Document Type : Original Article


Department of Public Health, The Student’s Research Committee, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran


Introduction and Objective: Colorectal cancer is one of the most important and most common
cancer and second leading cause of cancer deaths worldwide. Through secondary prevention of
this cancer, effective proactive measures would be taken to treat and to prevent the incidence of the
disease. The fecal occult blood test(FOBT) has priority over other methods and is recommended for
adults above 50 years. This study was carried out to assess perceived barriers related to participating
in colorectal cancer screening programs among average risk population, based on health belief
model. Materials and Methods: A cross‑sectional survey of 196 individuals of more than 50 years
was conducted in Isfahan. The target group consisted of people going to laboratories for doing
FOBT test(n = 98), and those who refrained from going to laboratories (n = 98). The questionnaire
was used based on barrier assessment question associated with performing fecal occult blood
test. The data collected were analyzed using descriptive and inferential statistics methods. Results:
The mean score of perceived barriers in the first group was 40.9 and in other group was 56.54,
with significant difference statistically (P < 0.001). Lack of information, fear of cancer diagnosis,
lack of recommendation by doctors, and not setting the priority of time for doing the test were
some of barriers reported by the nongoing group. Discussion and Conclusion: According to
this study, it seems that there is an urgent need to more information to be provided for the public
about colorectal cancer and its prevention through screening, as important step to increase the
rate of early detection and curb the mortality rate, costs, and improve community health outcomes.


1. World Health Organization (WHO). 58th World Health Assembly
approved resolution on cancer prevention and control: WHO;
2005 [cited 2012]. Available from:
2. Organization WH. Fact sheet N 297: Cancer. Geneva: WHO. 2008.
3. Chu KC, Tarone RE, Chow W‑H, Hankey BF, Ries LAG. Temporal
patterns in colorectal cancer incidence, survival, and mortality
from 1950 through 1990. Journal of the National Cancer Institute
YANG H. Tocopherols and the treatment of colon cancer. Annals
of the New York Academy of Sciences 2004;1031:223‑33.
5. Mousavi SM, Gouya MM, Ramazani R, Davanlou M, Hajsadeghi N,
Seddighi Z. Cancer incidence and mortality in Iran. Annals of
Oncology 2009;20:556‑63.
6. Alireza S, Mehdi N, Ali M. Cancer occurrence in Iran in 2002, an
international perspective. Asian Pacific Journal of Cancer Prevention
7. Ansari R, Mahdavinia M, Sadjadi A, Nouraie M, Kamangar F,
Bishehsari F, et al. Incidence and age distribution of colorectal
cancer in Iran: Results of a population‑based cancer registry. Cancer
Letters 2006;240:143‑7.
8. Hawk ET, Levin B. Colorectal cancer prevention. Journal of Clinical
Oncology 2005;23:378‑91.
9. Judith M SK, Richard F, Janghorbani M (translator). Introduction
to epidemiology. 2nd ed. Isfahan: Isfahan University of Medical
Sciences; 2006.
10. Jemal A, Murray T, Samuels A, Ghafoor A, Ward E, Thun MJ.
Cancer statistics, 2003. CA: A Cancer Journal for Clinicians
11. James AS, Campbell MK, Hudson MA. Perceived Barriers and
Benefits to Colon Cancer Screening among African Americans
in North Carolina How Does Perception Relate to Screening
Behavior? Cancer Epidemiology Biomarkers and Prevention
12. Bandi P, Cokkinides V, Smith RA, Jemal A. Trends in colorectal
cancer screening with home-based fecal occult blood tests in adults
ages 50 to 64 years, 2000-2008. Cancer 2012;118:5092‑9.
13. Mandel JS, Church TR, Bond JH, Ederer F, Geisser MS,
Mongin SJ, et al. The effect of fecal occult‑blood screening on the
incidence of colorectal cancer. New England Journal of Medicine
14. Brouse CH, Basch CE, Wolf RL, Shmukler C, Neugut AI, Shea S.
Barriers to colorectal cancer screening with fecal occult blood
testing in a predominantly minority urban population: A qualitative
study. Journal Information 2003;93.
15. Saito H, Soma Y, Koeda J, Wada T, Kawaguchi H, Sobue T, et al.
Reduction in risk of mortality from colorectal cancer by fecal
occult blood screening with immunochemical hemagglutination
test. A case-control study. International Journal of Cancer
16. Keyhani BSM. Epidemiological evaluation of colorectal cancer. Acta
Medica Iranica 2003;41.
17. Cokkinides VE, Chao A, Smith RA, Vernon SW, Thun MJ.
Correlates of underutilization of colorectal cancer screening
among US adults, age 50 years and older. Preventive Medicine
18. Zheng Y‑F, Saito T, Takahashi M, Ishibashi T, Kai I. Factors
associated with intentions to adhere to colorectal cancer screening
follow‑up exams. BMC Public Health 2006;6:272.
19. Farmer MM, Bastani R, Kwan L, Belman M, Ganz PA. Predictors of
colorectal cancer screening from patients enrolled in a managed
care health plan. Cancer 2008;112:1230‑8.
20. Tang TS, Solomon LJ, McCracken LM. Barriers to Fecal Occult
Blood Testing and Sigmoidoscopy Among Older Chinese-American
Women. Cancer Practice 2001;9:277‑82.
21. Busch S. Elderly African American women’s knowledge and belief
about colorectal cancer. The ABNF journal: Official journal of the
Association of Black Nursing Faculty in Higher Education, Inc.
22. Green PM, Kelly BA. Colorectal cancer knowledge, perceptions,
and behaviors in African Americans. Cancer Nursing
23. Kelly KM, Phillips CM, Jenkins C, Norling G, White C, Jenkins T,
et al. Physician and staff perceptions of barriers to colorectal
cancer screening in Appalachian Kentucky. Cancer Control
24. Hoff G. CRC screening: Review of the evidence and suggestions
on when and how to move on from randomized trials to screening
programmes. Scandinavian Journal of Gastroenterology
25. Sun WY, Basch CE, Wolf RL, Li XJ. Factors associated with colorectal
cancer screening among Chinese‑Americans. Preventive Medicine
26. Bajracharya SM. An assessment of the perceived barriers and
strategies to promoting early detection of colorectal cancer: A
practitioners’ perspective. International Quarterly of Community
Health Education 2007;26:23‑44.
27. Rossi PG, Federici A, Bartolozzi F, Farchi S, Borgia P, Guasticchi G.
Understanding non‑compliance to colorectal cancer screening: A
case control study, nested in a randomised trial [ISRCTN83029072].
BMC Public Health 2005;5:139.
28. Austin KL, Power E, Solarin I, Atkin WS, Wardle J, Robb KA.
Perceived barriers to flexible sigmoidoscopy screening for
colorectal cancer among UK ethnic minority groups: A qualitative study. Journal of Medical Screening 2009;16:174‑9.
29. Van Rijn A, van Rossum L, Deutekom M, Laheij R, Fockens P,
Bossuyt P, et al. Low priority main reason not to participate in a
colorectal cancer screening program with a faecal occult blood test.
Journal of Public Health 2008;30:461‑5.
30. Greiner KA, James AS, Born W, Hall S, Engelman KK, Okuyemi KS,
et al. Predictors of fecal occult blood test (FOBT) completion among
low‑income adults. Preventive Medicine 2005;41:676‑84.