KNOWLEDGE AND ATTITUDE OF PHYSICIANS REGARDING SCREENING OF COLORECTAL CANCER AT AL-KARKH HEALTH DIRECTORATE

Background: Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer mortality worldwide, with incidence rising steadily in Iraq over the past two decades. Unlike high-income countries where mortality is declining due to screening, most Iraqi patients present at advanced stages. Key risk factors include age, family history, and lifestyle factors, highlighting the urgent need for effective screening, particularly colonoscopy, starting at age 45. Methods: This study was a descriptive cross sectional study conducted among internal medicine and general surgery physicians at Al-Imammein Al-Kadhimain medical city, Al-Yarmouk Teaching Hospital by sampling. To assess knowledge attitude and practice of colorectal cancer screening. A designed questionnaire was conducted to included physicians to assess knowledge, attitude and practice of colorectal cancer screening. Results: A total of 172 physicians participated, the majority being residents (95.3%). Overall knowledge about colorectal cancer (CRC) screening was limited, with only 10.5% achieving good knowledge, 49.4% acceptable, and 40.1% poor. While 75% correctly identified colonoscopy as the gold standard, substantial gaps existed regarding test sensitivity and specificity, especially for FIT and CT colonography. Regarding attitudes, 59.3% recommended screening for asymptomatic patients, most often colonoscopy every 5 years. Univariable regression showed that being a specialist (OR=15.2, p=0.004), having a family history of cancer (OR=2.52, p=0.066), and recommending screening (OR=3.85, p=0.039) were associated with better knowledge. In the multivariable model, specialist position (OR=15.0, p=0.0075) and family history of cancer (OR=3.15, p=0.0375) remained independent predictors. Conclusion: Colorectal cancer (CRC) is a major cause of cancer mortality, with incidence rising in Iraq where patients often present late. This study showed significant gaps in physicians’ knowledge and practices regarding CRC screening, with colonoscopy recognized as the gold standard but knowledge gap and limited practice persisting. Barriers included patient refusal and unclear pathways, underscoring the need for education, structured guidelines, and a national screening program.