conducting CRC education in urban-poor communities.