Skip to main content

Advertisement

Log in

Knowledge and Practice of Colorectal Screening in a Suburban Group of Iraqi American Women

  • Published:
Journal of Cancer Education Aims and scope Submit manuscript

Abstract

Colorectal cancer (CRC) was the second most common cancer among women in 2008, accounting for 571,000 cases, and 9.4 % of all cancer cases afflicting women worldwide. According to the World Health Organization (WHO) and the Iraqi National Cancer Registry (INCR), Iraq has seen a steady rise in CRC rates among its general population over the past several decades. Despite Iraq’s increasing national incidence of CRC and the growth of the US’ Iraqi immigrant population over the last 10 years, little remains known about the prevalence of CRC among the latter population, their knowledge of CRC and associated risk factors, or their behavioral intent and practices regarding CRC screening. The aims of this study were to (1) examine the knowledge of and adherence to National Cancer Institute screening recommendations for CRC among a population of Iraqi women living in the Washington D.C. Metropolitan Area and (2) test the efficacy of a one-time educational intervention conducted using linguistically and culturally appropriate materials to raise awareness of, and promote future adherence to, CRC screening methods. This descriptive study used a pre/post design with a 12-month follow-up. Following extensive dissemination of information regarding the study in the Iraqi American community in the study location, 50 women were initially recruited, of whom 32 participated in the study. The study’s findings revealed that the participants generally had low baseline levels of CRC screening adherence and preventive knowledge that significantly improved after the intervention as demonstrated by pre- and post-assessments of knowledge and behavior. These findings could be used to raise awareness (1) among clinicians regarding the need for early detection and screening of and referral for CRC treatment among Iraqi American women and (2) among Iraqi American women about risk factors for this disease and the importance of early detection and screening. The study also highlights the need for a larger study of knowledge, attitudes, and perceptions among both this population and the clinicians who serve them.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. IARC (2012) Cancer fact sheets: colorectal cancer incident and mortality worldwide in 2008 Summary. http://globocan.iarc.fr/factsheets/cancers/colorectal.asp. Accessed 5 Aug 2012

  2. World Cancer Research Fund (2013) Colorectal cancer. http://www.wcrf.org/cancer_statistics/data_specific_cancers/colorectal_cancer_statistics. Accessed 10 Mar 2014

  3. American Cancer Society (2011) Colorectal cancer facts and figures 2011-2013. American Cancer Society. http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-028312.pdf. Accessed 10 Mar 2014

  4. Levin B, Liberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, Dash C, GIardiello FM, Glick S, Levin TR, Pickhardt P, Rex DK, Thorson A, Winawer SJ (2008) Screening and surveillance for the early detection of colorectal cancer and adenomatous Polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 58(3):130–160

    Article  PubMed  Google Scholar 

  5. Kohler BA, Ward E, McCarthy BJ, Schymura MJ, Lynn AG, Ries CE, Jemal A, Anderson RN, Ajani UA, Edwards BK (2011) Annual report to the nation on the status of cancer, 1975-2007, featuring tumors of the brain and other nervous system. J Natl Cancer Inst 103:1–23

    Article  Google Scholar 

  6. Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN, Jemal A, Schymura MJ, Lansdorp-Vogelaar I, Seeff LC, van Ballegooijen M, Goede L, Ries LAG (2010) Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 116(3):544–573

    Article  PubMed Central  PubMed  Google Scholar 

  7. Iraqi National Cancer Registry (2008) World Health Organization (WHO). http://www.emro.who.int/ncd/pdf/iraq_cancer_registry_05.pdf. Accessed 13 Jul 2010

  8. Boyle P, Levin B (2008) World Cancer Report 2008. International Agency for Research on Cancer (IARC) – World Health Organization (WHO). http://www.iarc.fr/en/publications/pdfs-online/wcr/2008/index.php. Accessed 12 Jul 2010

  9. Al-Humadi AH (2008) Epidemiology of colon & rectal cancer in Iraq. World J Color Surg 1(Iss.1)Article 15

  10. Ananthakrishnan Ashwin N, Schellhase KG, Sparapani RA, Laud PW, Neuner JM (2007) Disparities in colon cancer screening in the Medicare population. JAMA Int Med 167:258–264

