Journal of Cancer Education

, Volume 33, Issue 2, pp 448–456 | Cite as

Knowledge and Awareness of Colorectal Cancer Early Warning Signs and Risk Factors among University Students in Jordan

  • Nizar M. Mhaidat
  • Belal A. Al-husein
  • Karem H. Alzoubi
  • Dima I. Hatamleh
  • Youcef Khader
  • Sinaa Matalqah
  • Abla Albsoul


In the present study, we aimed to assess the level of awareness regarding CRC warning signs and risk factors among undergraduate students. A cross-sectional survey using standardized questionnaire developed by the Cancer Research Center in the UK was carried out in three different public universities in Jordan including Jordan University of Science and Technology, Yarmouk University, and AL al-Bayt University over a 5-month period. Volunteers were asked about their knowledge regarding CRC symptoms, risk factors, and their behaviors regarding seeking medical advice. Findings revealed that response rate was 80.1%. Vast majority of responders were female (70.9%) and 18.2% of them were studying medical-related specialties. Regarding CRC symptoms, 14.3% of responders experienced poor knowledge, 52.9% have fair knowledge, and 32.8% have good knowledge. Abdominal pain was the most recognized warning signs where 70.8% of responders could recall it. In addition, risk factors awareness was lower than warning signs awareness. About 36.1% of responders have poor knowledge, 47.4% had fair knowledge, and 16.5% had good knowledge. Unhealthy diet was the most recognized risk factor where 32.3% of responders could recall it. Moreover, females were more aware regarding CRC symptoms. Similar findings were obtained for participants who were aged 20 years or more and for those who had previous experience of cancer. Students who were studying medical-related specialties were more aware of both CRC symptoms and risk factors than those who studying other specialties. Furthermore, regarding time to seek medical attention we found that 60.6% of volunteers would seek medical advice within 1 week of noticing CRC symptoms and 12% would seek it within 2 weeks. The mean duration for seeking medical advice was found to be 1.9 weeks. University students’ awareness level of CRC is poor, and therefore, extended attention should be attempted to enhance the awareness of CRC via continuous education programs, lectures, or campaigns to encourage the early detection CRC.


Colorectal cancer Awareness Risk factors Signs Bowel cancer 



We are grateful to the Deanship of Scientific Research of the Jordan University of Science and Technology for the financial support.

Compliance with Ethical Standards

The study protocol was approved by Institutional Review Board (IRB) of Jordan University of Science and Technology (JUST).

