Low CRC screening uptake in Singapore: Men, women face different barriers

Singapore sees low colorectal cancer (CRC) screening rates, and the factors that influence screening compliance seem to differ between men and women, as shown in a study.

In a cohort of 633 individuals (male, 55.29 percent; Chinese, 82.9 percent) between 50 and 69 years of age (mean, 58.2 years) who were eligible for CRC screening, only 132 (20.9 percent) complied. Compliance rates were similar between men and women. [Asian Pac J Cancer Prev 2024;25:867-873]

Most participants (86.9 percent) viewed routine screening as beneficial, citing improved treatment outcomes (89.6 percent) and reduced mortality rates (77.6 percent). Despite this, both men and women lacked awareness of specific screening guidelines.

Less than a third of participants (28.3 percent) were aware that CRC screening is recommended to begin at age 50 years. Furthermore, there was a gap between knowing the tests exist and when to get them. Of the 52.0 percent and 44.7 percent of participants who had awareness of colonoscopy and faecal immunochemistry test (FIT) as screening options, only 15.2 percent and 27.5 percent had knowledge of recommended screening intervals, respectively.

In multivariable logistic regression models, participants who were aware of the CRC screening guidelines were more likely to comply to them. This was true for both men (odds ratio [OR], 1.99; 95 percent confidence interval [CI], 1.62–2.46) and women (OR, 2.69; 95 percent CI, 2.01–3.61).

“Despite [the fact that] majority of the participants held favourable beliefs on cancer screening, the compliance rate on CRC screening in our surveyed population … falls below the levels reported in previous studies in Singapore,” the investigators noted. [Front Oncol 2021;11:684917; BMC Public Health 2013;13:677]

“Even with the consideration of the potential impact of the COVID-19 pandemic, during which some participants might have postponed their CRC screenings, the observed compliance rate remains unacceptably low. This highlights the pressing need to further understand the underlying factors that influence compliance with CRC screening in Singapore,” they added.

Gender-specific differences

Notably, there were gender disparities in several factors associated with CRC screening compliance.

First was that older age correlated with higher CRC screening compliance among men, but not women. Men in the 55-years-and-older age groups were roughly three times more likely to comply with CRC screening guidelines compared with those in the 50–54-years age group (55–59 years: OR, 3.12; 95 percent CI, 1.25–7.80; 60–64 years: OR, 2.99; 95 percent CI, 1.12–7.99; 65–69 years: OR, 3.53; 95 percent CI, 1.21–10.28).

“Most noncompliant male participants in the 50–54-years age group cited ‘feeling healthy’ or ‘no need to undergo screening’ as the primary justifications for their nonparticipation,” the investigators noted.

Meanwhile, among women, compliance with CRC screening was positively associated with the belief in the necessity of routine cancer screening for early cancer detection (OR, 12.07; 95 percent CI, 1.39–105.00), having a family history of cancer (OR, 2.52; 95 percent CI, 1.20–5.31), and compliance with breast cancer screening (OR, 3.12; 95 percent CI, 1.35–7.24).

“Previous research has indicated that women tend to prioritize healthcare seeking and preventive measures more than men. This could explain the higher likelihood of compliance with CRC screening among women who believe in the necessity of routine cancer screening,” the investigators said. [BMC Public Health 2009;9:213; BMC Fam Pract 2016;17:38]

“On the other hand, men may face unique challenges or barriers that affect their willingness to comply with CRC screening, such as higher levels of cancer stigma compared to women… Interventions for men should address a diverse array of factors that potentially affect their CRC screening compliance,” they added. [BMC Cancer 2019;19:566]

To achieve optimal participation in CRC screening, the investigators recommended that interventions be tailored to address the mentioned gender-specific factors and that education be integrated on screening guidelines as a core element of cancer prevention programs for the entire eligible population.