    Article  CAS  Google Scholar 

  11. Beydoun HA, Beydoun MA (2008) Predictors of colorectal cancer screening behaviors among average-risk older adults in the United States. Cancer Causes Control 19(4):339–359

    Article  PubMed  Google Scholar 

  12. Holden DJ, Harris R, Porterfield DS, Jonas DE, Morgan LC, Reuland D, Gilchrist M, Viswanathan M, Lohr KN, Lyda-McDonald B (2010) Systematic review: enhancing the use and quality of colorectal cancer screening. Ann Intern Med 152(10):668–676

    Article  PubMed  Google Scholar 

  13. Menees SB, Inadomi JM, Korsnes S, Elta GH (2005) Women patients’ preference for women is a barrier to colon cancer screening. Gastrointest Endosc 62(2):219–223

    Article  PubMed  Google Scholar 

  14. Irby K, Anderson WF, Henson DE, Devesa SS (2006) Emerging and widening colorectal carcinoma disparities between Blacks and Whites in the United States (1975-2002). Cancer Epidemiol Biomark Prev 15(4):792–797

    Article  Google Scholar 

  15. Pinczowski D, Ekbom A, Baron J, Yuen J, Adami H-O (1994) Risk factors for colorectal cancer in patients with ulcerative colitis: a case-control study. Gastroenterology 107:117–120

    CAS  PubMed  Google Scholar 

  16. Eaden JA, Abrams KR, Mayberry JF (2001) The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut 48:526–535

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Larsson SC, Giovannucci E, Wolk A (2005) Diabetes and colorectal cancer incidence in the cohort of Swedish men. Gut 28(7):1805–1807

    Google Scholar 

  18. Campbell PT, Deka A, Jacobs EJ, Newton CC, Hildebrand JS, McCullough ML, Limburg PJ, Gapstur SM (2010) Prospective study reveals association between colorectal cancer and type 2 diabetes mellitus or insulin use in men. Gastroentology. doi:10.1053/j.gastro.2010.06.072

    Google Scholar 

  19. Schatzkin A, Freedman LS, Dawsey SM, Lanza E (1994) Interpreting precursor studies: what polyp trials tell us about large-bowel cancer. J Natl Cancer Inst 86:1053–1057

    Article  CAS  PubMed  Google Scholar 

  20. Barnard J (2009) Screening and surveillance recommendations for pediatric gastrointestinal polyposis syndromes. J Pediatr Gastroenterol Nutr 48(Suppl 2):S75–S78

    Article  PubMed Central  PubMed  Google Scholar 

  21. Sesink ALA, Termont DSML, Kleibeuker JH, Van der Meer R (1999) Red meat and colon cancer: the cytotoxic and hyperproliferative effects of dietary heme. Cancer Res 59:5704–5709

    CAS  PubMed  Google Scholar 

  22. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348:1625–1638

    Article  PubMed  Google Scholar 

  23. Terry P, Giovannucci E, Michels KB, Bergkvist L, Hansen H, Holmberg L, Wolk A (2001) Fruit, vegetables, dietary fiber, and risk of colorectal cancer. J Natl Cancer Inst 93:525–533

    Article  CAS  PubMed  Google Scholar 

  24. Nilsen TIL, Vatten LJ (2001) Prospective study of colorectal cancer risk and physical activity, diabetes, blood glucose and BMI: exploring the hyperinsulinaemia hypothesis. Br J Cancer 84:417–422