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Al-Azri M, Al-Hamedi I, Al-Awisi H, Al-Hinai M, Davidson R (2015) Public awareness of warning signs and symptoms of cancer in Oman: a community-based survey of adults. Asian Pac J Cancer Prev 16(7):2731–2737CrossRefPubMedGoogle Scholar
  2. 2.
    Al-Azri M, Al-Rasbi K, Al-Hinai M, Davidson R, Al-Maniri A (2014) Awareness of risk factors for cancer among Omani adults—a community based study. Asian Pac J Cancer Prev 15(13):5401–5406CrossRefPubMedGoogle Scholar
  3. 3.
    Al-Tarawneh M, Khatib S, Arqub K (2010) Cancer incidence in Jordan, 1996-2005. East Mediterr Health J 16(8):837–845PubMedGoogle Scholar
  4. 4.
    Al-Tassan N, Chmiel NH, Maynard J, Fleming N, Livingston AL, Williams GT, Hodges AK et al (2002) Inherited variants of MYH associated with somatic G:C-- > T:a mutations in colorectal tumors. Nat Genet 30(2):227–232. doi: 10.1038/ng828 CrossRefPubMedGoogle Scholar
  5. 5.
    Andersen BL, Cacioppo JT (1995) Delay in seeking a cancer diagnosis: delay stages and psychophysiological comparison processes. Br J Soc Psychol 34(Pt 1):33–52CrossRefPubMedGoogle Scholar
  6. 6.
    Chubb D, Broderick P, Frampton M, Kinnersley B, Sherborne A, Penegar S, Lloyd A, Ma YP, Dobbins SE, Houlston RS (2015) Genetic diagnosis of high-penetrance susceptibility for colorectal cancer (CRC) is achievable for a high proportion of familial CRC by exome sequencing. J Clin Oncol 33(5):426–432. doi: 10.1200/JCO.2014.56.5689 CrossRefPubMedGoogle Scholar
  7. 7.
    CLSI (2008b) Reference method for broth dilution antifungal susceptibility testing of filamentous fungi; approved standard CLSI document M38-A2. Clinical and Laboratory Standards Institute, Wayne doi: 91100957 [pii]Google Scholar
  8. 8.
    De Nooijer J, Lechner L, De Vries H (2001) Help-seeking behaviour for cancer symptoms: perceptions of patients and general practitioners. Psychooncology 10(6):469–478CrossRefPubMedGoogle Scholar
  9. 9.
    Dent OF, Goulston KJ, Tennant CC, Langeluddecke P, Mant A, Chapuis PH, Ward M, Bokey EL (1990) Rectal bleeding. Patient delay in presentation. Dis Colon rectum 33(10):851–857Google Scholar
  10. 10.
    DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM (2011) Coloracta Cancer. In: Davis LE, Sun W, Medina PJ (eds) Pharmacotherapy: a pathophysiologic approach. McGraw-Hill Education, USAGoogle Scholar
  11. 11.
    Forbes LJ, Simon AE, Warburton F, Boniface D, Brain KE, Dessaix A, Donnelly C et al (2013) Differences in cancer awareness and beliefs between Australia, Canada, Denmark, Norway, Sweden and the UK (the International Cancer Benchmarking Partnership): do they contribute to differences in cancer survival? Br J Cancer 108(2):292–300. doi: 10.1038/bjc.2012.542 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Gimeno-Garcia AZ, Quintero E, Nicolas-Perez D, Jimenez-Sosa A (2011) Public awareness of colorectal cancer and screening in a Spanish population. Public Health 125(9):609–615. doi: 10.1016/j.puhe.2011.03.014 CrossRefPubMedGoogle Scholar
  13. 13.
    Hawkins NA, Berkowitz Z, Peipins LA (2010) What does the public know about preventing cancer? Results from the Health Information National Trends Survey (HINTS). Health Educ Behav 37(4):490–503. doi: 10.1177/1090198106296770 CrossRefPubMedGoogle Scholar
  14. 14.
    Hubbard G, Macmillan I, Canny A, Forbat L, Neal RD, O’Carroll RE, Haw S, Kyle RG (2014) Cancer symptom awareness and barriers to medical help seeking in Scottish adolescents: a cross-sectional study. BMC Public Health 14:1117. doi: 10.1186/1471-2458-14-1117 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Hvidberg L, Pedersen AF, Wulff CN, Vedsted P (2014) Cancer awareness and socio-economic position: results from a population-based study in Denmark. BMC Cancer 14:581. doi: 10.1186/1471-2407-14-581 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Keighley MR, O’Morain C, Giacosa A, Ashorn M, Burroughs A, Crespi M, Delvaux M et al (2004) Public awareness of risk factors and screening for colorectal cancer in Europe. Eur J Cancer Prev 13(4):257–262CrossRefPubMedGoogle Scholar
  17. 17.
    Kyle RG, Forbat L, Hubbard G (2012) Cancer awareness among adolescents in Britain: a cross-sectional study. BMC Public Health 12:580. doi: 10.1186/1471-2458-12-580 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    McCaffery K, Wardle J, Waller J (2003) Knowledge, attitudes, and behavioral intentions in relation to the early detection of colorectal cancer in the United Kingdom. Prev Med 36(5):525–535CrossRefPubMedGoogle Scholar
  19. 19.
