**7. Others prevention strategies**

Findings from a systematic review suggest that small media interventions (eg, interventions using mailed materials, text messages, and telephone calls) may be effective in improving screening uptake for breast, cervical, colorectal, and gastric cancer in Asian countries. Therefore, there is a priority need for programs that raise awareness about the warning signs and symptoms of cancer and the benefits of early detection. This form of secondary prevention should be implemented in countries in which resources for population-based screening are lacking, particularly for cancers. Overall, the findings of the evaluation indicate that a culturally adapted, evidence-based mass media intervention appears to impact positively in terms of improving CRC symptom awareness among population; and that impact is more likely when a campaign operates a differentiated approach that matches modes of communication to the ethnic and religious diversity in a population. Research shown that there was a significant improvement in the recognition of all CRC symptoms (prompted) at follow up and a significant improvement in the knowledge of three unprompted symptoms, i.e. 'blood in stool', 'feeling that the bowel does not empty after using the lavatory' and 'unexplained weight loss'.

A recommendation from a physician is the most influential factor in determining whether a patient is screened for colorectal cancer. While the vast majority of primary care physicians report that they screen for colorectal cancer, many patients do not receive the recommendation they need. People with a high risk for CRC should not be included in a routine screening used for the general population. Their screening must be started early in a shorter period, and using various tests. The United States Preventive Task Force recommends CRC screening for the average atrisk population, using an annual fecal occult blood test (FOBT), a periodic flexible sigmoidoscopy (FS), or a colonoscopy [22]. One of the solutions is to engage the primary care doctors and family physician in identifying and recommending high risk patients for colorectal cancer screening. The effectiveness of the family doctor's role has been proven in previous studies and should be the way forward to increase awareness and cancer screening uptake.

Simultaneously, concerted effort is needed to increase numbers of skill operators and availability of the procedure throughout the country. In certain Europe countries, nurses have been trained to perform endoscopy to reduce patient's waiting time. On the other hand, fecal occult blood test can be utilized for mass screening among low risk or asymptomatic patients.

All these barriers could be overcome with the implementation of governmentsubsidized nationwide population screening, with the provision of more accessible screening times such as having them available during non-working hours or nonworking days. However, even if the above-mentioned barriers have been overcome, it would not solve the problem if the people inherently do not wish to participate due to certain psychological barriers that are more difficult to tackle. Among these is the fatalistic belief that their lives are in the hands of fate or God. They believe that if it is destined that they are to have cancer, there is nothing they can do about it and early detection of cancer would not benefit them [23].

A patient's personal awareness of his or her risk level is important. Awareness of the health status of family members is also needed and should be encouraged. Awareness of discrepancies in screening rates for people in racial and ethnic groups can help to reduce these disparities.

**No Year Country**

**26**

16 2010

Washington,

RCT. A clinic-

Intervention

Usual care; no

Hispanic patients

Post differences

rates of FOBT

screening in

intervention

usual care group.

 and

2009. Nine-month

postintervention

cancer screening

among

underserved

Hispanics.

screening rates

were 26% among

patients who

received the mailed

packet only intervention

< .001 compared

with usual care)

and 31% in the

group that received

the mailed packet

and outreach

intervention

< .001 compared

with usual care). This compared with

2% in the group that received usual

care. Screening

rates in the mailed

FOBT only group and in the mailed FOBT and outreach

group were not

significantly

different (P = .28).

> **Table 1.**

*Evidence from previous studies on CRC screening and intervention*

 *modalities.*

 (P

 (P

 in

intervention

Data analysis

Culturally

[43]

*Colorectal Cancer*

appropriate

based

interventions

increase colorectal

 may

 clinic-

occurred between

November 2008

and September

who had been seen

in the Seattlebased community clinic, aged 50-79.

formal prompting

of colorectal

cancer screening, other than what is provided during a

physician visit.

groups received

either 1) mailed

fecal occult blood

test (FOBT) card

and instructions

on how to complete the test

(mailed FOBT

only); or 2) mailed

FOBT card and

instructions

how to complete the test, telephone

reminders,

home visits (mailed FOBT and

outreach)

 and

 on

based individual

randomized

 trial.

United States

 **Design**

**Intervention**

**Comparison**

 **Population**

 **Main Outcome**

**Result**

**Conclusion**

 **Reference**
