Colorectal cancer screening awareness among rural populations in Northern China

Colorectal cancer (CRC) remains one of the leading causes of cancer-related mortality worldwide, with incidence steadily increasing in China. Early detection through screening significantly reduces morbidity and mortality. However, awareness and participation remain inadequate, especially in rural populations, who account for nearly 39% of China's total population. Understanding awareness levels and associated factors is essential for developing targeted interventions.

A population-based cluster cross-sectional study was conducted between September 2022 and March 2024 in two rural villages in Beijing and Henan Province. All permanent residents were eligible for this observational assessment of CRC awareness, for this observational assessment of CRC awareness; when the number of eligible residents exceeded the required sample size, participants were randomly selected from household lists provided by local village committees to ensure proportional representation across age and sex. Data were collected using a standardized questionnaire assessing knowledge of CRC risk factors, preventive measures, early symptoms, and screening methods. Logistic regression was performed to identify factors associated with high awareness, defined as a total score ≥ 90 on the awareness scale.

Of the 2,091 participants, 60% demonstrated high awareness of CRC screening. Recognition of major risk factors such as advanced age (83.5%), colon polyps (88.1%), and family history (87.3%) was high, as was awareness of protective factors like dietary fiber intake/whole grains/yogurt (85.5%). Awareness of early symptoms such as blood in the stool (88.4%) and abdominal pain/incomplete evacuation (95.5%) was strong, but recognition of fatigue and anemia was lower (77.4%). Awareness of fecal occult blood testing (82.0%) and fecal genetic testing (85.1%) was slightly lower than for colonoscopy (86.7%). Logistic regression showed that age, gender, education level, alcohol consumption was significantly associated with higher awareness (P < 0.05).

This study provides the first evidence of CRC awareness among rural populations in Northern China, revealing knowledge gaps in non-specific symptoms and non-invasive screening methods. Despite relatively high awareness, uptake of screening remains limited, indicating barriers such as access, cost, and cultural factors. Tailored education, accessible screening, and behavioral interventions are needed to improve prevention and early detection in these underserved communities.