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Ferrari P, Jenab M, Norat T, Moskal A, Slimani N, Olsen A, Tjonneland A, Overvard K, Jensen MK, Boutron-Ruault M-C, Clavel-Chapelon F, Morois S, Rohrmann S, Linseisen J, Boeing H, Bergmann M, Kontopoulou D, Trichopoulou A, Kassapa C, Masala G, Krogh V, Vineis P, Panico S, Tumino R, van Gils CH, Peeters P, Bas Bueno-de-Mesquita H, Ocke MC, Skeie G, Lund E, Agudo A, Ardanaz E, Lopez DC, Sanchez M-J, Quiros JR, Amiano P, Berglund G, Manjer J, Palmqvist R, Van Guelpen B, Allen N, Key T, Bingham S, Mazuir M, Boffetta P, Kaaks R, Riboli E (2007) Lifetime and baseline alcohol intake and risk of colon and rectal cancers in the European prospective investigation into cancer and nutrition (EPIC). Int J Cancer. doi:10.1002/ijc.22966

    Google Scholar 

  26. Calonge N, Petitti DB, DeWitt TG, Dietrich AJ, Gregory KD, Harris R, Isham G, LeFevre ML, Leipzig RM, Loveland-Cherry C, Marion LN, Melnyk B, Moyer VA, Ockene JK, Sawaya GF, Yawn BP (2014) Screening for colorectal cancer. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org. Accessed 15 Sept 2014

  27. Smith RA, Brooks D, Cokkinides V, Saslow D, Brawley OW (2001) Cancer screening in the United States, 2013: a review of current American Cancer Society guidelines, current issues in cancer screening, and new guidance on cervical cancer screening and lung cancer screening. CA Cancer J Clin 63(2):87–105

    Article  Google Scholar 

  28. Houston TP, Eslter AB, Davis RM, Deitchman SD (1996) The U.S. Preventive Services Task Force guide to clinical preventive services, Second Edition. doi: 10.1016/S0749-3797(97)00066-4

  29. Levin B, Smith RA, Feldman GE, Colditz GA, Fletcher RH, Nadel M, Rothenberger DA, Schroy PS III, Vernon SW, Wender R, National Colorectal Cancer Roundtable (2002) Promoting early detection tests for colorectal carcinoma and adenomatous polyps. Cancer 95:1618–1628

    Article  PubMed  Google Scholar 

  30. American College of Gastroenterology (ACG) (2012) Colorectal cancer. ACG Patient Education & Resource Center. http://patients.gi.org/topics/colorectal-cancer/#screening. Accessed 12 Jul 2012

  31. Winawer SJ, Fletcher RH, Miller L, Godlee F, Stolar MH, Mulrow CD, Woolf SH, Glick SN, Ganiats TG, Bond JH, Rosen L, Zapka JG, Olsen SJ, Giardiello FM, Sisk JE, Van Antwerp R, Brown-Davis C, Marciniak DA, Mayer RJ (1997) Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 112:594–642

    Article  CAS  PubMed  Google Scholar 

  32. Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Hartford WV, Provenzale D, Sontag S, Schnell T, Durbin TE, Nelson DB, Ewing SL, Triadafilopoulos G, Ramirez FC, Lee JG, Collins JF, Biran Fennerty M, Johnston TK, Corless CL, McQuaid KR, Sampliner RE, Morales TG, Fass R, Smith R, Maheshwari Y, Gregorio Chejfec for the Veterans Affairs Cooperative Study Group 380 (2000) Use of colonoscopy to screen asymptomatic adults for colorectal cancer. N Engl J Med 343:162–168

    Article  CAS  PubMed  Google Scholar 

  33. Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF (2000) Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 343:169–174

    Article  CAS  PubMed  Google Scholar 

  34. Sonnenberg A, Delco F, Inadomi JM (2000) Cost-effectiveness of colonoscopy in screening for colorectal cancer. Ann Intern Med 133:573–584

    Article  CAS  PubMed  Google Scholar 

  35. Lewis JD (2000) Prevention and treatment of colorectal cancer: pay now or pay later. Ann Intern Med 133:647–649

    Article  CAS  PubMed  Google Scholar 

  36. Anderson WF, Guyton KZ, Hiatt RA, Vernon SW, Levin B, Hawk E (2002) Colorectal cancer screening for persons at average risk. J Natl Cancer Inst 94:1126–1133

    Article  PubMed  Google Scholar 

  37. Terrazas A (2009) Iraqi immigrants in the United States. Migration Policy Institute. Accessed 15 Sept 2014

  38. Chatelard G (2009) Working paper no. WP-09-68- Migration from Iraq between the Gulf and the Iraq Wars (1990-2003): historical and socio-spatial dimensions. https://www.compas.ox.ac.uk/publications/working-papers/wp-09-68/. Accessed 15 Sept 2014.

