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PURPOSE Raising awareness of colorectal cancer (CRC) symptoms for early recognition, reduction of modifiable risk factors, and removing barriers to seeking medical help could lower its mortality. This study aimed to assess the level of public awareness of CRC in the Gaza Strip. MATERIALS AND METHODS This was a cross-sectional study conducted at three hospitals and 10 high schools between September and October 2017. The Arabic version of the validated Bowel Cancer Awareness Measure (BoCAM) questionnaire was used to evaluate awareness of CRC symptoms and risk factors, and barriers to seeking medical help. Adults (age ≥ 18 years) in three major hospitals and adolescents (ages 15 to 17 years) in 10 schools were recruited for face-to-face interviews to complete the BoCAM. RESULTS Of 3,172 potential participants, 3,080 completed the BoCAM (response rate, 97.1%). Among these, 1,578 (51.2%) were adults and 1,614 (52.4%) were females. Persistent abdominal pain was the most commonly recognized CRC symptom (n = 1,899; 61.7%), whereas anorectal pain was the least common (n = 1,056; 34.3%). In total, 2,177 (70.7%) were not confident in recognizing CRC symptoms or signs. Having a bowel disease was the most frequently recognized CRC risk factor (n = 1,456; 47.3%) and diabetes the least recognized (n = 591; 19.2%). The overall mean scores ± standard deviations for recalling and recognizing CRC symptoms were 1.2 ± 1.3 and 4.3 ± 2.3, respectively (out of 9 points). The overall mean scores ± standard deviations for recalling and recognizing CRC risk factors were 0.7 ± 0.8 and 8.0 ± 3.1, respectively (out of 16 points). Emotional barriers were the most commonly reported barriers to seeking medical help, with feeling worried about what a doctor might find as the most common barrier (n = 1,522; 49.4%). CONCLUSION Public awareness of CRC is suboptimal in Gaza. Improving CRC awareness with educational interventions is needed, including in local schools.

Background: Raising awareness of colorectal cancer (CRC) symptoms for early recognition, reduction of lifestyle risk factors, and removing barriers to seek medical help could lower its mortality. This study aimed to assess the level of public awareness of CRC in the Gaza-Strip. Methods: This is a cross-sectional study conducted at three hospitals and ten high schools between September and October 2017. The Arabic version of the Bowel Cancer Awareness Measure (BoCAM) questionnaire was used to evaluate awareness of CRC symptoms, risk factors, and barriers to seek medical help. Adults (aged ≥18 years) in the three hospitals, and adolescents (aged 15-17 years) in ten schools were recruited for face-to-face interviews to complete the BoCAM. Findings: Of 3172 potential participants, 3080 completed the BoCAM (response rate = 97·1%). Among them, 1578 (51·2%) were adult and 1614 (52·4%) were females. Persistent abdominal pain was the most commonly recognized CRC symptom (n=1899, 61·7%). In total, 2177 (70·7%) were not confident in recognizing CRC symptoms. Having a bowel disease was the most frequently recognized CRC risk factor (n= 1456, 47·3%). The overall mean score for recognizing CRC symptoms was 4·3 ± 2·3 out of 9 and for risk factors 8·0 ± 3·1 out of 16. Emotional barriers were the most commonly reported barriers to seek medical help with feeling worried about doctor's findings as the first reason (n= 1522, 49·4%). Interpretation: Public awareness of CRC is suboptimal in Gaza. Improving CRC awareness (e.g., educational outreach) is needed, including in local schools. Funding Statement: No funding was received for this study. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study was approved from the Department of Human Resources Development at the Ministry of Health in the Gaza-Strip, the authorized body to provide approvals for clinical studies.

Introduction: Colorectal cancer (CRC) is a major cause of cancer deaths worldwide. Raising the awareness of CRC symptoms for early recognition, prevention via reduction of lifestyle risk factors, and removing barriers to seek medical help could lower its mortality. This study aimed to assess the level of public awareness of CRC in the Gaza Strip, and compare it between adults and high-school students (HSS). Methods: This is a cross-sectional study conducted at 3 major hospitals and 10 high schools (recruitment used stratified sampling) in the Gaza Strip between September and October 2017. A previously pilot-tested, Arabic version of the Bowel Cancer/CRC Awareness Measure (CAM) questionnaire, a validated standardized questionnaire to measure public CRC awareness, was used. It consists of four sections: sociodemographic data, awareness of CRC symptoms, awareness of CRC risk factors, and barriers to seek medical help. Adults (aged ≥18 years) visiting or admitted to any of the three hospitals, and high-school students (aged 15-17 years) in any of the ten schools were recruited for face-to-face interviews to complete the CAM. Patients and visitors to oncology departments were ineligible. Informed consent and ethical approval were obtained. Results: A total of 3080 participants completed the CAM questionnaire (of 3236 approached; response rate was 97.3% in HSS and 92.8% in adults). 1502 (48.8%) were HSS (730 males; 48.6%) and 1578 (51.2%) adults (736 males; 46.6%). Overall, 1391 (45.2%) reported that the chance of getting CRC is not related to age. A persistent abdominal pain was the most commonly recognized cancer symptom (n=1899, 61.7%) while pain in back passage was the least (n=1056, 34.3%). 2177 (70.7%) reported that they are not confident in recognizing CRC symptom/sign. Having a bowel disease (e.g, ulcerative colitis) was the most frequently recognized CRC risk factor (n= 1456, 47.3%) and having diabetes was the least (n=591, 19.2%). In general, adults have better awareness than HSS in terms of: recognizing CRC symptoms (mean score = 20.8 vs 18.7 of 24 total score, p< 0.0001) and its risk factors (mean score= 27.2 vs 25.4 of 45 total score, p< 0.0001). Worry about what a doctor might find was the most reported barrier to seek medical help among adults (n= 773, 49%), whereas, lack of confidence to talk about symptoms with the doctor was the most commonly reported one in HSS (n= 777, 51.7%). Conclusions:The public awareness of CRC is suboptimal in the Gaza Strip. Interventions to improve the public awareness of CRC (e.g., educational outreach) is warranted. School curriculums should include awareness sessions on cancer symptoms and risk factors, including CRC. Citation Format: MohamedRaed Elshami, Tamer Abdalghafoor, Maha Alfaqawi, Ayoub AbuNemer, Mohammed Ghuneim, Hussien Lubbad, Batool Almahallawi, Mosab Samaan, Abdallah Alwali, Ahmad Alborno, Deyaa Al-kafarna, Aseel Salah, Karam Shihada, Mohammed Abo Amona, Amira Al-Najjar, Rana Abu Subha, Basma Alhelu, Israa Abujayyab, Loai Albarqouni, Bettina Bottcher. Public awareness of colorectal cancer in the Gaza Strip: A comparative cross-sectional study between adults and high school students [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5284.