    McVeigh TP, Lowery AJ, Waldron RM, Mahmood A, Barry K (2013) Assessing awareness of colorectal cancer symptoms and screening in a peripheral colorectal surgical unit: a survey based study. BMC Surg 13:20. doi: 10.1186/1471-2482-13-20 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Mitchell E, Macdonald S, Campbell NC, Weller D, Macleod U (2008) Influences on pre-hospital delay in the diagnosis of colorectal cancer: a systematic review. Br J Cancer 98(1):60–70. doi: 10.1038/sj.bjc.6604096 CrossRefPubMedGoogle Scholar
  21. 21.
    Ng SC, Wong SH (2013) Colorectal cancer screening in Asia. Br Med Bull 105:29–42. doi: 10.1093/bmb/lds040 CrossRefPubMedGoogle Scholar
  22. 22.
    Pande R, Leung E, McCullough P, Smith S, Harmston C (2014) Impact of the United Kingdom national bowel cancer awareness campaign on colorectal services. Dis Colon rectum 57(1):70–75. doi: 10.1097/01.dcr.0000437689.19579.97
  23. 23.
    Power E, Miles A, von Wagner C, Robb K, Wardle J (2009) Uptake of colorectal cancer screening: system, provider and individual factors and strategies to improve participation. Future Oncol 5(9):1371–1388. doi: 10.2217/fon.09.134 CrossRefPubMedGoogle Scholar
  24. 24.
    Power E, Simon A, Juszczyk D, Hiom S, Wardle J (2011) Assessing awareness of colorectal cancer symptoms: measure development and results from a population survey in the UK. BMC Cancer 11:366. doi: 10.1186/1471-2407-11-366 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Power E, Wardle J (2015) Change in public awareness of symptoms and perceived barriers to seeing a doctor following be clear on cancer campaigns in England. Br J Cancer 112(Suppl 1):S22–S26. doi: 10.1038/bjc.2015.32 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Quaife SL, Forbes LJ, Ramirez AJ, Brain KE, Donnelly C, Simon AE, Wardle J (2014) Recognition of cancer warning signs and anticipated delay in help-seeking in a population sample of adults in the UK. Br J Cancer 110(1):12–18. doi: 10.1038/bjc.2013.684 CrossRefPubMedGoogle Scholar
  27. 27.
    Redeker C, Wardle J, Wilder D, Hiom S, Miles A (2009) The launch of Cancer Research UK’s ‘reduce the risk’ campaign: baseline measurements of public awareness of cancer risk factors in 2004. Eur J Cancer 45(5):827–836. doi: 10.1016/j.ejca.2008.10.018 CrossRefPubMedGoogle Scholar
  28. 28.
    Robb K, Stubbings S, Ramirez A, Macleod U, Austoker J, Waller J, Hiom S, Wardle J (2009) Public awareness of cancer in Britain: a population-based survey of adults. Br J Cancer 101(Suppl 2):S18–S23. doi: 10.1038/sj.bjc.6605386 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Sanderson SC, Waller J, Jarvis MJ, Humphries SE, Wardle J (2009) Awareness of lifestyle risk factors for cancer and heart disease among adults in the UK. Patient Educ Couns 74(2):221–227. doi: 10.1016/j.pec.2008.08.003 CrossRefPubMedGoogle Scholar
  30. 30.
    Sharma VK, Vasudeva R, Howden CW (2000) Colorectal cancer screening and surveillance practices by primary care physicians: results of a national survey. Am J Gastroenterol 95(6):1551–1556. doi: 10.1111/j.1572-0241.2000.02093.x CrossRefPubMedGoogle Scholar
  31. 31.
    Simon AE, Waller J, Robb K, Wardle J (2010) Patient delay in presentation of possible cancer symptoms: the contribution of knowledge and attitudes in a population sample from the United Kingdom. Cancer Epidemiol Biomark Prev 19(9):2272–2277. doi: 10.1158/1055-9965.EPI-10-0219 CrossRefGoogle Scholar
  32. 32.
    Stubbings S, Robb K, Waller J, Ramirez A, Austoker J, Macleod U, Hiom S, Wardle J (2009) Development of a measurement tool to assess public awareness of cancer. Br J Cancer 101(Suppl 2):S13–S17. doi: 10.1038/sj.bjc.6605385 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Su TT, Goh JY, Tan J, Muhaimah AR, Pigeneswaren Y, Khairun NS, Normazidah AW, Tharisini DK, Majid HA (2013) Level of colorectal cancer awareness: a cross sectional exploratory study among multi-ethnic rural population in Malaysia. BMC Cancer 13:376. doi: 10.1186/1471-2407-13-376 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Wauters H, Van Casteren V, Buntinx F (2000) Rectal bleeding and colorectal cancer in general practice: diagnostic study. BMJ 321(7267):998–999CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Yardley C, Glover C, Allen-Mersh TG (2000) Demographic factors associated with knowledge of colorectal cancer symptoms in a UK population-based survey. Ann R Coll Surg Engl 82(3):205–209PubMedPubMedCentralGoogle Scholar

Copyright information

© American Association for Cancer Education 2016

Authors and Affiliations

  • Nizar M. Mhaidat
    • 1
  • Belal A. Al-husein
    • 1
  • Karem H. Alzoubi
    • 1
  • Dima I. Hatamleh
    • 1
  • Youcef Khader
    • 2
  • Sinaa Matalqah
    • 3
  • Abla Albsoul
    • 4
  1. 1.Faculty of PharmacyJordan University of Science and TechnologyIrbidJordan
  2. 2.Faculty of MedicineJordan University of Science and TechnologyIrbidJordan
  3. 3.Directorate of HealthMinistry of HealthAmmanJordan
  4. 4.Faculty of PharmacyUniversity of JordanAmmanJordan

Personalised recommendations