Public awareness of colorectal cancer symptoms and risk factors, and exploring screening barriers across nine countries: A multi-national cross-sectional study

Colorectal cancer is the second leading cause of cancer-related deaths worldwide and the third most common type of cancer overall. Colorectal cancer can be avoided with regular screening and lifestyle modifications. This study aimed to identify the barriers to screening for colorectal cancer and to evaluate the public's awareness and knowledge of the disease's symptoms and risk factors. A cross-sectional study was conducted across nine countries from February 1, 2024, through April 3, 2024, targeting individuals aged 18 years and older. Data were collected using an online self-administered questionnaire in collaboration with national leaders and local team members in each country. Logistic regression analyses were employed to examine factors associated with participants' knowledge, awareness, and screening barriers. Among the 13,030 participants, awareness of CRC symptoms was highest for "lump in the abdomen" (70%) and lowest for "back pain" (39%). The most recognized risk factor was "history of bowel disease" (71%), whereas the least recognized was "low fruit/vegetable intake" (33%). The primary barrier to screening was the belief in low personal risk due to the absence of symptoms (63%). Multivariate logistic regression identified working in the healthcare sector as the strongest predictor of high knowledge (aOR = 2.70, 95% CI: 2.50-2.94) relative to non-healthcare participants. Higher knowledge was also significantly associated with male sex, older age (25-49 years), and university-level education (all p < 0.001). Colorectal cancer usually goes unnoticed until it reaches an advanced stage, when treating it becomes far more difficult. These findings underscore an urgent need for targeted, culturally sensitive public health campaigns across the region to address knowledge gaps and mitigate barriers, particularly the prevalent misconception of asymptomatic low risk. These include avoiding risk factors, maintaining a healthy lifestyle, and participating in screening programs to detect disease early.