Colorectal cancer screening and awareness among patients attending outpatient clinic at Muhimbili National Hospital (MNH), Dar Es Salaam-Tanzania

Abstract

ABSTRACT BACKGROUND Colorectal cancer (CRC) is among the most commonly diagnosed cancers worldwide. There were 1,360,602 new cases of CRC worldwide and it was the 3rd most common cancer, accounting for 9.7% of all cancers apart from non-melanoma skin cancers (GLOBOCAN, 2012). The crude incidence of CRC in SSA for both sexes was found to be 4.04 per 100 000 population (4.38 for men and 3.69 for women). It is the 5th most common cancer in SSA. CRC is not uncommon in Tanzania and it shows a trend towards a relative young age with a median age at presentation of 46 years majority of patients presenting late with advanced disease. It accounts for 4.7% of all malignancies and with male to female ratio of 1.6:1. It also accounted for 5.4% of all cancer deaths among females in Tanzania (WHO, 2014). However, according to WHO report of 2014 there is no screening program for CRC in the country. Also there is no study that has been done to determine the prevalence of CRC or the public awareness about CRC in the country. OBJECTIVE: To determine the prevalence of colorectal cancer and awareness among adult patients attending outpatient clinic at Muhimbili National Hospital (MNH), Dar Es Salaam-Tanzania. METHODOLOGY: The study was descriptive cross-sectional study involving patients who are 40 years or older attending NHIF outpatient clinic at Muhimbili National Hospital (MNH) from October 2016 to March 2017. The patients were screened for CRC using FOBT and colonoscopy was performed for those with positive fecal occult blood and biopsies taken for histological confirmation. The level of awareness of CRC and its risk factors was assessed by administering a validated questionnaire. RESULTS: The total of 512 participants were involved in the study with slight women predominance 52.7% (n=270). The mean age of the participants was 54.4 years and majority, 144(28.1%) had the body weight in the category of 70-79 kg with the mean weight of 76.4 kilograms. Of all participants, 91(17.8%) were hypertensive patients who came for routine follow up or drug refilling and 46(9.0%) had diabetes mellitus. Of all participants, 63 (12.3%) had positive FOBT and 33 (52.4%) of them underwent colonoscopy. Among patients who underwent colonoscopy, 7 (21.2%) had CRC. The overall prevalence of CRC among adult patients who are 40 years and above ranged from 1.4% to 2.5%. Of the all 512 patients involved in the study, 185 (36.1%) were aware of CRC. The awareness among males and females was 32.6% and 39.2% respectively. The level of awareness was lowest (32%) among those aged above 70 years and was highest (40%) among those aged between 50 and 59 years. The level of awareness was increasing proportionately with the level of education; 25% among those with no formal education and 41% among those with college or university education. Only 94 (38.8%) males and 102(42.1%) of females agreed that family history of CRC is a risk factor while 81(33.5%) males and 66(24.4%) females were able to identify old age as a risk factor. Rectal polyps was identified as the risk factor for CRC by 148(61.2%) of males and 155(55.9%) of females. Excessive alcohol use was identified as the risk factor for CRC by most of the respondents, 196 (81.0%) of males and 227 (84.1%) of females. CONCLUSION: Colorectal cancer is common in many asymptomatic patients with positive FOBT. FOBT can be used successfully as a screening tool for CRC. Te level of awareness of the CRC is generally below forty percent among adult patients attending outpatient clinic at MNH. RECOMMENDATION: We recommend routine screening of adults 40 years and above for CRC using FOBT. This should be accompanied with an educational program for raising the level of awareness of CRC among adults.