Gender-based differences in colorectal cancer screening uptake in Singapore: a cross-sectional study

Colorectal cancer screening is an evidence-based preventive approach. Singapore has a national screening programme, but local studies suggest poor uptake. Gender differences in screening uptake exist in the literature, and women in Singapore are exposed to cancer screening (via breast and cervical programmes) earlier than men. This study aimed to identify gender differences, as well as analyse barriers and facilitators associated with being screen-current for colorectal cancer within the genders, using the Health Belief Model.

This was a cross-sectional study conducted in a large public primary care institution in Singapore. Using consecutive sampling, 426 colorectal cancer screening age-eligible (50 years and above) individuals (232 females, 54.5%) completed a single questionnaire measuring knowledge of colorectal cancer symptoms and prevention, Health Belief Model factors, and colorectal cancer information sources.

Women had higher knowledge of colorectal cancer symptoms but perceived more barriers. Fewer women were screen-current (33.6%) compared to men (43.4%). Factors associated with knowledge of colorectal cancer symptoms and prevention differed between men (F[13, 178] = 4.51, R2 = 0.138) and women (F[13, 217] = 5.18, R2 = 0.171). Knowledge of symptoms and cues to action was associated with screen-currency in men (Wald χ2 = 33.93, pseudo R2 = 0.18), but the regression model failed to reach significance for women.

A one-size-fits-all approach to health promotion is likely insufficient in boosting compliance with colorectal cancer screening recommendations. Further work must be done to understand the more qualitative nuances surrounding women's challenges in being screen-current in Singapore.