Colorectal Cancer Screening in Malaysia: Understanding the iFOBT-to-Colonoscopy Gap

Area of Science:

• Public Health
• Gastroenterology
• Health Services Research

Background:

• Colorectal cancer (CRC) is a significant public health issue in Malaysia.
• Despite expanded national immunochemical fecal occult blood test (iFOBT) screening, diagnostic colonoscopy completion rates after positive results are low.

Purpose of the Study:

• To examine the persistent gap between iFOBT screening and colonoscopy completion in Malaysia.
• To propose an integrated conceptual framework for interventions aimed at improving diagnostic follow-up.

Main Methods:

• Literature review and synthesis of existing evidence on screening attrition.
• Integration of the Health Belief Model (HBM) with the Socio-Ecological Model (SEM) to conceptualize barriers and facilitators.
• Development of a multi-level framework for intervention strategies.

Main Results:

• Increasing iFOBT uptake is observed, but colonoscopy completion remains suboptimal.
• Key barriers include fear, anxiety, cost, logistics, poor awareness, fragmented referrals, and weak care coordination.
• The integrated HBM-SEM framework illustrates how multi-level factors influence screening adherence.

Conclusions:

• Addressing the iFOBT-to-colonoscopy gap requires a coordinated, multi-level systems approach.
• Interventions must target both behavioral and structural barriers to enhance CRC screening continuity.
• Proposed strategies include patient navigation, reminders, provider engagement, digital tracking, outreach, and public-private partnerships.