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Key study urges awareness-building as ‘cornerstone’ of cancer control
View(s):- Poor public awareness on colorectal malignancies impede early detection for better survival outcomes
By Kumudini Hettiarachchi
It creeps up on unsuspecting people who not only ignore the tell-tale signs but are simply ignorant of the red flags.
Prof. Dakshitha Wickramasinghe
“Substantial gaps” have been found with regard to public awareness on colorectal cancer, by a new study, a first using a validated tool, conducted at the largest tertiary care institution – the National Hospital of Sri Lanka (NHSL). A validated tool is an assessment instrument such as a survey, scale or software that has been tested rigorously.
Colorectal cancer is among the five most common cancers in Sri Lanka, with an age-standardised incidence rate of 10.2 per 100,000 reported in 2019. Recent data from the National Cancer Registry have highlighted an upward trend in incidence and mortality (deaths).
“This emphasises the growing national burden,” points out Prof. Dakshitha Wickramasinghe, who was part of the study, ‘Awareness of colorectal cancer symptoms and risk factors: a cross-sectional study at the largest tertiary care centre in Sri Lanka’.
The study has been published in the prestigious, peer-reviewed British Medical Journal (BMJ) Open, in October last year (2025).
Prof. Dharmabandhu N. Samarasekera
The study team, along with Prof. Wickramasinghe, comprised Dr. D.G. Wickramasinghe, Dr. T. Nugaliyadda, Dr. Piyumi M. Perera and Prof. Dharmabandhu N. Samarasekera, all from the Department of Surgery, Faculty of Medicine, University of Colombo.
Dr. D.G. Wickramasinghe
Underscoring that colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer-related mortality globally, Prof. Wickramasinghe says that an estimated 1.9 million newcases and 935,000 deaths have been recorded in 2020. The global burden is projected to increase, reaching around 3.2 million cases and1.6 million deaths by 2040.
The study had been conducted at the NHSL’s outpatient clinics, with 506 adults over 18 years of age taking part, over the period May 2022 to May 2023. The participants included clinic attendees and those accompanying the attendees, with the exclusion criteria being those with gastrointestinal conditions or malignancies (cancers).
These participants (269 or 53.2% males and 237 or 46.8% females) had been requested to answer an interviewer-administered, culturally-adapted Bowel Cancer Awareness Measure (BCAM) questionnaire.
According to Prof. Wickramasinghe, the findings were disturbing.
- Of the 506 participants, slightly over half – 297 or 58.7% could not name a single symptom of colorectal cancer unprompted.
- The ‘most identified’ symptom without prompting was blood in stools. That too was identified only by 93 or 18.4%. However, prompted awareness had shown a marked improvement with 381 (75.3%) identifying blood in stools when provided with a list.
- When prompted with symptom-related statements, 365 (72.1%) also identified bleeding from the back passage as signs of colorectal cancer.
Dr. T. Nugaliyadda
- Other frequently recognised symptoms included unexplained weight loss by 329 (65%) and pain in the back passage by 311 (61.5%).
- The identification of other commonly unprompted symptoms was also poor: abdominal pain by only 55 (10.9%) and constipation by only 49 (9.7%).
- Persistent abdominal pain had the lowest recognition rate by 44 (8.7%).
- As in prior studies, participants had recognised overt or widely publicised symptoms more readily than subtle ones. Fatigue, unexplained weight loss and anaemia, early signs, had been least recognised.
With regard to ‘commonly recognised’ risk factors and awareness of risk factors, the study had found:
- Nearly half – 224 or 44.3% could not identify any colorectal risk factors unprompted.
- The most commonly recognised risk factors, when prompted, had been excessive alcohol intake by 368 people (72.7%) and low-fibre intake by 324 people (64.0%).
- The most frequently recalled unprompted factors included low dietary fibre intake by 79 (15.6%); alcohol consumption by 71 (14.0%); and smoking by 59 (11.7%).
- When provided statements about risk factors, 368 participants (72.8%) had agreed that alcohol consumption increases the risk, while 379 (74.9%) identified frequent consumption of deep-fried foods and 324 (64.0%) recognised low-fibre intake as a risk factor.
- Increasing age was recognised by 208 participants (41.1%).
- In contrast, non-modifiable factors (age and family history) were widely recognised, suggesting cancer is often perceived as genetic or ‘fate-driven’, with less appreciation of lifestyle influences.
Dr. Piyumi M. Perera
Prof. Wickramasinghe explained that ‘awareness’ was defined as the ability to recognise colorectal cancer symptoms and risk factors either spontaneously (unprompted) or when prompted with a list, rather than medical knowledge or familiarity with screening.
Females (237) and those older in age (34) were “significantly” associated with higher symptom awareness; while it was lower among participants with lower education and the unemployed, he said.
Reiterating that unprompted awareness of colorectal cancer symptoms and risk factors was suboptimal in this population, with marked gaps in spontaneous recall, he urges that public health campaigns should target men, younger adults and individuals with lower education to enhance awareness among them, promoting earlier detection to improve survival outcomes and prevent death.
A lack of awareness and emotional barriers such as stigma, fear and embarrassment can also delay help-seeking behaviour, leading to late-stage diagnoses and poorer prognoses, he adds.
The study has suggested the integrating of colorectal cancer literacy into national Non-Communicable Disorders (NCD) programmes.
“Community health promotion offers a low-cost, high-yield strategy to encourage earlier detection and reduce disease burden. Future policies should prioritise awareness-building as a ‘cornerstone’ of cancer control in resource-limited settings like Sri Lanka,” adds Prof. Wickramasinghe.
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