Awareness of Cancer Warning Signs and Risk Factors in Malaysia

Study conducted in Malaysia focused on assessing awareness of cancer warning signs and risk factors in the population aged 40 and above. The research highlighted the importance of early detection, addressing misconceptions, and promoting screening uptake to combat the growing burden of cancer in the country.

• Cancer awareness
• Malaysia study
• Early detection
• Risk factors
• Population health

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1. Roshidi Ismail*, Liam J Murray, Michael Donnelly, Nabilla Al Sadat, Tin T Su AWARENESS OF CANCER WARNING SIGNS AND CANCER RISK FACTORS IN Findings from a national-representative telephone survey MALAYSIA 27/9/2024 1

2. CONTENTS Background Methods Findings Discussion Conclusion 27/9/2024 2

3. BACKGROUND Growing burden of cancer in Malaysia Cancer in Malaysia present late (Leong et al 2009, Razak et al 2009, Hisham 2004) Lack of awareness and negative beliefs about cancer implicated Poor screening uptakes Increasing awareness on cancer warning signs may promote early presentation, result in early treatment and increase screening uptake Awareness of cancer risk factors are key towards positive behavioural change in cancer prevention 27/9/2024 3

4. BACKGROUND (2) Awareness vary across socio-demographics Non-recognition of symptom seriousness associated with patient-related delay in diagnosis (Macdonald et al 2006) Currently in Malaysia, there are no general cancer awareness measures developed, validated or used on a population-representative sample. The study is to provide a national baseline level of cancer awareness in Malaysian population 27/9/2024 4

5. METHODS Awareness and Beliefs about Cancer adapted to Malaysia (ABC-M) Forward and backward translation to Malay, Mandarin and Tamil; and cognitive interviewing Quantitative assessment of content relevance and quality of translation Random digit dialing; Computer assisted telephone interview on mobile phone numbers 1895 participants aged 40 and above took part 27/9/2024 5

6. METHODS (2) There are many warning signs and symptoms of cancer. Please name as many as you can think of.. I am now going to read out a list of things which may or may not increase your chances of getting cancer in general. For each one can you tell me how much you agree or disagree that it may increase your chances of getting cancer? Awareness of signs/symptoms 1 open ended question 11-item symptom recognition questions Awareness of cancer risk factors 12-item risk factor prompted questions Data were weighted according to age, sex and ethnicity based on 2010 Malaysian population census Analysis with Stata 10 27/9/2024 6

7. RESPONSE RATE 27/9/2024 7

8. RESPONDENTS CHARACTERISTICS 27/9/2024 8

9. RESPONDENTS CHARACTERISTICS (2) 27/9/2024 9

10. NUMBER OF RECALLED AND RECOGNISED SIGNS/SYMPTOMS RECALLED RECOGNISED (WHEN PROMPTED) OVERALL 0.16 (0.14-0.19) OVERALL 5.47 (5.25-5.69) FEMALE 5.75 (5.43-6.07) MALE 5.19 weighted mean, (95% C.I) (4.88-5.50) 27/9/2024 10

11. RECOGNISED AS WARNING SIGNS FOR CANCER (WEIGHTED %) 10 20 30 40 50 60 70 80 unexplained lump or swelling 72.0 unexplained bleeding 60.6 a persistent unexplained pain 58.5 unexplained weight loss 54.1 persistent cough or hoarseness 53.8 change in bowel / bladder habits 47.6 difficulty in swallowing 44.0 a sore that does not heal 43.8 change in mole apperance 43.4 unexplained tiredness 42.8 unexplained night sweats 26.3 27/9/2024 11

12. WEIGHTED PERCENTAGES OF SYMPTOM RECOGNITION VERSUS RECALL 80.0 70.0 60.0 50.0 PERCENT 40.0 72.0 60.6 30.0 58.5 54.1 53.8 47.6 44.0 43.8 43.4 42.8 20.0 26.3 10.0 4.7 3.4 3.2 2.0 1.1 0.9 0.8 0.3 0.0 0.0 0.0 0.0 An unexplained lump or swelling Unexplained bleeding A persistent unexplained pain Unexplained weight loss A persistent cough or hoarseness A change in bowel or bladder habits A persistent difficulty in swallowing A sore that does not heal A change in the appearance of a mole Unexplained tiredness Unexplained night sweats Prompted Recalled 27/9/2024 12

13. PERCENTAGE OF WARNING SIGNS RECOGNISED ACCORDING TO GENDER 90 80 70 60 Percent 50 40 68.1 76.0 57.8 56.9 63.4 60.2 30 52.6 51.5 56.7 55.1 46.7 48.5 47.8 47.3 46.4 46.0 41.2 40.8 39.7 39.2 20 28.0 24.6 10 0 Female Male 27/9/2024 13

14. WEIGHTED PERCENTAGE FOR AWARENESS OF CANCER RISK FACTORS 100 90 80 70 60 86.2 85.4 80.0 86.0 88.0 78.4 84.5 84.9 50 61.3 63.2 59.4 81.5 58.2 56.2 54.1 60.9 57.1 67.6 59.0 57.2 48.8 56.2 61.6 40 59.0 57.4 61.7 55.3 54.7 52.1 43.9 45.9 43.0 38.6 30 40.2 41.8 37.0 20 Smoking Exposed to other people s smoke Exposure to radiation such as radon and x- ray Having a close relative with cancer Drinking more than one unit alcohol a day Not doing much physical activity Eating red or processed meat once a day or more Being obese Eating less than 5 portions of fruits and vegetables a day Infection with HPV Being over 70 years old Sunburnt more than once as a child Overall Female Male 27/9/2024 14

15. MV negative binomial regression model Rate Ratio 95%CI P Adjusted Mean 5.64 5.31 5.81 5.63 4.80 5.77 5.49 5.54 3.89 6.19 5.37 95%CI value 0.135 0.414 0.003 0.201 0.552 0.003 0.001 SEX Female Male AGE GROUPS 40-49 50-59 60+ ETHNICITY Malay Chinese Indian Other University education Yes No DIFFCIULT ACCESS TO DOCTORS Yes No EXPERIENCE OF CANCER (self, family or friend) Yes No 1.06 Ref Ref 0.97 0.83 Ref 0.95 0.96 0.67 1.15 Ref 0.98-1.15 0.90-1.05 0.73-0.94 0.88-1.03 0.84-1.10 0.52-0.88 1.06-1.25 5.32-5.96 5.05-5.57 5.60-6.02 5.28-5.98 4.23-5.37 5.49-6.06 5.18-5.79 4.87-6.22 2.90-4.89 5.72-6.65 5.16-5.58 SYMPTOM AWARENESS & DEMOGRAPHIC CHARACTERISTICS 0.75 Ref 0.57-0.98 0.036 4.16 5.56 3.06-5.25 5.35-5.76 1.12 Ref 1.03-1.23 0.006 5.99 5.33 5.56-6.42 5.10-5.56 27/9/2024 15

16. DISCUSSION Awareness of symptoms and risk factors of cancer in Malaysia could be improved. Several items are more recognised as cancer symptoms and risk factors while some are less recognised Recall of cancer symptoms are bizarrely low probably due to mobile telephone interviewing method Ethnic minority, older aged and lower education groups seem to have lower awareness similar to other studies 27/9/2024 16

17. CONCLUSION Several cancer warning signs and cancer risk factors were not well recognised by the Malaysian population. Strengthening of health literacy may be needed in order to improve early presentation and promote risk reduction activities, beginning with increasing cancer awareness 27/9/2024 17

18. THANK YOU 27/9/2024 18