  39. Grieco E (2003) Iraqi immigrants in the United States. Migration Policy Institute. http://www.migrationpolicy.org/article/iraqi-immigrants-united-states-0. Accessed 3 Nov 2014

  40. Arshad S, Williams KP, Mabiso A, Dey S, Soliman AS (2011) Evaluating the knowledge of breast cancer screening and prevention among Arab–American Women in Michigan. J Cancer Educ 26(1):135–138

    Article  PubMed Central  PubMed  Google Scholar 

  41. Nassar-McMillan S, Jamil H, Lambert RG (2010) Chemical, environmental, and trauma exposures and corresponding health symptoms among Iraqi American women. J Appl Biobehav Res 15:88–102

    Article  Google Scholar 

  42. Shah SM, Ayash C, Pharaon NA, Gany FM (2008) Arab American immigrants in New York: health care and cancer knowledge, attitudes, and beliefs. J Immigr Minor Health 10(5):429–436

    Article  PubMed  Google Scholar 

  43. Williams KP, Mabiso A, Todem D, Hammad A, Hamade H, Hill-Ashford Y, Robinson-Lockett M, Palamisono G, Zambrana RE (2011) Differences in knowledge of breast cancer screening among African American, Arab American, and Latina women. Prev Chornic Dis 8(1):A20

    Google Scholar 

  44. Saadi A, Bond B, Percac-Lima S (2011) Perspectives on preventive health care and barriers to breast cancer screening among Iraqi women refugees. J Immigr Minor Health. doi:10.1007/s10903-011-9520-3

    Google Scholar 

  45. Jean-Jacques M, Kaleba EO, Gatta JL, Garcia G, Ryan ER, Choucair BN (2012) Program to improve colorectal cancer screening in a low-income, racially diverse population: a randomized controlled trial. Ann Fam Med 10(5):412–418

    Article  PubMed Central  PubMed  Google Scholar 

  46. Elmunzer J, O’Connell MT, Prendes S, Sania SD, Sussman DA, Volk ML, Deshpande A (2011) Improving access to colorectal cancer screening through medical philanthropy: feasibility of a flexible sigmoidoscopy health fair for uninsured patients. Am J Gastroenterol. doi:10.1038/ajg.2011.147

    PubMed  Google Scholar 

  47. Jeong KE, Carins JA (2013) Review of economic evidence in the prevention and early detection of colorectal cancer. Heal Econ Rev 3:20

    Article  Google Scholar 

  48. Fox SA, Murata PJ, Stein JA (1991) The impact of HCP compliance on screening mammography for older women. JAMA Int Med 151:50–56

    Article  CAS  Google Scholar 

  49. Azaiza F, Cohen M (2008) Colorectal cancer screening, intentions, and predictors in Jewish and Arab Israelis: a population-based study. Health Educ Behav 35(4):478–493

    Article  PubMed  Google Scholar 

  50. Al-Omran H (2005) Measurement of the knowledge, attitudes, and belief of Arab-American adults towards cancer screening and early detection: development of a survey instrument. Ethn Dis 15(1 Suppl 1):S15–S16

    Google Scholar 

  51. Swan H, Siddiqui AA, Myers RE (2012) International colorectal cancer screening programs: population contact strategies, testing methods and screening rates. Pract Gastroenterol XXXVI(8):20–29

    Google Scholar 

  52. Strauss A, Corbin J (1998) Basics of qualitative research: techniques and procedures for developing grounded theory. Sage Publications, Thousand Oaks

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Irene Jillson.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jillson, I., Faeq, Z., Kabbara, K.W. et al. Knowledge and Practice of Colorectal Screening in a Suburban Group of Iraqi American Women. J Canc Educ 30, 284–293 (2015). https://doi.org/10.1007/s13187-015-0813-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13187-015-0813-4

Keywords

Navigation